South Shore groups tackle mental health gap
April 8, 2013
Editor's note: This is the first installment in a three-part series on mental health at the South Shore.
Ernie Klindt moved to South Lake Tahoe in 1994. Four years later, he entered El Dorado County's mental health system because he needed medication and counseling for his bipolar and schizoaffective disorder.
"Back then, there were more services for us," Klindt said.
According to El Dorado County Mental Health Division Program Manager Laura Walny, the county's mental health division underwent a series of budget cuts more than a year and a half ago. A merger between the Health Services Department and the Human Services Department in fall 2011 created the Health and Human Services Agency, an umbrella that includes the Mental Health Division. The point was to bridge gaps in the agency, Walny said.
Now the goal is to build on that foundation at the community level. Walny said the county has discussed implementing a dual diagnosis program, which partners mental health with the alcohol and drug programs, and more intensive case management services, which wrap around patients' needs.
The Community Health Needs Assessment that Barton Memorial Hospital published last September identified mental health as one of three top medical issues at the South Shore. While the percentage of South Shore residents with fair or poor mental health is lower than the national rate, the number of suicides per capita is higher.
Approximately 10 percent of people in the health needs assessment suffer from major depression, compared to 11.7 percent nationwide. And almost 28 percent of the residents have sought help for mental health, compared to 24.4 percent in the U.S.
It's a problem that has led the hospital and county to look for solutions to mental health issues in the rural community.
While Walny said the county doesn't have a definitive timeline for the wraparound care and accessibility improvements, county staff members have met with South Shore groups to bridge the gap between mental health services in the community.
"I think some of the biggest challenges for South Lake Tahoe is that it's geographically distant and weather plays a role in accessibility. It can really create barriers. And funding always plays a role," Walny said.
Developing wraparound care
When Klindt gets the "feeling that (he) wants to end everything," he said going to the hospital can be expensive for the insurance company and follow-up in the form of steady counseling can be difficult to schedule.
"When I have issues, when I need to be seen, I need to be seen," he said.
According to Dr. Warren Withers, medical director at Barton, patients are evaluated medically after they're admitted to the hospital. County mental health staff then conducts another evaluation.
"If they are not able to be medically cleared (like overdoses for example) then those patients are admitted into the hospital until they are medically cleared," Withers wrote in an email.
Klindt's care is complicated by a host of other health issues, one of which requires supplemental oxygen. While Klindt said he has considered relocating to Sacramento, it would mean leaving behind the life he's established in South Lake Tahoe.
"The problem I'm going through now is that I'm set up here. I would be going down there with no support. I call it living in the concrete jungle," Klindt said.
Some of the problems arise because of South Lake Tahoe's location away from any major city centers, according to Diana Hankins, president of the local National Alliance on Mental Health chapter. Barton isn't a psychiatric hospital, but it has donated money to other mental health community groups — Barton has given $5,500 to NAMI since 2010. It also contracts currently with three psychiatrists who help patients via the telemedicine program and it offers a free bereavement camp for children in June.
The county's mental health division relies on teleconferencing between South Lake Tahoe patients and psychiatrists since the doctors live and work off the hill.
Hankins proposes a 23-hour holding facility for people suffering from a mental health crisis. It would be a safe place for the clients to go where a nurse practitioner and psychiatrist could evaluate a patient immediately.
The funding to staff and rent the facility could come from Proposition 63 funds, or the Mental Health Services Act, according to Hankins. So far that money hasn't helped with these rural community issues, Hankins said.
Walny said she doesn't know if the county would have money for that facility, but more national attention on mental health could direct more money to those coffers. Already the county plans to add six beds to its 10-bed Psychiatric Health Facility in Placerville.
"We're really taking a look at each of the units we have to see what's working best and what we can improve on," Walny said. "It would certainly be nice if we saw some more funding, but unfortunately there's no way to predict which way the funding will go."