Mental Health: How To Inspire Zero Confidence

(by Mark Scaramella, Bruce Anderson, James Marmon & several members of the Board of Supervisors)

WE’RE STILL TRYING TO DECIPHER what’s happening with the reporting of Mendocino County’s privatized Mental Health system. We recently asked the Health & Human Services Department staff for copies of Ortner’s latest “timeliness of access” report and their latest bill. After a few days of unnecessary runarounds they duly provided them. It turns out the “timeliness of access” report for Ortner’s newly privatized “access center” (which seems to be a subcontracted program that Ortner administers, for a fee) is a simple one-page summary assessment of Ortner’s responses to Mendolanders who contact the crisis line and/or the Access Center.

WE'RE NOT SURE how their “goals” were set or how reasonable they are, but it appears that the Access Center is largely meeting their goals, although the “average response time from referral to face to face” of 3.5 days seems awfully long.

ALL THE TERMS on the chart seem subject to interpretation — such as “billable clinical assessments: CIC / BPSA” which we assume means that the chart only covers those clients who Ortner can bill the County/Medicaid for. We’re also concerned about the last line of the chart where it first says “timeliness of routine (initial) medication appointments” then mysteriously refers to it as “the initial medical appointment.” We hope the mental health service is not just dispensing psych drugs, but that's what it sounds like.

WE’LL BE EXPLORING Ortner’s latest bill in a subsequent report. But for May 2015 Ortner billed $317k, which translates to about $3.8 million per year, well under their recent “base match” (advance-reimburseable funding) allocation of $5.1 million.

UNFORTUNATELY, the numbers on the access timeliness chart don’t add up and there’s no explanation of the discrepancies. The Timeliness report says there were 834 calls, 754 in English, 10 in Spanish and 70 (?) in some other (unspecified) language. There were also (coincidentally?) 70 billable clinical assessments. It also says there were 134 crisis calls, but only 53 assessments, without any explanation of what happened to the other 81 crisis calls, although a footnote refers to 27 cases where “criteria were not met.”

PERHAPS there are people outside the County’s insular Mental Health establishment who can do a better job of interpreting Ortner’s self-reporting. Too bad the County’s oversight arrangements don’t track, probe or report on any of this activity on a regular, continuing basis. It seems like the basic info is available to do that. At least to start.

A DOMINANT THEME running through all the mental health system is the lack of meaningful management reporting and the absence of follow-up questions. Skepticism, of course, is generally disallowed in Mendocino County as a form of very bad manners or, as the libs put it, "inappropriateness." Whether it’s Ortner or Redwood Quality Management (Ortner’s partner for the under 25 set), or County staff or the Board of Supervisors, there are lots of claims that “things are better,” or “we’re working on that,” or “we know we have some issues with that,” etc. But nobody ever says anything remotely like “show me the documentation or report to support or explain that.”

Last week’s Mental Health presentation by Health and Human Services Director Stacey Cryer and Mental Health honcho (and former Ortner executive) Tom Pinizzotto is representative of how disorganized and confusing it all is, and stands in stark contrast to the hyper-organized presentations on much less important topics. Instead there was a jumbled sprawl of paperwork, most of it handwritten notes on lined yellow paper not supplied to the Board or put on the record.

YOU’D THINK that with all the millions the County is spending annually on mental health, all the rhetoric about how important they say it is, the near-constant criticism of various parts of the program, the newness of the privatization of process, all the computers they have these days, that somebody — anybody! — would realize that good reporting and accountability are essential. But this is Mendocino County where not only is there no history, there’s never, ever, any serious ongoing mandatory reporting on the activities of the County’s single biggest employer: Mendocino County (and its departments and contractors). Ditto for the innumerable jive "non-profits" based here.

ON-LINE COMMENT OF THE DAY: Regarding Mental Health...

