The Community Mental Health Forum, sponsored by Tri-City Medical Center, is a group of local advocates who have been fighting hard to gain better, more timely urgent care for the residents of North County. The North County community now numbers more than 1 million people. Many citizens who are unfunded have been unable to get treated except in emergency rooms primarily set up for physical health care. Those trying to get help for their mental health needs often wait long hours to see a psychiatrist. Our hospitals then must pick up these costs as the county psychiatric hospital in San Diego is too crowded and too far away.

Forum members felt the county could open a walk-in center to stabilize clients, provide medication, less costly care and bring relief to the emergency rooms. Such a center for children opened April 23 in Oceanside with a contract from Rady Children's Hospital San Diego and funded by the Mental Health Services Act, or Proposition 63. Previously, an uninsured child in crisis would be taken by his family to a children and youth county emergency clinic in Chula Vista.

The forum is still advocating for an adult/older adult walk-in center, an idea that has not received a bid in its last three "requests for proposal" from any provider. The fear appears to be that such a facility would be overwhelmed by large numbers of consumers, far more than the 439 consumers funded in the proposal, which itself was far less than what the forum had hoped for.

The problem with contractual services in our county's managed-care system is that each contract at each county clinic has a base client number to be served for a set amount of dollars. When there are more clients than dollars, the waits increase dramatically. When the wait time is too long, clients are forced to use the emergency rooms along with those already needing urgent care services. The increase of population in North County and the decrease in state and federal mental health funding results in San Diego County Mental Health Services not being able to make ends meet.

Funding for our core services is not keeping up with our needs, and Prop. 63 dollars, welcome as they are, must offer new and innovative services to unserved clients throughout the county, especially North County, and cannot be used to supplant existing (core) services.

North County's next biggest unmet need is a 14-bed crisis house in the Escondido area. More crisis beds are less costly than hospital beds and can effectively stabilize clients in need of further supervision. Maybe then we can find the money to expand our 40-hour walk-in center into a true 24-hour urgent care facility.

Carlsbad resident Liz Kruidenier is co-chairperson of the Community Mental Health Forum, sits on the board of the National Alliance on Mental Illness North Coast chapter and serves on the mental health adult and housing councils for San Diego County.