Mental Health Services Criticized

Department May Owe State $21 Million

<strong>Defending the department:</strong> County Mental Health Director Dr. Ann Detrick has spent much of her two years in Santa Barbara changing, and hopefully improving, department practices. She gave the Board of Supervisors an extensive, if not complex, update on Tuesday.
Paul Wellman (file)

While mental health consumers and advocates have pointed to a recently released report on county mental health departments throughout California that shows Santa Barbara County as one of the worst in the state, officials in the Alcohol, Drug & Mental Health Services (ADMHS) department say the data indicates where the county once stood, but that changes have been made for the better.

Aside from that explanation by Ann Detrick, county mental health director, in front of the Board of Supervisors on Tuesday, the only crystal clear revelation during three hours of testimony and presentation from ADMHS was that the department is still potentially liable for tens of millions of dollars owed to the state because of operational mishaps over the past decade, though that number is lower than previous estimates.

“It shows symptoms of a department that isn’t operating properly,” said Annmarie Cameron, executive director of Santa Barbara Mental Health Association

The statewide report on county mental health departments — conducted by the California External Quality Review Organization — ranks Santa Barbara County as one of the worst counties in the state, which some directors at community-based organizations said was evidence that the mental health department is continuing to struggle. “It shows symptoms of a department that isn’t operating properly,” said Annmarie Cameron, executive director of Santa Barbara Mental Health Association, while noting that the state’s budget is making it difficult to do good work.

The report shows that, out of three recommendations from the previous year’s report, the county didn’t address one and only partially addressed the other two. Additionally, the report said the department’s leadership did not promote a clear mission, vision, or set of priority initiatives. Detrick said that the report was based on a December 2008 visit but, by the time a December 2009 analysis was carried out, it was “our impression that we made some significant improvements,” she said. “We know that our department has had various areas that needed improvement. … The report wasn’t really surprising.”

Many issues face the department, as Governor Schwarzenegger has once again recommended pulling Mental Health Services Act money to help the state’s General Fund. “That would be pretty devastating for us,” Detrick said, also pointing out decreasing revenue from sales tax. The governor has also proposed eliminating or reducing CalWORKS and Offender Treatment Programs, which give some money to ADMHS. All this during a time when more people are using mental health services than ever before.

Based on numbers from the Auditor-Controller, the county is looking at paying a potential $21 million back to the state — $9.3 million in bad billing the county self-disclosed and a potential liability of $12.2 million from the Multi-Integrated Services to Children program liabilities from fiscal year 2002-2003 to 2007-2008. The state has already withheld $2.2 million for the 2002-2003 fiscal year, while the county is formally appealing to reverse all or at least a portion of that amount, according to Auditor-Controller Bob Geis, whose office has stepped in to help right the ADMHS ship. Aside from the $2.2 million held back by the state, the county is considering the money it might owe as only a potential liability, pending the outcome of the appeals.

As bad as those numbers sound, however, they are lower than originally projected months earlier, when the combined total appeared to be more than $30 million owed.

The rest of the presentation was filled by ADMHS detailing the changes the department has undertaken in the last year, many of them expected to help on the fiscal end. Included in the changes — perhaps most importantly — was dropping the practices that got the county in trouble. Instead, the department has reportedly been using a new information system and has also put qualified staff in the proper places to run the department efficiently. The county is also purportedly staying on top of claims for MediCal and Medicare and submitting reimbursements in a timely fashion. Quality assurance in terms of training staff in correct documenting practices has more than tripled from two years ago.

“How do you measure the outcomes?” he asked. “How do you know how to measure?”

Still, many questions remain about how these new practices will pay off, a point Mike Foley, Casa Esperanza executive director, pointed out at the end of the meeting Tuesday. He raised multiple questions about how the data presented would translate to real results for the department. “How do you measure the outcomes?” he asked. “How do you know how to measure?” The four supervisors present, however, seemed content with the presentation, not commenting on any of Foley’s points.


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