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Denial of Service

We read Malcolm Macdonald’s item about the Supervisors’ putting a hold on Measure B spending with great interest. (See separate article this week.) The complaints from Fort Bragg about being ignored in Measure B planning are important and, unfortunately, typical, of the Ukiah-centric drivers of the B bus.

The Supervisors’ unanimous vote to hold off on Measure B spending until a “business plan” is developed, assumes that there is the basic competence to develop a sensible business plan with reasonable assumptions for the “business” to be done. As we have noted before Mental Health Director Dr. Jenine Miller is focused almost exclusively on reimbursable services and clients, a strategy that leaves out many of the free range psychotics the police alone deal with everyday. As a result, Dr. Miller and the rest of the mental health posse never talk about providing services beyond their business as usual. So there’s never any estimate, much less cost estimate, of the street crazies, or the deranged homeless or the substance abusers which most of us who voted for Measure B expected to be removed from the streets or, at a minimum, restored to unobtrusive functioning. 

Neither does the “Behavioral Health Advisory Board” ever get into that subject because, again, not reimbursable — off the table. If the “business plan” is, as expected, same old reimburseable same old but with an in-county facility, then there’s plenty of money in Measure B’s coffers because much of the existing services rendered are already reimbursable and do not need more money from Measure B. If, on the other hand, the “business plan” is to follow the spirit of Measure B, then it should be simple: Provide a Psychiatric Health Facility (PHF) and deal to whatever extent possible with the doomed people presently causing so much upset from the everyday population whose public spaces have been made into No Go Zones by the volatile mentally ill.

But nobody has asked for a plan in the original spirit of Measure B or even asked about it.

As to the PHF, which the Supes seem so worried about having enough Measure B money to pay for, that also should not require a business plan. If the Board accepts the preposterous cost estimate for a PHF provided by CEO Angelo and her Measure B Project Manager Alyson Bailey, the Mendo PHF would cost a preposterous $20 million.

More than two years ago consultant Lee Kemper said a new PHF would cost $8 million, and he backed it up with comparisons to similar facilities in other counties.

But it doesn’t even need to cost $8 million. Adventist Health is already on record as offering to remodel their old emergency room in Ukiah into a PHF — a facility already built to hospital standards. The Adventists’ proposal was brought forward by Supervisor Williams; the Measure B Committee discussed it and somebody was supposed to have been asking the Adventists for a formal cost estimate. Williams even noted, without contradiction from anyone else, that having a PHF at or near a hospital has several other obvious advantages. But, as usual, it has foundered in the usual Measure B incompetence on top of CEO Angelo’s grossly overpriced $50,000-kitchen approach to everything involving Measure B.

So if the BOARD continues to base its Measure B decisions on these Angelo-skewed assumptions about only dealing with the reimbursable “severely mentally ill” while proposing grossly overpriced gold-plated new facilities, Mendo runs the risk of ending up exactly where it’s headed: no services for the people Measure B was supposed to help and an overpriced and unnecessary new PHF that, if it’s ever even built, will soak up every penny of Measure B money that may be left over after the economic downturn and the already approved $5 million dollar price tag for Camille Schraeder’s Crisis Residential Treatment Center which should have cost less than $1 million.

Dr. Jenine Miller, Mendo’s Director of Behavioral Health Services (aka Mental Health Director) wrote the following to explain why she did not include any money for operation of a Psychiatric Hospital Facility (PHF) in the Measure B cost projections:

“Mendocino County could benefit from having an acute psychiatric facility within the county. The collaboration [with an unidentified entity, but perhaps Camille Schraeder’s Redwood Quality Management Company (RQMC) or similar] would suggest that the county contract with an operator [like RQMC] that can run a facility independent of additional monies from Measure B beside that cost of building or renovation of the facility. We would also suggest that the selected contractor [RQMC or similar; RQMC already has a contract with Lake County] work with other counties such as Lake, private insurance companies and Medicare to help with meeting capacity and operating cost. This proposal would also require any agency using the facility to place an individual to cover the cost, if not allowable by insurance…”

Let’s stop there: “…require any agency using the facility to place an individual to cover the cost…”? In other words providing service to uninsured persons would be at Ms. Schraeder’s expense and at her own discretion? And no money from the Measure B services fund (theoretically 25% plus an ongoing 1/8th cent continuing amount is for services), which was intended to cover just such services? 

Again, we find that Mendo’s mental health people have no intention of meeting the spirit or intent of Measure B, preferring instead to waste millions of dollars on a PHF that won’t even provide services to a large segment of the intended clients, unless a private contractor feels like doing it out of the goodness of their cash and carry heart.

Dr. Miller continues: “If this facility is operated similar to other private facilities, the collaboration [Mendo & Schraeder or similar] believes the facility would be able to operate without Measure B dollars to support operational cost. Therefore, we did not project any Measure B dollars for a PHF.”

This appears to us to be not only a betrayal of Measure B and its voters, but a way to make it look like there’s plenty of money to build the gold-plated and grossly overpriced $20 million PHF that Dr. Miller and the Measure B project manager forecast. In their obviously self-serving financial projections the only way Mendo can afford a $20-million PHF is to deny services to the very people Measure B was supposed to help.

In a related item, the Gualala-based Independent Coast Observer reported last week in their coverage of the Board’s decision last Tuesday to put additional Measure B spending on hold that the PHF is now planned to be built near the existing Crisis Residential Treatment facility next door to the Schraeders’ facility on Orchard Street in Ukiah. We have not seen anything that specific on where the County plans to build a PHF. But it’s certainly possible, and if true would be further evidence that the entire Measure B project is being handed over to Ms. Schraeder and Co.

