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Mental health averts more layoffs Collins says budget closer to balancing By Jonel Aleccia A second wave of layoffs in the Jackson County Mental Health Department has been averted, despite concern over more than $1 million in changed charges for acute hospital psychiatric care. "We�ve got the budget within $175,000 of balancing," said Hank Collins, county health and human services director. "We�re not going to do any more layoffs right now." Last week, 11 skills trainers and health assistants received notice that their jobs were cut. Of those, three will be reassigned within the department, Collins said. Further cuts were avoided by not filling several vacant posts and by trimming some mental health service contracts, he said. An estimated $1.1 million must be sliced from the $9.6 million Mental Health Department budget, part of an overall $40 million county Health and Human Services budget. In part, the cuts result from changes in a fee agreement for services at the 2 North psychiatric unit at Rogue Valley Medical Center. A joint decision by area health directors now requires Jackson County to reimburse coalition members if the number of "bed days" used exceeds agreed-upon allocations. Hospital rates, including an estimated 50 percent discount given to a coalition of five southwest counties, have not changed. The funding shift, combined with an estimated one-third increase in usage so far this fiscal year, accounts for the necessary cuts, Collins said. In the first six months, Jackson County used 2,635 bed days. If that trend continues, usage will be about 35 percent higher this year than last. "A bed day is one person, one day in the hospital," he said. "At up to $450 a day, that�s $14,000 a month. That starts swelling the numbers pretty quickly." But at least one worker who lost his job criticized the decision to cut front-line mental health workers, many of whom treat disturbed children. "Next time there�s a school shooting, next time there�s a lock-down like there was at Scenic (Middle School) a couple weeks ago, it�s not going to be my fault," said Ian McDonald, 28, a dismissed skills trainer. "I can find another job. Other people can find another job. I thought people cared about the kids." Services to disturbed children and other clients will be scaled back, but not eliminated, Collins said. That could mean more group instead of individual therapy sessions or more short-term treatment, for example. "It�s always a matter of status and priorities," Collins said. "We have to pay close attention to people in danger of going to the hospital." Deciding who is admitted to the hospital�s mental health ward � and who pays the costs once they�re there � is a delicate and complicated act, insiders agree. Counties are required by law to provide acute mental health services to people enrolled in the Oregon Health Plan and to indigent clients. To meet that need, the coalition of Jackson, Josephine, Douglas, Curry and Klamath counties has long reserved about 14 of the 25 beds at 2 North. Of those, just over nine are set aside for indigent clients. About $1.5 million in state funds is routed through Jefferson Behavioral Health, a Josephine County agency, to serve those people unable to pay. The number of psychiatric referrals to the RVMC emergency room ranges from a few every day to more than a dozen, according to hospital and county sources. One hospital survey counted 1,300 psychiatric evaluations last year. Ailments can range widely, said Richard H. Phillips, a staff psychiatrist. "There are people who are frankly psychotic and a danger to themselves," he said. "Others come in and they�ve been cutting on themselves." A county crisis team offers intervention and evaluation; admissions are authorized only by psychiatrists. If the beds at 2 North are filled, clients may be referred to local respite beds or as far as Portland. It�s an imperfect system, agreed Collins and Scott Sonenshine, RVMC clinical manager for mental health. The tension between the need for treatment and the need to contain costs is constant, they said. "The issue becomes how to ration the limited resources we have," Sonenshine said. "We have an excellent system with limited resources." Reach reporter JoNel Aleccia at 776-4465, or e-mail [email protected] Mail Tribune Home | Ottaway Newspapers, Inc. | Dow Jones & Co., Inc. | Privacy | Contact Us Copyright � 2001 Mail Tribune, Inc.