Counties already reeling from cuts in mental health programs due to reduced sales taxes now face what could be another billion dollars in lost revenue.

According to lobbyists at California State Association of Counties, if the proposal in the May Revision to eliminate $2 million in state spending for adult mental health managed care is adopted, counties could additionally lose $8 million in federal funds for the program.

These cuts could be difficult for counties like El Dorado where administrators already cut $2.4 million and 10 staff positions in Placerville and South Lake Tahoe.

In neighboring Placer County, the number of positions in the Adult System of Care (Mental Health, Substance Abuse treatment, Adult Protective Services, Public Guardian and In Home Support Services) has decreased about 24 percent in the last two years. One of two Auburn clinics has been closed and hours are being examined.

Meanwhile the number of Crisis Service evaluations increased by 200 to hit the 2,000 mark in 2008. So as resources are decreased, demand continues to grow.

The county is trying to get creative by encouraging people to move from outpatient mental health therapy, assistance and medication programs to primary care providers and other less expensive options.

“We triage to determine the highest need, and deliver services in the most efficient way possible,” said Marueen Bauman, director of the Placer County Adult System of Care.

One creative way Placer County has lowered costs is by opening a Welcome Center at the former state mental institution, now the county offices at DeWitt Center in Auburn.

In the former barracks buildings, clients trained as Navigators, deliver services that were previously delivered by professionals. Volunteers act as resources to guide people through the self-help services such as computers, crafts and peer-to-peer counseling session calendars.

One example is the Listening Well Program. The county spent some $200,000 over a two-year period to have the creator of the therapeutic storytelling process put 40 people through intensive workshops and train some of the participants to share the strategies with others.

Now volunteer navigators lead others in eight-week programs aimed at focusing on their individual accomplishments.

“Participants need to own the program,” says Cindy Bigbee, program supervisor.

The shift to more peer counseling and less formal resource management seems to be working. The number of people in outpatient mental health decreased 30 percent over the last year. A program that served 1,525 people in 2008 is now serving 1,063 people.