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Older Adults Underserved, S.D. Health Experts Say
By Jonathan Heller, San Diego Union Tribune
April 19, 2005
Experts in the mental health field say San Diego County government needs to reach out to the community more to find older adults who need services.
That's just one of the recurring themes county mental health officials are hearing as they hold public forums on how to best spend $40 million in new revenue expected from the state next year.
More attention also should be paid to housing for the mentally ill and family-oriented services, among other needs, according to those who work with the mentally ill.
The money comes as a result of Proposition 63, which California voters approved in November. It imposes a 1 percent tax on personal net income over $1 million.
San Diego County's share represents a nearly 20 percent boost to the $206 million mental health budget, said Piedad Garcia, director of systems of care for the county Mental Health Services Division of the Health & Human Services Agency.
The county can spend the money only on new or expanded programs. It can't use the funds to maintain existing programs.
Older people, who tend to be isolated and are especially vulnerable to depression, are among the most underserved segments of society, said Denise Nelesen, a spokeswoman for the county Aging and Independence Services Department.
"Our big concern is for the people who stop socializing, stop connecting, stop even going to church," Nelesen said. "We find that when people get out and get involved, they are much less likely to have depression."
For Erika Reynolds, a private geriatric psychiatrist in Mission Valley, the biggest challenge is not creating additional services but helping seniors learn about services already available.
"I wish it was easier for people to get information," Reynolds said. "The issue of how you get people (connected with services) the first time is a big concern."
To catch more seniors in the net, Bettie Reinhardt, executive director of the San Diego chapter of the National Alliance for the Mentally Ill, advocates that the county focus on "assertive community treatment" - sending specialized teams of social workers, nurses and peer counselors into the community.
"The idea is to wrap the services around the person, rather than expecting them to take our poor public transportation to myriad different places," Reinhardt said.
More and better mental health services also are needed for children and young and middle-aged adults, officials said.
A pressing need is to provide more family-oriented services, said Dr. Mark Chenven, a child psychiatrist and former medical director for children's mental health services in the county Health and Human Services Department.
Often, a person might receive services for a disease, such as schizophrenia, but no attention is paid to the effect the disease might have on that person's children, Chenven said.
The same can be said for children, who might be undergoing treatment for attention deficit disorder, but little or no counseling is provided to the parent.
"It cuts both ways," Chenven said.
Housing for those with mental illnesses is another area of need.
"It's such a gigantic problem that nobody really addresses it," said Jane Fyer, president of the Vista-based Schizophrenics in Transition, which provides services and housing for those coping with the disease.
"A person cannot get well if they're worried about living on the street," Fyer said.
Another problem exists for those who need outpatient services, Fyer said. The county has reduced the number of day treatment clinics that provide medication and therapy because of budget constraints. The slack has been picked up by "clubhouses," private facilities under contract with the county to provide group counseling and other services for the mentally ill. Patients cannot receive medication at clubhouses.
"Clubhouses have picked up the ball, but the obvious question is, are people getting the services they really need?" Fyer said.
The county held several public workshops in March to gather comments on how best to spend the Proposition 63 revenue. It is holding meetings through May 3 with mental health professionals and others who work in the field.
The county must adopt a plan for the funds by summer or fall and submit it to the state for approval, Garcia said.
The new revenue could reach the county by next spring.
"We have our marching orders from the Legislature and the state," Garcia said. "It's an opportunity to add new services and improve our (existing) services."
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