In December of 2007, the Napa County Department of Health and Human Services was in crisis.

All of the county’s full-time staff psychiatrists left or reduced their hours to secure higher-paying positions at state-run institutions.

The change came on the heels of a federal court decision to boost the salaries of psychiatrists employed by the state. To fill in the gaps, county officials hired two temporarily-placed psychiatrists for adult patients and a third interim physician for children.

County health officials say things are getting better, but critics say some patients still cannot gain access to care due to long waits to see county psychiatrists. Another concern is the so-called “revolving door” of temporary county psychiatrists who don’t have time to develop therapeutic doctor-patient bonds.

Today, just one vacant psychiatrist position remains. Three staff psychiatrists join one temporarily-placed doctor to serve the 940 local residents currently enrolled in the county’s mental health program, said Jaye Vanderhurst, mental health director of the county’s Health and Human Services Department.

Gayle Whitlock, a counselor at a county-funded residential program called Progress Place, said patients at her facility desperately need adjustments to their medications, but that some face waits of up to six months to see county psychiatrists.

As a result, she said, many patients are on their own and eventually return to the facility, where the maximum stay is 30 days. Progress Place residents, who suffer from schizophrenia, depression, obsessive-compulsive disorder, anxiety disorders and other serious conditions, sometimes find themselves at homeless shelters or on the street after their 30 days are up, she said. Access to proper medication would help them avoid this cycle.

“These people are dealing with hallucinations and severe depression,” Whitlock said. “It’s quite frustrating on my end, as a counselor.”

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Dr. Zoe Martinez, the county’s psychiatric medical director, said the length of waits for patients depend on the severity of each case. While patients emerging from correctional facilities or Napa State Hospital are typically seen within two weeks, those referred by case managers, doctors or therapists may wait for one to two months, she said.

Self-referred patients with less serious conditions can be on the waiting list for up to a year, she added.

“We’re doing everything we can to see as many people as possible, but we’re prioritizing those with the most severe symptoms because we have to,” said Martinez.

Napa County Health and Human Services Director Randy Snowden said recruiting staff psychiatrists is difficult in an environment where doctors working for the state make markedly higher salaries.

Snowden added that although county psychiatrists make less than that of their counterparts at Napa State and other facilities, the county provides “a different working environment. ... I think there are a lot of psychiatrists who would prefer to work in this clinic than in a locked institution.”

Last year, Vanderhurst said Napa County psychiatrists made about $14,000 a month while state-employed psychiatrists made about $18,000 a month.

Aside from the salary disparity, Snowden said it is difficult just finding qualified candidates for the jobs.

Bridging the gap

Another challenge the county faces is recruiting bilingual mental health workers. Vanderhurst said about 17 percent of the 940 people currently seeking mental health treatment through the county are Spanish-speaking.

No bilingual psychiatrists, psychologists or registered nurses are currently employed by the county’s mental health division, which depends on translators in psychiatric sessions.

Lawrence Swaim, Service Employees International Union shop steward at Bella House — a residential treatment program funded by the county and run by the Progress Foundation — said the county should pressure the state for more resources for psychiatric treatment. To deal with growing patient needs in the meantime, Swaim said a medical consortium of nurses, psychiatric technicians and case managers could make suggestions for medications, thereby reducing clients’ needs for face time with county-employed psychiatrists.

Dr. Robert Moore, medical director of Clinic Ole, said some patients who originally sought help through the county turn up at his clinic. Moore said about 20 percent of the clinic’s 18,000 patients battle with depression.

In response — and at a time when statewide funding for psychiatric services is decreasing — the clinic is running a series of day-long, five-day training sessions designed to teach the clinic’s primary care physicians and nurse practitioners to properly prescribe psychiatric medications. The trainings are run by a committee including Moore, two psychologists, a medical director of another facility and others.

“I decided we quickly needed to (increase) our capacity to bring these services up to a higher level,” said Moore. The training sessions typically draw between 40 to 70 medical professionals from Clinic Ole and facilities in Yolo, Sonoma, Marin and Solano counties. The clinic’s last training is scheduled for Sept. 1, he said.

“Clinic Ole is committed to working with the county to best provide services given our mutual constraints,” Moore said. “We’re both committed to working with each other in this environment.”