Vonnie is a tall, blond woman in her late 50s, who was diagnosed with mental illness thirty years ago. Like many long-time consumers in the county system, she's not insured. Recently, she called up a local clinic to ask about getting in for psychiatric services.
Vonnie: I had moved from the west side to the east side, and I preferred to get them on the east side since I don't drive on the freeways and it's a long ride.
Because of funding cuts, she was told, the agency was not accept her as a new patient. In fact, many county agencies have severely restricted their intake since July.
Vonnie: When I asked about "Well can I be on a waiting list?" "Um - there IS no waiting list." and they didn't know when the intake dept was going to be open. So I'm calling at least two months in advance because that was the earliest they could give me. I'm at the point that I no longer care.
Vonnie figures she's in better shape than most. At least she has a decent place to live, has a little money to fall back on, and knows enough about her condition to get by for a while. But she says, she's very worried about people who may be calling in for the first time.
There are people who will get a response sooner than Vonnie did. People who call the county's emergency hotline in a certifiable state of crisis will get some attention. Officials define "crisis cases" as people deemed dangerous to themselves or to others. At that point, they'll be picked up and assessed by a mobile crisis team, and sent to the shrinking circle of hospitals that still maintain emergency psych wards. Odds are they will only be kept for a day or two. But if you are in crisis, be sure to call before midnight. Budget cuts have limited the hours mobile crisis will respond. After hours, the dispatchers are obliged to send out the police.
Judy Peters is a 30-year veteran of community mental health. She's spent the past year assessing needs and priorities at the request of the Federation for Community Planning.
Judy Peters: One of the things that happens as a result of declining revenues and budgets being cut is that you have to close the front door. You have so many clients that you are seeing in your center, that you have full caseloads as it is. So what you do is you close the front door because you can't let anyone into your house since your house is so full and you can't feed anyone else.
Peters says many factors contribute to the fiscal crisis that's forced agencies to close intake. The main pressure, she says, is the county's relationship to Medicaid, the federal system of health care for the poor.
The county's working under a double mandate: First--to serve Medicaid patients, for which it can be re-imbursed... and second, to serve the working poor, for which it may never be compensated. The county would love to spend money on working poor who are desperately ill, but who don't qualify for federal coverage. But their resources are increasingly committed to Medicaid. To compound matters, Medicaid enrollment is on the rise. In his state of the state speech last week, Governor Taft said he will seek to cut Medicaid expenditures to help with the state's budget shortfall.
This lop-sided system has been further hobbled by the fact that the state has not followed through on some old promises. George Gintoli is the former director of North Coast Behavioral Healthcare. It's one of the few state mental hospitals left in operation. Dr. Gintoli remembers when leaders began undoing state institutions, handing responsibility over to local mental health boards with a bill called the Ohio Plan.
George Gintoli: I thought it was a great idea because for a long time there was no sense of ownership or responsibility for people that were stuck in long term hospitals-they just stayed there. And with the creation of what was called community support programs, more & more people were able to leave 20-30 years of being stuck in a psychiatric hospital and were able to move into structures community support program.
The problem was that in many places, like Cleveland, community support programs never grew big enough to handle all the consumers who needed them. While the Ohio plan was a significant step toward helping people with mental illness become more independent, many felt its promise was never fulfilled. Some felt that the level of funding was never adequate, while others lay the blame at the doors of local leaders for failing to ensure dedicated dollars for mental health services.
At best, Ohio's system is marked by inequities. At worst, in places like Cleveland, service providers are coming to the end of their ropes - among them, Clemente Powell. Powell runs a drop-in center on Cleveland's East Side, Home for TLC. In this storefront, he provides several dozen people with a daily lunch, activities, field trips, and games of pool. But community based empowerment programs like this one are not covered by Medicaid. It might be at risk as the county and state trim budgets to the quick.
Clemente Powell: How can I tell somebody no, and put them back out in the cold? How can I tell them "I'm not going to feed you"? How can I tell someone no you can't get warm? I'm not going do it.
In the meantime, risks are rising for mental health consumers out there who may not understand what's happening to them. Vonnie, who was recently turned away from intake warns that the system is driving itself into crisis mode.
Vonnie: Well I would think they'd just want to say "OK, I guess I'm not going to get any help and not try anymore." And it's hard enough to ask for help, and then if you're turned down. What are you supposed to do?
Leaders may indeed soon have a chance to take a first step to heal the system. Cuyahoga County Commissioners are expected to announce a Health and Human Services Levy for 2003 within the next two weeks. Sources with the county say it's very likely the levy will be placed on the ballot in a special election this May. For ideastream, I'm April Baer in Cleveland.