Mental Health Funds for Youths in Jeopardy

Penny Sylvester describes her autistic son as a “little professor.” The 12-year-old boy is highly intelligent but does not know how to interact with others.

For the last 2 1/2 years, a therapist contracted by the Los Angeles County Department of Mental Health--and paid with state funds--had worked with the boy at his school in Agoura Hills. In that time, the boy learned to open up to his classmates and teachers.

But a recent debate over who should pay for the bulk of such services--the county or the state--has jeopardized such psychological care for special education youngsters and put new burdens on their families.

County officials, whose governments are financially strapped with other problems, believe the state should foot the bill, as it has for 18 years. But a recent audit by the state controller’s office contends that counties should pay for 90% of the services. The spat could affect reimbursement going back a year.

With its cash flow uncertain, the agency that had been providing Sylvester’s son with help withdrew its services May 24. Stirling Behavioral Health Institute was the only provider of the program for Las Virgenes Unified School District, in Calabasas and Agoura Hills. Now, 107 children must look for mental health care elsewhere.

“One has to understand the emotional needs these children have,” said Peggy Woodall, a school district official who is helping search for alternatives. “I shudder to think what could happen.”

Stirling is an extreme case, believed to be the only agency in the state to have withdrawn such services. But many mental health-care providers for the 27,645 California children who use the program, generally known as “3632” after the Assembly Bill that funded it in 1984, said they too may have to cut services if they are not guaranteed reimbursement.

The providers also suggested that the state could be vulnerable to lawsuits since federal law mandates free mental health services as part of national programs for special education children.

Stirling officials said they regret the cuts but had no alternatives if they wanted to remain in business.

“It is very difficult,” said Iraj Broomand, Stirling’s executive director. “We have a commitment to serving these kids and hopefully something is going to change.”

A solution may rest with a bill that was approved last week by the state Legislature and now is being reviewed by the governor. The bill would place full financial responsibility on the state’s general fund. Gov. Gray Davis has not yet taken a position on the bill, according to his office.

When the program was established, 90% of its costs were covered under a state fund for community mental health programs and 10% of the expenses were paid out of the state’s general fund. But the community mental health fund was eliminated in 1991 and never replaced. For the next 11 years, most counties were fully reimbursed from the state’s general fund.

But in a recent audit, the state controller’s office advocated that state spending on the services be restricted to 10% and that counties pick up the rest. That would create more strain for, among others, Los Angeles County, which recently recommended the closure of several of its health facilities.

As the debate continued, mental health advocates lobbied for last week’s bill and garnered an approval by the Legislature’s budget conference committee to pay $60 million to the counties for outstanding services, going back to last July. The figure is still $35 million short of last year’s total costs. Nevertheless, proponents call it a step in the right direction.

The dispute comes amid a $24-billion state budget deficit that is reducing other health services for children.

Los Angeles County has the largest 3632 program in California, with 9,000 children, costing the state $22 million last year. Two-thirds of the county’s services are provided by private agencies that are working without guarantees of payment.

“It really puts a nonprofit organization in a risky situation,” said Elizabeth Pfromm, executive director of Los Angeles Child Guidance Clinic, which provides mental health care. “We don’t want to turn the kids away because we’re part of the community.”

Services remain for nearly 1,000 children in Los Angeles Unified School District. But some agencies are putting new referrals on a waiting list, said Rene Gonzalez, director of psychological services for the district.

Stirling, which has 380 clients with mental health problems such as depression and attention deficit disorder, laid off seven staff members and may close a clinic in Van Nuys. Children in the program are being referred to other clinics and agencies.

Some employees, such as Bobbie Johnson, the therapist for Sylvester’s son, left because there was no guarantee of being paid.

“I had two weeks to say goodbye to kids I’ve been working with for two to three years,” Johnson said. “That’s very disruptive and can cause serious problems for the children.”

Sylvester, who asked that her son’s name not be used, said she is worried about the financial burden, but has begun to pay Johnson out-of-pocket for visits at home. “I’m not going to bounce my child around,” she said.

Assemblyman Darrell Steinberg (D-Sacramento), who played a strong role in pushing the bill, said: “These are some of our most vulnerable children. They shouldn’t be caught in a funding dispute.”