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The Big Swindle

A READER WRITES: “What you and all of these latter day crusaders for preserving the sanctity of mediocrity (that has characterized county delivery of adult mental health services for a quarter century) seem to be ignorant of is that children's mental health services was successfully privatized a dozen or more years ago and that the supposed good old days that you wish to return to never existed. The simple fact is that delivery of adult mental health services has improved with Ortner and is likely to continue to improve - something that was never achieved under the county run system despite decades of effort. And going with Optum would have meant throwing overboard Redwood Children's Services, the children's mental health provider. The alternative to privatization with Ortner/Redwood was not to stay with the failed County MH delivery system, but to dump Redwood and have Optum handle both adults and children. Optum would have brought in their own people and taken the profits outtahere. As it is, cadres of local poverty pimps are still getting a slice of the pie.”

This assumes that the only way to “improve” mental health services was to privatize them. The reader says that “decades of effort” were made but nothing improved. Why might that be? In fact, no real effort was made. The only effort we could find in reviewing our archive of Mental Health Department coverage spanning “decades” was a parade of incompetents installed by the County as Director of Mental Health. The primary “service” the public expects out of the Mental Health Department is crisis services. But during those alleged “decades of effort” referred to by Reader Writes, the only change made to crisis services was the controversial closure of the Psychiatric Health Facility (PHF) back in the early 2000s, which lead to even more reliance on cops as crisis intervention workers. What was the reason given the then-Supervisors that the PHF had to close? Answer: The well-paid staff was stressed out themselves. How about a crisis van on call 24/7 to back up the cops on mental health calls? Even with the extra $1 mil state windfall from Proposition 63, the County and its Mental Health Board couldn’t get past an ill-considered Request For Proposals to contract it out so no one bid the job. End of project. The funds were there, the idea pursued, but dropped. Nobody pressured the Mental Health Department to get the Crisis Van up and running. Crisis services dropped to near nothing and cops continued to do all the mental health heavy lifting, justly complaining that they shouldn't be doing all of it alone.

Up pops Pinizzotto. He becomes the County's go-to mental health guy, arranging the sale of the County's mental health services to his former employer, Ortner Management Group of Yuba City. His present employer just happens to be the County of Mendocino. Pinizzotto now reports directly to the Supervisors, faithfully telling them that “delivery of mental health services had improved with Ortner.”

For years we pointed out that Mendo’s Mental Health Department was not only overstaffed but doing a lousy job — a fact we reported on at length. Here are a few excerpts from prior discussions of Mental Health from the AVA archives:

Jim Shields, January 2001 — A couple of weeks ago, I reported to you that the Supes — with the exception of Mike Delbar — caved in to Mental Health Director Kristy Kelley’s demand to permanently shut down the county’s Psychiatric Health Facility (PHF). I’ve said time and time again, the Board just doesn’t have the political will to tell the Mental Health Department to do its job: Provide acute psychiatric care for folks — some of whom are also caught up in the criminal justice system. For you anglers out there, you’re familiar with the old saying about when a fish stinks, it stinks from the head down. The Mental Health Department is stinking up the joint, and you can look no further than its head — Ms. Kelley — to find the source of the stench. The Supes swallowed hook, line and sinker, Kelley’s pitch that the Board could utilize $900,000 in purported savings from the PHF’s closure “towards the development of a comprehensive and effective mental health system of care.” This new scheme would result in kinder, gentler “helping professionals” from the Mental Health Department reaching out and laying the healing hands on the troubled souls who no longer would require the services of the PHF unit. How’s the new system working? Several days ago, the helping professionals locked a troubled soul in a DMH vehicle for three hours on a sweltering day. The abandoned troubled soul kicked out the car’s window in order to relieve himself. It’s also way past time for the Supes to relieve Kelley — permanently — from her post.

Jim Shields, January 2001 — Psychiatric Unit Still Closed — Since we’re on the subject of how government treats humans, the situation with the County’s Psychiatric Health Facility is truly criminal. The PHF (pronounced “puff”) unit has been shut down since last December. The PHF unit deals with the very, very mentally ill, some of whom are violent and/or criminal offenders. These folks require 24-hour attention in the special facility. The County Jail is neither equipped nor does it have the qualified staff to care for people who are charged with crimes but are also mentally ill. Likewise, harmless but mentally ill folks who wander the streets getting into mischief don’t belong in jail. They need care and treatment. But when the county’s Mental Health Department closes the only facility that offers specialized treatment, there are no good alternatives.