As we reported recently, the Board (barely) approved $1.4 million in funding for a Behavioral Health Specialist to respond with law enforcement to mental health/potential 5150 calls as part of a “Mobile Crisis Team.”

During the discussion lame duck Supervisor John McCowen claimed he had been pushing for such a concept for at least 15 years. We have been closely following this idea for longer than that and are not aware of a single time Supervisor McCowen has brought up the subject. And if he had it’s pretty clear that his claim of support has been extremely ineffectual as the idea languished for at least those 15 years.

Nevertheless, the idea remains a good one, as explained by one of its actual (and recent) proponents, Sheriff Matt Kendall:

“Service gaps we are currently seeing are due to a reactionary approach instead of a pro-active approach. I am always concerned that prevention isn't funded so the result is a more expensive fix. Pay now or pay later, however later always comes with interest. The national narrative regarding police intervention into mental health is truly what Sheriffs have been speaking about for years. We have a limited bag of tools when we arrive to a Mental Health or addiction crisis. We are trying to fix complicated machinery with a flat rock and a bent screw driver. Behavioral health personnel constantly say it isn't safe to do their jobs, I agree with them and believe it is my job to keep them safe so a dual response is needed, however it will become much safer when we are proactive. If we aren't proactive, everyone winds up in crisis before actions are taken. Recent legislation and decriminalization clearly shows people don't want the police involved in mental health and addiction problems however legislative mandates are calling for more training of the police in these areas. That makes no sense. We have to move forward in bridging these service gaps and the best way to do this is to work together. There is way too much finger pointing and we all need to come together and say it is our problem, not mine or theirs. I truly believe when we get back to looking at the humans in this equation, instead of the industrialized machine which HHSA has become, we will all be better off. The test has to be do we have less issues with addictions, 5150s — not how much money did we spend.”

Overlooking for the moment the Sheriff’s blunt description of HHSA as an “industrial machine,” the Sheriff specifically mentions “addiction problems” as part of his expectation for the kinds of incidents the Mobile Crisis Team will respond to, “problems” that Dr. Miller has steadily ignored. Yet here’s $1.4 million for three people under Dr. Miller’s supervision to ride along with law enforcement on mental health/addiction calls. The proposal that the Supervisors authorized $1.4 million to be spent on leaves a lot of unanswered questions.

What vehicles will be used for the mobile crisis team and who will pay for them? How will dispatch work and how will the Behavioral Health person be included in the actual response? Will a deputy have to run over to Orchard Avenue to pick them up before responding to a crisis or will the Behavioral Health person have their own vehicle and be dispatched separately? Who will pay for the law enforcement portion of the “team”? What are the hours of operation? Will the Behavioral Health people respond to calls on nights and weekends? How much funding is available from other sources? Who’s in charge of making the program work and accumulating the statistics that are supposed to be reviewed by the Measure B committee in five months? Will the Behavioral Health person be an employee of Camille Schraeder or a County employee? …

Sheriff Kendall’s enthusiastic support of the mobile crisis team in concept is certainly a key component in the success of the Mobile Crisis Team, but given the Behavioral Health staff’s record of ignoring troubled people and these kinds of calls, it’s going to be a real challenge to overcome the many obstacles that the Behavioral Health people have been putting up to prevent the creation of a Mobile Crisis Team thus far.

Last Tuesday Dr. Miller also reported that Mendo’s suicide rate is up by almost a factor of two this year over last year. In the past Mendo averaged about 20 suicides per year and last year there were 23. This year there have been 26 Mendo suicides already through August. Dr. Miller didn’t offer much besides vague cliches in response, saying that “more outreach” needs to be done and people (her staff? Schraeder’s employees?) have to directly ask people if they’re suicidal more often. Dr. Miller also suggested “developing more support groups in English and Spanish” and use social media more — neither of which are particularly professional responses. And Dr. Miller mysteriously said nothing about the dramatic increases in drug overdoses.

Lee Kemper, Jenine Miller

When Matt Lefever of the new and always pertinent asked neighboring counties about their experience with suicide in the wake of the pandemic, the two he spoke to said they had not seen any significant increase. Nobody seems interested in digging in to what factors may be contributing to Mendo’s unusually high rates of suicide and drug overdose. And if all we’re going to get from Dr. Miller’s privatized crew with their support groups and facebook posts, nothing much will improve and the Mobile Crisis Team will remain immobile.

At Tuesday's meeting the Board of Supervisors approved a vague concept recommended by an ad hoc committee for a Public Safety Review Board and turned it over to County Counsel Christian Curtis to draft the specifics. Apparently the proposed review board would involve reviewing complaints against officers, among other things. Whatever written paperwork the ad hoc committee prepared wasn’t posted in the Supes agenda packet as it should have been, so for now we’ll have to wait and see if this is a good idea or, more likely, another politically expedient extra hassle for the Sheriff.

Supervisor Ted Williams went on at great length about the seemingly insurmountable bureaucratic and staff-intensive problems with the County’s current pot permit program after noting that Supervisor John McCowen’s use-permit/program “streamlined” reform proposal had been abandoned in favor of trying to fix the existing problem-plagued program with more ad hoc committee meetings.

PS. Our hard working supervisors won’t meet again until September 22. 

PPS. Here’s the kind of thing that passes for a “status report” according to the latest Health and Human Services Agency Status Report of August 24, 2020: Adult and Aging services “continues to provide critical services to clients.” Apparently, the Board and the Public are supposed to be impressed that the Adult and Aging services people haven’t all quit. 

One Comment

  1. James Marmon September 10, 2020


    In the councils of government, we must guard against the acquisition of unwarranted influence, whether sought or unsought, by the HHSA industrial complex. The potential for the disastrous rise of misplaced power exists, and will persist.

    James Marmon MSW

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