Mentally ill may lose as evaluators eliminated

Budget cuts are eliminating 17 mental health jobs across Missouri that patient caregivers, judges and law enforcement officials believe are vital to saving lives of the state's mentally ill.

One of those employees losing his job is Cape Girardeau's Bob LeFebvre, mental health coordinator to 14 Southeast Missouri counties.

"Missouri has been pretty progressive in the last 20 years in regards to mental health," he said. "To lose this service statewide is a huge step backward. It's really a loss of service to the community."

The Department of Mental Health's pruning of $13.4 million from its budget includes a $939,906 elimination of funding for the 17 mental health coordinators and their eight clerical staff members.

Unless legislators find a way to save the jobs by June 15, Missouri's courts and families will no longer have mental health coordinators to help make involuntary commitment or psychiatric treatment decisions for those needing care.

The program was created in 1978. For 10 of the last 22 years, LeFebvre has helped families find treatment for their ill loved ones. He investigates people alleged to be mentally ill and harmful to themselves or others and provides consultation and training to mental health facilities, courts and law enforcement agencies.

"We serve the courts and law enforcement, but the families that contact us are our primary constituents," LeFebvre said.

Of the 480 cases he investigated in 2002, about 30 percent were ordered into hospital care. Most were provided assistance in contacting a local outpatient psychiatric resource as an alternative to hospital-based care, he said.

For months, the Department of Mental Health has met with the state's budget office almost weekly to find ways to trim more expenses, said department spokeswoman Jeanne Henry. The results of those meetings were the elimination of 145 administration staff jobs and the closing the Woodson Center, which is a children's psychiatric center in St. Joseph, and a vocational and rehabilitation program at the Marshall Habitation Center in Marshall.

"The vow we made is that we would protect the direct line staff of day-to-day caregivers," she said.

But the attrition and consolidation just wasn't enough to satisfy the budget.

The coordinator program was then evaluated by an executive team, which asked whether the coordinators were being used to their maximum potential.

"And they weren't," Henry said.

In addition, the department's Access Crisis Intervention system partially overlaps the responsibilities of the coordinators, making the coordinators particularly vulnerable, Henry said. The ACI system is available through a toll-free crisis hotline. Mental health workers answering the hotline provide a telephone intervention to the crisis caller. If the crisis cannot be managed by the hotline, an on-call mental health professional is available by phone or within the community when necessary.

Preventing tragedy

But Tina Hartlein, program director of the Senior Lifestyles Geriatric Psychiatric Unit at the Missouri Delta Medical Center in Sikeston, Mo., said some people requiring psychiatric care don't fit within the crisis team's guidelines for immediate intervention, and a tragedy can result. She is terrified what the cuts will do to those homebound patients who may not strongly exhibit their mental disorders.

"These patients will literally fall through the cracks and die as a result of no one being able to help them," Hartlein said. "This will end up costing the state more in the long run, and it will hurt people by these actions. That's very frustrating for me."

She recalls a homebound patient for whom psychiatric care came too late. A Division of Senior Services caseworker visited a home and felt the patient was at risk and notified the region's crisis team, which decided not to handle the case and turned it over to LeFebvre for further evaluation.

"By the time he was able to get there to assess her, she was in such bad shape that she went right from the emergency room right into intensive care," Hartlein said. "She was on medication for a heart condition and had suffered from delusions thinking someone was poisoning her and she stopped taking her pills. Her lungs filled with fluid."

The patient died a few weeks later, she said.

"If only intervention had come sooner," Hartlein said. "Without Bob, that's going to happen a couple of times a month."

Cape Girardeau County is less likely than surrounding counties to suffer from the loss of LeFebvre, said Associate Circuit Judge Peter Statler. Several private and public mental health specialists provide the county's courts with most of the assistance needed, he said.

"I don't think the effect on our court here will be that great, but I don't know about the other areas," Statler said. "It won't be pretty."

Capt. Carl Kinnison of the Cape Girardeau Police Department said the city has seen less of a need for the mental health coordinator's services over the last several years due to the presence of the Community Counseling Center.

Valuable asset

Scott County Associate Circuit Court Judge W.H. Winchester said he is sorry to see LeFebvre go.

"He's probably one of the most valuable assets the Mental Health Department has," Winchester said. "He is certainly valuable to me and to the other area probate judges. It's great to have a mental health coordinator to come in and evaluate someone and then report back to us so we can make an informed decision about whether to commit someone to a hospital."

Combined with other cuts to state programs involving direct home care, the loss of the mental health coordinator can create a burden on the courts and law enforcement, he said. Families will have no one else to turn to for help in more rural areas where psychiatric professionals are scarce.

"It's going to be a real burden on city law enforcement officers, who aren't really trained to help people who have mental problems or are overdosed," Winchester said.

Henry isn't optimistic about a change in the cuts, but she doesn't rule it out.

"The legislators are certainly being receptive and we are hoping someone out there can come up with the answer," she said.

Hartlein isn't willing to leave it up to chance, and fighting for her patients.

"The number-one thing we're doing is having people concerned write their legislators and the governor," she said. "We want to create enough of an alarm that the governor may stop and change his mind about these cuts. If that doesn't work, I don't know what we'll do."

mwells@semissourian.com

335-6611, extension 160