SACRAMENTO -- California has begun transitioning its mental health services program to concentrate care on the most serious patients residing in state mental hospitals and prisons, but the cost-cutting move is raising concerns about patient care from state workers.
The state announced last week it will hand off more responsibility for public mental health programs to counties as part of Gov. Jerry Brown's ongoing push to move services to California's local governments. The administration says the reorganization will allow the state to form a new Department of State Hospitals that focuses exclusively on 6,300 patients in state hospitals and prisons.

"We think that as a package we're providing a set of proposals that saves money but doesn't change the quality of care and also increases safety," Department of Mental Health acting-chief deputy director Kathy Gaither said in an interview Monday.

Earlier this year, state mental health officials assigned a committee to come up with a plan to improve care and safety while also finding places to cut costs within the state's mental hospital system. The committee returned with a blueprint for overhauling the department's policies and procedures. It cuts 346 positions in the current year to save $122.6 million and eliminates 620 positions to save $193 million next year.

The administration says it does not plan layoffs because many of those positions are already vacant or can be done through attrition.

Safety Now!, a coalition of psychiatric technicians, physicians and other state hospital workers, warns that the plan would reduce staffing ratios by nearly one-third.

"It is clear that only short-term monetary goals are driving the state's decision to cut staff," Stuart Bussey, a doctor and president of the Union of American Physicians and Dentists said in a statement. "We know that if treatment staff are cut, patient safety will certainly deteriorate further, and assaults will increase -- and that will ultimately cost the state of California more money in lawsuits than these proposed cuts will save."

The new structure reduces patient-to-staff ratios, a move state officials say is needed to cut down on the use of overtime and contract staff -- the two single biggest drivers of increased hospital spending. The department plans to modify staff levels based on the patients' needs, putting more psychologists and psychiatrists with the most serious and aggressive patients and fewer with the more stable patients.

This week the Department of Mental Health will start with a pilot program at Atascadero State Hospital to treat its most aggressive patients together. If successful, that approach could expand to the state's four other mental hospitals, Metro, Napa, Coalinga and Patton, along with two psychiatric programs at Vacaville and Salinas Valley state prisons.