Mental health has long been relegated to the bench as medical heavyweights such as breast cancer and heart disease battle for center stage. So, severe budget cuts in recent years have meant cutting into already lean services.

Yet, not all cuts were harmful ones, said Deborah Blalock, executive director of the Charleston Dorchester Mental Health Center.

“While the cuts were very painful, they forced us to be very efficient,” Blalock said. “We’ve learned good things.”

For instance, small clinics in Charleston, Dorchester and Berkeley counties closed in an effort to centralize staff and cut lease payments and other operating costs. Among them were the Charleston Dorchester center’s satellites in Edisto and McClellanville.

That meant rural patients, who often lack transportation or cannot drive themselves, were forced to find ways to travel to the central office in West Ashley for care. Another office is in Summerville.

But then the center bought an RV dubbed Highway to Hope that acts like a mini-mobile mental health clinic. It takes care directly to rural communities — minus the operating costs of a fixed building — from McClellanville to Hollywood thanks to grant money from The Duke Endowment and the Roper St. Francis Foundation.

“It’s proven to be a really effective model,” Blalock said.

In addition, when the mentally ill wind up in emergency rooms or hospitals across the state without good access to psychiatric care, a new tele- psychiatry program is available. The computerized system allows patients to use monitors to talk face-to-face with psychiatrists who might be hundreds of miles away.

Psychiatrists then can assess and suggest treatment options to ER staff who might not be mental health experts and are dealing with myriad other patients.

That, in turn, saves time and the high costs associated with emergency care.

About 25 ERs are using telepsychiatry across the state, including Roper St. Francis Mount Pleasant, Summerville Medical Center and Roper Berkeley.

“It has been invaluable,” Blalock said.

Local mental health centers also are winnowing caseloads to see which patients can succeed with less oversight.

Some patients are doing well enough today that they don’t need to see caseworkers as often anymore.

Others only need medication monitoring.

Still others can be served in the community, such as children who can get ADHD drugs from private pediatricians.

“Looking at cost-effective ways to do things is not a bad idea,” said Deborah Calcote, executive director of the Berkeley Community Mental Health Center.

Plus, as psychiatric research, medications and treatments improve, local centers are standardizing treatment plans using evidence of what works fastest, best and is most cost-effective.

“We want folks to get better faster,” Blalock said. “A segment of folks will need our care for the rest of their lives. But hopefully, many won’t.”