According to MH Director Kristy Kelley, her PHF staff is burned out and can’t handle the stress of their jobs. Read Glenda Anderson’s front-page Ukiah Daily Journal report for all the details, but allow me to say this: These are handsomely-paid professionals. One has to presume they went into their chosen profession with their eyes wide open. If they no longer can perform their jobs, they need to get off the County’s payroll and find something else to do. At Tuesday’s BOS meeting, Kelley spoke as if the PHF unit would not be reopening anytime soon, if at all. She even talked about turning the PHF unit space over to another department. CAO Jim Anderson, to his credit, told the Supes it was “premature” to be exploring such a drastic option. There are serious questions about Kelley’s performance as head of one of the County’s most critical services. Granted, her staff may be stressed out, but closing the PHF is no solution. Her five bosses on the Board of Supervisors need to take decisive action — it’s been allowed to fester far too long. Cops have a hard enough time dealing with the run-of-the-mill, garden-variety types of criminals and assorted low-lifes who operate in Mendoland. Mentally ill folks need to be cared for by professionals. When there’s no place to put them, the cops are forced to deal with them. This requires deputies to hold them pending finding a suitable, oftentimes out-of-county mental facility to house them. This breakdown in mental health services is both a burden on law enforcement and an extra expense to taxpayers. It’s also unfair to people who aren’t lawbreakers but just sick mentally. Bringing law enforcement into the equation has the effect of criminalizing something which ain’t criminal. The cops don’t like it any better than we do, but right now they have little choice.

Jim Shields, August 2001 — It was painful to witness, but at Tuesday’s Supes’ confab, the criminal justice types reluctantly threw in the towel. We’re speaking of the Board’s decision to permanently close the county’s Psychiatric Health Facility. You can’t blame the Sheriff, Public Defender, Probation Department, DA, or the Courts for running up the white flag. They all saw the handwriting on the wall months ago. With the exception of Mike Delbar, who voted against locking the doors of the PHF unit, the rest of Board just didn’t have the political will to tell the Mental Health Department to do its job: Provide acute psychiatric care for folks — some of whom are also caught up in the criminal justice system — right here in Mendocino County.

Instead, the county will utilize $900,000 in purported savings from the PHF’s closure “towards the development of a comprehensive and effective mental health system of care.” Why must the PHF unit be closed in order to attain that lofty goal? Isn’t that what the Mental Health Department has been doing all along?

Anyway, these new, enhanced services don’t include local care for those whose severe mental health problems lead them into conflicts with the law or who pose a threat to themselves, as in suicidal tendencies. As a recent letter-writer opined, Mendocino County is becoming something of a haven for those who want to end it all, but that’s a subject best left closed, just like the PHF unit.

The problem with most of these folks is there’s no place to care for them in a Mendocino County sans a PHF. So, as has been the case since last year (when the PHF’s doors were “temporarily” closed), those individuals will be transported to out-of-county mental health hospitals. As you can imagine, that situation makes things a bit difficult for an already short-staffed Sheriff’s Office, which provides the out-of-county transportation for mentally ill inmates from the hospital to the courts. Likewise, defense attorneys are burdened with literally going the extra mile to meet with clients who may be in an Alameda County facility. Needless to say, family and friends of the mentally ill encounter the same sorts of difficulties.

But those are the prices that everybody pays when the county is working “towards the development of a comprehensive and effective mental health system of care.” When you think about it, closing the PHF is somewhat similar to the Supes’ decision to close all of the county’s landfills. Back then the Supes didn’t have the political will to deal with the dump issue. Now, we just ship the garbage out-of-here, out-of-sight, out-of-mind — it’s somebody else’s problem.

Mark Scaramella, June 2003 — In fact, the Supervisors couldn’t “look at the numbers” if they wanted to. The county does such a bad job reporting on routine things like department staffing levels, lost time accounting, position vacancies, outside contracting, consulting, temporary help, and on and on, that Supervisor Delbar recently exclaimed that he was surprised that the Mental Health Department had somehow ballooned up to 140 staffers.

