CUT TWICE, MEASURE ONCE: It couldn’t have been a simpler question. The answer was anything but. Little wonder. The county’s ever-embroiled Department of Alcohol, Drug and Mental Health Services (ADMHS) was involved.
It was late Tuesday afternoon, and County Supervisor Steve Lavagnino was asking ADMHS czar Alice Gleghorn why she could not state with certainty how many “face-to-face appointments” her staff clinicians schedule per day with those in need. Gleghorn, tough and gruff, was hired a year ago to impose order on a department mired in chaos. Gleghorn’s answer? She’s “working on it.”
Just a few minutes earlier, the supervisors officially rechristened Gleghorn’s shop the “Department of Behavioral Wellness.” The name change emerged out of a yearlong, top-to-bottom, $100,000 “rebranding” effort conducted by Idea Engineering, a private consulting firm. The hope is to boost morale among the department’s 377 employees, shed negative baggage that’s long dogged the department, and project the warm, caring competence its 15,000 desperate clients — both addicts and the mentally ill — long to experience.
Many mental-health advocates take a dim view. One described the new name as “a merengue” designed to euphonize the harsh realities of mental illness and addiction, thus adding to the stigma. Others objected the new name projects a happy-faced optimism that masks a blame-the-victim mindset; if only those in need “behaved” better, they’d get well.
Personally, when I hear words like “rebranding,” I reach for my gun. But as bureaucratic acronyms go, I also have to admit ADMHS is a mouthful of broken teeth. Maybe the new name will give the department a regenerative jolt of “fake-it-’til-you make it” therapy. Or perhaps another effort at slathering lipstick onto the face of a recalcitrant pig. Time, presumably, will tell. Or not.
In the meantime, the county supes want Gleghorn to report to them twice a year with a short list of crucial “metrics” showing whether the multimillion-dollar, three-year effort — dubbed “Systems Change” — to reform the department actually translates to improved care. It’s a good idea, hatched by area mental-health agitators. They wanted to know how many mentally ill wind up in county jail, how many get stockpiled in emergency rooms, how many get shipped out of county for hospitalization, and how long it takes them to be seen by a psychiatrist. This Tuesday, Gleghorn came back with a list of 14 metrics of her own, which — with a few tweaks — got the Good Housekeeping Seal of approval from the supes and all assembled.
As for Lavagnino’s question, the search for answers highlights serious tensions within the department — whatever it’s called — that threaten to undermine any effort to make things better. For example, there’s an ADMHS internal document produced last December concluding that the average county shrink sees on average only 4.1 patients a day. On its face, that seems an astonishing number. Sansum’s shrinks see nearly three times that many, but their patients are not nearly so distressed. Other county mental-health departments — that serve comparably challenged populations — reportedly see 8. When asked about this, Gleghorn said a more accurate number is closer to 6.
In recent negotiations between the union representing county shrinks, doctors, and dentists, this issue became a serious bone of contention. County negotiators pushed for increased productivity; the shrinks objected they were not widgets and that patient-per-day stats were inherently meaningless given the very different assignments — clinic hours, crisis care, team treatments, and hospital rounds — county psychiatrists routinely handled. Ultimately a contract was approved giving ADMHS administrators unilateral authority to set productivity guidelines at a later date. This contract was approved last fall over the strenuous objection by the county shrinks, but they were outnumbered by doctors and dentists working for the Public Health Department for whom such targets were not so inflammatory.
Last October, 12 county shrinks signed a blistering letter and mailed it to the Mental Health Commission accusing ADMHS leadership of bad planning and bad faith, leading to bad blood, bad morale, and high turnover. The shrinks’ metric of choice was the loss — by resignation, retirement, or transfer — of 10 psychiatrists in the past 12 months. For a department budgeted to have 21, that seems like a lot. Even so, the department’s own numbers indicate only 77 percent of the authorized psychiatric positions are “occupied.” And of the five private shrinks the county had hired on a contract-out basis, one is now on the job. Department officials say it was only nine and that six new psychiatrists have since been hired. And the shrink shortage, they note, is a nationwide problem.
It’s pretty typical for such Joe Hill gripes to emerge during collective bargaining. What’s most striking is that one of the letter’s signatories was Leslie Lundt, then medical director of the county’s 16-bed psychiatric hospital. That would put Lundt squarely in the executive administrative class. Since then, it’s worth noting that Lundt was rewarded with a job promotion and a $25,000-a-year raise. Lundt’s schedule was sufficiently slammed, she said, so she didn’t have time to comment. The other shrinks I contacted declined to comment, saying they feared retaliation.
The metric I have heard from Lundt, however, is that a county Santa Barbara’s size needs a psychiatric hospital — for people at danger to themselves or others — with at least 40 beds. To the extent ADMHS is growing faster than 0any county department in terms of costs — by 139 percent over the last 14 years — it’s because Lundt is forced to ship our acutely ill patients to out-of-county facilities.
But that’s an old story, one dating back at least 40 years. Why nothing has been changed in all that time remains the simplest of questions. But the answer, as always, is anything but.