"I watched the entire [Board of Supervisors] presentation, if you could call it a presentation. It appears to me that HHSA [Mendocino County Health & Human Services] was not prepared to give one at all. The amended mental health contract was put on the consent calendar squeezed between a late 10 o’clock start and an 11:30 timed item. During that time period the BOS presented a couple of proclamations, public expression, and a long break so that the supervisors could review a large stack of paperwork given to them during public expression by the HHSA director [Stacey Cryer]. It was obvious that the CEO [Carmel Angelo], HHSA director, and Chair Carre Brown had purposely placed the amended contract on the Agenda’s consent calendar at the last moment in order to avoid any questions or criticism from other supervisors or the public. Chair Brown and the HHSA director were noticeably annoyed by the fact that the item had been pulled for discussion and comment. Chair Brown expressed anger on at least a couple of occasions during the discussion and eventually slammed her gavel down declaring a lunch break.

I thought it was interesting that the item was not put on the Agenda and before the full board until Friday afternoon knowing good and well that the contract had to be approved by Tuesday to avoid a stoppage in services. That left Supervisor McCowen hustling all day Monday and into the evening hours searching for clarification from HHSA staff. Instead of clarity, the Board was confused even more by the HHSA’s director’s inadequately prepared presentation and the stack of last minute documentation thrown at them. The HHSA director’s only explanation to the board’s questions was that Mental Health Administration was very complicated and extremely difficult to understand. That was evident based on her avoidance to clearly answer questions and her so called presentation. If anything, that presentation created more confusion and unanswered questions.

"Chair Brown, the CEO, and HHSA director all knew that the amended Mental Health contract would be a hot issue and that other board members and the public would have questions as to the delivery of services and their costs. I’m not sure of how the board members felt about the tactic to rush it through at the last moment, but I was personally offended.

"From the beginning of the privatization two years ago HHSA has kept Mental Health Service Delivery a mystery and away from the public, the Mental Health Advisory Board, and Mendocino County Board of Supervisors. Any time a question is asked, of HHSA, they answer by declaring it to be too complicated, or things are getting better. No one really knows exactly what is going on. To paraphrase what the mental health director Tom Pinizzotto stated during the unorganized presentation, 'This is all new, no other county is doing it, we are learning as we go.'

"My suggestion would be to have an independent audit and evaluation of our Mental Health program so that we could have an honest and accurate view as to where we are really at and what areas need to be improved. This is too important of an issue to just muddle our way through it, learning on the run. It is apparent that there was never a clear plan of implementation and I think our mentally ill population has suffered because of that failure. Mendocino County cannot keep throwing money at these contractors without knowing what is working and what is or not. HHSA has been given two years to implement this program and was afforded the faith by the BOS to do so. I for one have lost all faith in what they are doing and I would like to get some real answers. I believe that there is an abundance of our county’s mentally ill clients who are not being adequately served or served at all. "

— James Marmon, Former County Social Worker, Ukiah

POSTSCRIPT BY MARK SCARAMELLA Another minor feature of the meeting that Mr. Marmon accurately summarizes above was this exchange between Supervisor John McCowen and Supervisor Dan Hamburg during the discussion of the consent calendar which occurred before the discussion Mr. Marmon refers to:

McCowen: “I would like to pull Item 5(p), which is the Mental Health Services Act Annual Plan. I request that we consider that along with items 4(f) and 4(g), the contract renewals for our Administrative Service Organizations (Ortner Management Group and Redwood Quality Management Company which “administer” mental health services for a fee by farming much of the line work out to local helping non-profits). A big part or the primary part of what we are contracting with them for is to implement the Mental Health Services Act Annual Plan so therefore to me it makes sense to consider those items all together.”

Board Chair Carre Brown: “At the discretion of the chair I will direct that unless any supervisor has a problem. Seeing none, item 4(p) on the consent calendar will be taken up  shortly with the other items.”

Supervisor Dan Hamburg, after noting the Mental Health Board had already voted to approve the Mental Health Services Act Plan 9-1 and “congratulating” the Mental Heatlth Department for “accepting” a $500k grant for residential crisis management programs, added: “Not to drag out this discussion of the consent calendar too long, but I do want to ask the maker of the motion [McCowen] just to explain to me the relationship between the approval of the Mental Health Services Act Plan and the upcoming discussion with the two ASOs. It seems to me they are really — the plan is one thing, the implementation of the plan by the ASOs, which is of course part of their contractual obligation, seems to me to be something else. So I guess in some way I just want to know why you want to hold up approving the plan when we are going to — it just seems different to me than contracting with the ASOs to implement the plan. So maybe you could just elucidate me a little bit.”