Mark Scaramella, June 2003 — County CAO Jim Andersen offered this explanation of the Mental Health Department budget:

“The Mental Health Department is continuing to propose a spending plan that is consistent with revenues that can reasonably be expected to be earned in the 2003/04 fiscal year. The revenues will include approximately $1.0 million in a MediCal Cost Report claim that is expected in January of 2004. The Administrative Office and the Mental Health Department are recommending that the revenue be realized, and utilized to finance the payment of indirect costs to the General Fund and to reduce the deficit in the Special Revenue fund by approximately $650,000. This plan is being proposed, in part, to maintain the practice of payment of indirect costs (self-sufficiency), as well as to mitigate a deficit that is expected to be in excess of that which was previously communicated to the Board. The current deficit projection at the close of 2002/03 is anticipated at $2.0 to $3.0 million.”

How, exactly, can this $2-$3 million deficit be called “self-sufficiency”?

Mark Scaramella, September 2003 — Mental Health Director Beth Martinez, trying valiantly to pick up the pieces of a department riddled with incompetents and badly managed for two decades because supervisor Shoemaker inserted his pals in the department’s key positions, said her department will be $1.8 million in the red this year, adding that she was confident that she’ll be able to pay back about $300,000 of that amount. Martinez said that most of Mental Health’s clients are eligible for Medi-Cal, hence state reimbursements. Very few people who are not eligible for Medi-Cal present themselves to Mental Health; well-to-do mental cases pay for private assistance. “5150s” — cop code for persons deemed a danger to themselves or others, or are considered to be in “crisis” (suicidal or seriously depressed) are not required to present proof of insurance for their initial screening and their referrals for help, which is the same department policy in place before the budget crisis. (And as if a dangerously crazy person were together enough to bring his paper work along with him or even know where it or he was. Mental Health had been authorized for staffing up to 170 people. 45 positions were cut, but only nine of those were actual staffers and they volunteered to be laid off. The Sheriff’s Department presently bears the burden of caring for the aggressively deranged. That task proved to be beyond the capacities of the County’s helping professionals. Which is just as well; the average deputy at least brings commonsense, real life experience and human sympathies to work with him. At the County-run mental health unit therapists were locking themselves in their offices and frantically dialing 911 for the cops whenever a “client” went off. And clients were going off all the time because their tax paid therapists were driving them crazy. (Many of our therapists graduated from the more depraved sectors of the local counterculture, deriving, then, from a kind of socially sanctioned insanity that would have rendered them totally, permanently unfit for public employment in any other country in the world. Not here. They have allies and friends on the Board of Supervisors.) Treatment and hospitalization costs have gone up faster than reimbursement rates, and if the treatment and hospitalization is legally mandated, there’s not much left over for early intervention or ongoing service. The financial crunch in Mental Health stemmed from increased mandated costs and lower state reimbursements, leaving little money or staff time for non-crisis mentally ill Mendolanders.

* * *

Those last two items, where it was reported that Mental Health was millions of dollars in the red for several years in a row, were the real reason Pinizzotto was brought in to privatize Mental Health. The billing was done badly and Official Mendo, instead of revising the billing procedures, subsidized the deficit by putting a hiring freeze on Social Services and drastically cut back on Mental Health General Fund positions (under then HHSA boss Carmel Angelo, now the County’s CEO), even though most Social Services jobs were paid out of state and federal funds. In fact there was no “effort,” much less “decades” of it, to improve Mental Health services, especially crisis services — if there had been there would at least have been a crisis van in Mendocino County like there is in San Francisco, Contra Costa and Sonoma counties. Official Mendo not only made no “effort” to improve Mental Health services, they intentionally neglected it and made it objectively worse by closing the PHF simply because the staff was complaining, and cutting crisis workers, leaving only the specialized grant-driven non-general-fund non-crisis programs that did nothing to deal with mental health problems but employed many local psychiatrists and psychologists and counselors to make sure the next year’s grants were obtained. Then when the services were cut back (down to near zero on the Coast) Mendo threw up its over-wrung hands and bought Pinizzotto’s Ortner brand of snake oil for over $7 mil and put Pinizzotto in charge of monitoring the “improvement.”

We doubt the “reader” can cite even one concrete example of legitimate “efforts” which were undertaken over the last few “decades” to improve County Mental Health services before the County gave up and handed millions of dollars over to Pinizzotto-Ortner. Handing the product of decades of mismanagement over to Pinizzotto’s former employer in an obviously sleazy way was only pushed through because the County wanted to get rid of a dysfunctional Mental Health organization which their own failure and neglect had created.

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