County administrators say they are moving ahead with plans to create a local agency to coordinate services for the mentally ill, after more than three years of delays costing them thousands of dollars in state money.
Although advocates for the mentally ill say they are relieved that plans may be moving ahead, they decry the bureaucratic foot-dragging that centered on how the proposed agency would be structured.
"There are a lot of services that could be in place by now if we had the agency and the resources," said Lois Miller, executive director of Omni House, a community-based program for the mentally ill. "We have really lost out by not having this in place."
Without a central agency, said Lee Deckelnick, executive director of Arundel Lodge Inc., an Annapolis-based rehabilitation and residential center, mentally ill people in Anne Arundel County have to call dozens of organizations before they can find help. That extends to housing, counseling and monitoring their medication.
"We have lost opportunities to develop an integrated, well-coordinated system of mental health services here," Mr. Deckelnick said. "At this point, we just need to get it done."
A study completed last year estimated that at least 8,300 seriously mentally ill people live in Anne Arundel, a figure the Alliance for the Mentally Ill thinks is low, said Thomas M. Schulz, president of the county chapter. Based on other studies showing that the mentally ill make up about 5 percent of the population, the number is probably closer to 22,000, he said.
Many of those people, he said, are going without services.
"The county's mental health system is in the Dark Ages," he said. "It's really such a messed-up system it makes me sick just to think about it."
Mr. Schulz, who was tapped two years ago to serve on the board of directors when a mental health agency was eventually established, said he is so frustrated by delays and bureaucracy that he wrote to County Executive Robert R. Neall in May asking that his name be removed from the board's list.
Ms. Miller said housing for mentally ill adults is one of the most crucial needs here -- one that a mental health agency could address as a top priority.
"I had a situation just last week where a young woman could no longer live here with her aunt, and there was absolutely nowhere for her to go," she said. "We finally ended up having her father come up from Virginia and take her down there. . . . She would have preferred to stay here."
vTC Mr. Schulz said such crucial services as a mobile crisis team are missing, making it difficult, if not downright impossible, to get patients in crisis into treatment.
"If a person refuses to go to the hospital, and you have no system to get him into treatment, then you have no [mental health] system at all," said Mr. Schulz, who has a mentally ill son living in Connecticut, where many more community-based services are in place.
Ardath Cade, Anne Arundel's new manager of human services programs, said the county is working in earnest to set up an agency that would allocate the $7 million in state money it gets annually for mental health. The agency also would be able to seek new funds through state, federal or private grants and to create new programs and services.
County officials have agreed on a model, Mrs. Cade said. Mental health advocates and the county's mental health advisory board insisted that the agency be a private, nonprofit organization, as opposed to making it an arm of county government. Meeting that goal held things up, she said.
But Mr. Schulz said the problem was not so much the private, nonprofit model as the county's reluctance to give up control of more than $7 million in state aid.
"The health department wanted it," he said. "They didn't want to give up control of that money. That was the problem."
Anne Arundel's prolonged journey toward establishing a central agency began in 1989, when O. James Lighthizer was county executive. Over the next 3 1/2 years, the county submitted three proposals for a core service agency, all of which were approved by the state's Mental Hygiene Administration but never carried out, said Jim Stockdill, deputy director of the administration.
Since the state first began advocating a more localized, coordinated system of serving the mentally ill, 11 core service agencies have been formed serving 15 counties (some smaller counties share an agency). Anne Arundel County is the only "major county" still without one, Mr. Stockdill said.
The absence of a core service agency has hurt the county in many ways, advocates said.
First, the county has lost out on $200,000 annually to help cover the cost of running such an agency. Second, counties with agencies have fared better in securing state and federal grant money, said Mr. Stockdill.
Finally, counties with agencies are allowed to "roll over" unused state funding at the end of the year, while counties without agencies must return excess funds, he said.
In the fiscal year that ends June 30, Anne Arundel would have had enough money left over to establish new residential beds for the mentally ill, said Susan L. Giraldi, coordinator of special programs for the Mental Hygiene Administration. Instead, that money will probably go toward paying off deficits in other counties.
A "residential bed" refers to a place for mentally ill residents to live that is affiliated with a community-based treatment and rehabilitation program, Ms. Miller said. The beds can be in group homes, where at least four residents live, or in individual homes or apartments. Omni House, for example, has 63 beds scattered throughout North County in a number of apartments.
Ms. Giraldi would not specify the amount Anne Arundel County will lose but said one residential bed alone costs about $32,000 a year to maintain.
Lost opportunities such as this are what frustrate providers such as Ms. Miller, who struggle constantly to find places for mentally ill people.