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Mendocino County’s Leaky Lifeboat

This is how the Grand Jury concluded its report on the current functioning of Mendocino County's Mental Health Department this year:

“The Mendocino County Mental Health Branch has balanced the budget this year, but at what cost? Mental Health went from providing adequate public service to clients, and from supporting functioning outreach services, to a program that now mostly serves the County’s financial needs. Mental Health staff report that money seems more important than clients. This echoes the widespread idea — ‘if you can’t bill for it, cut it.’ Mental Health services are at a very low level in Mendocino County even for those who are insured. Existing client services are stretched so thinly that positive outcomes are questionable. Saving money on future treatment by supplying preventative elements, does not exist. Despite low morale, many caseworkers and some supervisors continue to perform heroically, doing the best they can with what they have. The Grand Jury heard an outside agency report that they have had an influx of ‘refugees’ from the eroded Mental Health services. The agency stated that they are committed to be a ‘lifeboat,’ providing services (even free) as long as possible. This is a clear indication of the drastic failure of the Mental Health system in Mendocino County to meet the needs of its citizens.”

Stacey Cryer responded for the department. We've edited her pseudo-responses way down in the interests of preserving the reader's mental health, but also in full knowledge that there are people who enjoy decoding self-serving nonsense for themselves. If you're in the latter category, we'd be happy to provide everything in all their full, numbing fulsomeness, but you can find them in all their unreadable glory for yourself on-line.

• Grand jury finding #1 — “Mental Health Administration/Management. Administrators often communicate using top-down directives without adequate explanation or input from employees, stakeholders or board members.”

Ms. Cryer: “Disagree partially. It is common business practice for administrators to communicate directions and decisions to his/her supervisees [sic] and for the supervisees/managers to communicate to their employees…”

Translation: We have lots of meetings so how could anyone complain about decisions or non-responsiveness?

• Finding #3: “Staff members report that MH administrators are unlicensed or often not trained in mental health issues, operate with administrative indecision, provide uneven direction and supervision of employees.”

Response: “Disagree partially. There are five administrators on the county mental health senior management team…"

Cryer goes on to cite the dubious, circular, coffeebar credentials these people award themselves.

Translation: Look at our bona fides. Hubba-hubba! And you dare say we don't know what we're doing?

• Finding #5. “The grand jury received complaints that two mental health staff members reversed police and hospital staff recommendations to hospitalize clients under HS Code section 5150 regarding individuals who are a danger to themselves and others.”

Response: “Disagree partially. Mental Health does at times rescind 5150 holds that have been placed by law enforcement only after a thorough crisis assessment and in consultation with a supervisor. The crisis worker always consults with law enforcement and hospital staff before making a final determination. When the crisis worker finds the client does not meet the legal criteria to be held on a 5150 or there is a less restrictive option to treat the individual the 5150 will be rescinded with a follow-up for care and safety. One of the goals of the California Lanterman-Petris-Short Act was to end the inappropriate and involuntary commitment of mentally disordered persons. The least restrictive option should always be explored if it is in the best interest of the client.”

Translation: Those crazy people who are too much for us to handle we direct the hospital to release them back to the street, a policy we euphemize as the “least restrictive option.”

• Finding #8. “The State conducts annual Medi-Cal audits with a four-year period delay and mistakes accrue penalties during that period. Penalties from Medi-Cal audits have been a huge financial drain to Mental Health, and…”

Finding #9. “Mental Health has lacked internal audits and training to discover Medi-Cal billing errors. However, they have now hired a worker to minimize audit exceptions and maximize reimbursements. Mental Health expects caseworkers to spend 70% of their time working on billable Medi-Cal issues. However, the achievable goal appears to be around 40% because most of their time is used for other non-billable tasks.”

Response by the Board of Supervisors: “The Mendocino County Board of Supervisors disagrees partly with this finding. As clarified by the HHSA Director in her response, which is incorporated herein, by reference, the State conducts annual Cost Report Settlement Audits, however, due to staffing shortages at the state level, these audits are conducted six years after the fact. Mistakes do not accrue penalties — it is the audit exceptions themselves that have been a financial drain. Mental Health has made great progress in its most recent audit reports but the failure to do timely audits by the State means that problems may not be identified and corrected in a timely manner, potentially resulting in multi-year audit exceptions.”

Translation: It’s not as bad as it was, but it’s still a big drain and nothing more can be done about it, especially given that few, if any of us, possess basic math skills.

• Finding #20: “Public Health clinics are reporting a large increase in their mental health client load.”

Response: “Disagree partially. Yes, there are large increases in the mental health caseloads at the health clinics. These increases include clients (low mental health need) who are not the target populations for mandated County mental health services, clients who are reentering the county from prison reform (AB-109) and a smaller percentage of clients with high mental health need, seriously mentally ill, who are best served by county mental health. The health clinics are an important part of the overall delivery system. However, their service model and reimbursement structures do not allow for, nor meet the specialty needs of the seriously mentally ill population. Health clinics and county mental health have initiated discussions concerning the differences in scope of services for care managers. Health clinics and county mental health have developed a hybrid model of care management that will meet the needs of both entities (serving clients who have low mental health demand and the seriously mentally ill population which usually requires more assertive and comprehensive care management. Three new positions for care managers have been added to the hillside clinic and coast clinic for care managers to better serve the seriously mentally ill population who receive primary care at the health clinics.”

Translation: “There’s no money in this for us, so we don’t “serve” them and they end up in larger and larger numbers at the already overburdened local clinics that are not staffed to handle disturbed persons. Besides which America is crumbling every which way, a gestalt not conducive to mass mental health.”

• Recommendation #8: “The county establish suitable local housing for clients returning from mental health out-of-town placement.”

Response: “The recommendation has not yet been implemented but will be in the future. Establishing suitable local housing for clients returning from out of town placement has been an ongoing issue for Mendocino County as well as the majority of small rural counties. County mental health has Mental Health Services Act funds available to develop the housing continuum. County mental health and stakeholders will initiate the planning process for a comprehensive, integrated, sustainable and seamless three-year Mental Health Services Act plan in July 2012. Housing is a key element of the plan and will be addressed during the planning process.”

Translation: That'll be the day.

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