McCowen: “If it's not in the plan we cannot require them to perform a particular function. You did reference the acceptance of the grant for a crisis residential treatment program. Those funds as I understand it are simply for capital costs of acquisition of a building. Then we need someone to actually operate the program. Logically, to me, that would be our ASOs.”

Hamburg: “Well, yeah…”

McCowen (raising a hand to cut off Hamburg so he could continue): “It's not clear to me that this is currently in the Mental Health Services Act Plan. But again, not to drag it out, I think we should have that discussion as part of the consideration of their contracts.”

Hamburg: “Okay. It just seemed to me like two different things and I, like, you know, I mean, I would even quibble with the example you just used but I am not going to.” [Laughs smugly.] Whatever.”

HAMBURG is a wholly owned subsidiary of Ortner and the Mental Health Department and apparently sees his role on the Mental Health Board and on the Board of Supervisors as a staunch defender of whatever Pinizzotto and Ortner are doing. He gets testy and petty whenever any questions about Mental Health arise and is one of the prime reasons for the problems described by Mr. Marmon (and me), particularly: “From the beginning of the privatization two years ago HHSA has kept Mental Health Service Delivery a mystery and away from the public, the Mental Health Advisory Board, and the Mendocino County Board of Supervisors.”

A READER WRITES: "Like James Marmon, I too watched the entire Supes meeting on the mental health contracts, but a few corrections are in order. The contracts were on the regular calendar, not consent. It was the Mental Health Services Act that was on consent until McCowen pulled it. And the large volume of material that was distributed was at McCowen's request. The contracts posted online showed none of the changes or the dollar amounts from previous years. McCowen asked for the redline version to show the changes. Which proves Marmon's point that HHSA is heavily invested in keeping mental health privatization under wraps.

ONLY GJERDE AND MCCOWEN showed any real interest in getting answers. When Gjerde asked why Ortner's admin fee was several times more than Redwood’s, Brown promptly adjourned for lunch. When they came back, Hamburg immediately made a motion to rubberstamp the contracts. Woodhouse quickly seconded Hamburg's rubberstamp motion. When McCowen asked for discussion, Brown refused. The motion passed with Gjerde's question still unanswered. I hope the Grand Jury is paying attention on this one.”

WE ALSO HOPE the DA has someone watching these highly suspicious transactions. As for Hamburg, a presumed liberal, one would think he would have opposed privatization of mental health services as one more step towards the rightwing dream of dismantling government responsibilities altogether. But then Ortner's man in Mendo, Tom Pinizzotto, has run personal errands for Hamburg, and Hamburg has always run interference for Ortner, most notably when Pinizzotto, from his present position as an administrator with Mendo's non-privatized half of mental health services, arranged for Hamburg's troubled son to jump the line at the County Jail for treatment at Ortner's $800-a-day facility in Yuba City. The Superior Court, stuffed with long time Hamburg affiliates, subsequently waived pay-back fees for Hamburg, a wealthy man. We live in hope that Supervisors Brown and Woodhouse will wake up to join McCowen and Gjerde in trying to restore honest functioning at Mental Health.

One Response to "Mental Health: How To Inspire Zero Confidence"

  1. Grateful from Fort Bragg   July 19, 2015 at 4:55 pm

    I just really want you all to know how grateful I am and how important it is that these stories and conversations are being published. So thank you.

    I agree there is simply too much confusion (smoke and mirrors) even to those of us who have been following this outsourcing of oversight to Ortner since the beginning.

    Thanks for translating the doublespeak and the flimsy platitudes that are so frequently supplied in the place of actual, concrete evidence.

    I look forward to more discussion about all of this. Thank you again so much. I am not sure if everyone realizes how paramount it is to resolve these issues before it gets any worse.


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