A perfect storm was brewing in Fresno County in spring of 2005 for children and adults needing mental health services.
The behavior health department was projecting a deficit of $10 million, the number of uninsured people requiring help had risen by an estimated 15%, the cost of prescription drugs was soaring and the county owed the state millions of dollars for back Medi-Cal claims that didn't qualify for reimbursement.
Its back against the wall, Fresno County slashed programs, left positions vacant and used drug samples from pharmaceutical companies to treat patients. And at year's end — now facing a $16 million deficit in the latest behavioral health budget — the county turned jail psychiatric services over to the department of public health in an effort to save money.
That move in itself wasn't harmful, but it opened the door to a policy decision that would end up ravaging our community: withholding vital medication from mentally ill inmates.
An eight-month investigation by reporters Marc Benjamin and Barbara Anderson published in today's edition of The Bee documents the pain, anguish and terror suffered by some inmates, as well as their families, because of the county's policy.
According to family members, psychiatrists and lawyers interviewed for the stories, inmates sit for weeks in cells without medication previously prescribed by private doctors. And if they do receive medication, it is often at a dose that doesn't treat their illness or is a less-effective generic.
The price of warehousing the mentally ill instead of medically treating them while in jail is staggering. Jail violence increases. Courts clog as cases are delayed because inmates are incompetent to stand trial. Inmates released early because of jail overcrowding commit additional crimes — including homicide — because of their sickness. Taxpayer costs escalate with inmates making repeated trips to state hospitals.
The county's mistake wasn't trying something new: substituting cheaper generics for expensive name-brand drugs, some of which are abused by inmates suspected of faking mental illness.
The mistake was not recognizing early on — or flat out ignoring — the fact that this policy was a dangerous and expensive failure.
When the condition of a mentally ill inmate improves at a state hospital, the county should provide the same medications upon the inmate's return to Fresno.
Something else must be said: At the highest levels of Fresno County leadership, decisions often are driven by an ideology that says the cheapest way to go is the only way to go.
Much too often, there is no consideration of people's real needs and how the county might improve the lot of those who are suffering.
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