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Mental Health Homes Out to Bid

Clients Being Reassessed for Stripped-Down Support


Wednesday, July 23, 2008

Most county mental health clients in supportive housing will begin reassessment this week as Mental Health Services reorganizes around a budget slashed by almost a third, down to $6.4 million from almost $10 million last year. Department director Ann Detrick has issued a Request for Proposals, due mid-August, for a million-dollar-a-year contract to provide residential support for 130 people in the South County, conceding that this will result in reduced intensity of care in group homes for indigent clients disabled by severe mental illness. She reiterated that she committed to a net loss of zero beds, however, and to ensuring that no one is evicted onto the streets or into a homeless shelter.

It could have been worse: The county rescued the department from a shortfall of almost $7 million by doling out to the department, reluctantly and after much persuasion, a one-time contribution of around $4.2 million from the county’s general fund. Outlining the department’s fiscal crisis at a July 18 meeting of the Mental Health Commission, county auditor-controller Bob Geis said it would be possible to dig deep into the forensics of the snafu and generate a scandal along the lines of that which surrounded the county’s owner-occupied affordable housing program in 2006.

Geis said he would rather focus on fixing the problem. However, he briefly described for commissioners a bureaucratically Byzantine state billing system rife with pitfalls, into some of which the county has fallen, notably when mental health workers extended services hoping for state or federal reimbursement that did not materialize. On top of that, funds from a half-cent sales tax passed by voters in 1992, which are supposed to match MediCal funding for mental health services at the rate of 50 cents for each dollar, remain flat, even while MediCal expenditures-which do not cover the entire cost for treating MediCal-eligible clients—are increasing. That means that the difference would have to come out of the county’s general fund, which traditionally is used primarily for public safety agencies including police, fire, the District Attorney, and the Public Defender. Last but not least are the increasing costs for county employees’ health insurance and retirement.

Geis said he is working with Detrick, who came on board just months ago as the new director for the Alcohol, Drug, and Mental Health Services Department, to straighten out the billing system and bring expenditures into line with income.

Detrick, meanwhile, explained this week that she made the controversial decision to split the $4.2 million budget bailout extended by the Board of Supervisors between this year and next, instead of using it all this year, because it is one-time money only and she has no reason to believe that things will be financially better next year.

Already gone are voluntary admissions to Cottage Hospital’s psych unit for clients in crisis. Also, most residents of Casa del Mural, in particular, where a dozen severely mentally ill clients received round-the-clock, on-site supervision, have already been placed “in other programs or situations appropriate for them,” she said, though she did not provide specifics. She said that the Casa facility will probably be converted for use as supportive housing, which she described as “stable” but less intensive. The South County’s two other mental health board-and-care homes, both run by Phoenix House, will continue to operate, though its outpatient program will be axed. County mental health employees, in the clinics for example, who are members of Service Employees International Union Local 620 are taking a pay cut in the form of a two-week furlough.

Dietrich said that the three community-based organizations currently providing care in some 11 South County homes are welcome to make a proposal to administer the stripped down, million-dollar-a-year contract. She added that the decision to put the job out to bid “has nothing to do with performance of individual CBO staffers, who do an incredible job of helping people with mental illness.”

Roger Thompson, a county mental health consumer activist who is well versed in the financial factors involved, said he understands Detrick’s reasoning but it is “not my reasoning.” Thompson disagreed with her decision to take the funds out of the adult mental health services rather than other options, which include alcohol and drug services, or administration. He has urged the supervisors to shift funding into mental health services from public safety or other general fund priorities. Thompson denounced the state’s system for reimbursing MediCal dollars “highly complex and offensively inefficient.” He and other consumer advocates, and providers, lamented the disruption of stable, familiar, caring homes with loyal staff.

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