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Crazy Talk About Mental Health

On November 14 the Board of Supervisors received a mental health a report on the mental-health services transition from Yuba-City-based Ortner Management Group to Ukiah-based Redwood Quality Management.

As usual whenever the subject is mental health services, several important issues were danced around without getting to the heart of the matter. One has to assume that nobody really wants to know what’s going on. Instead all we get is lots of psycho babble terminology mixed with cozy semi-coded insider talk which dances around the problems in a way that makes sure nothing is actually dealt with.

Supervisor Dan Hamburg: “Just looking at the second page of the data dashboard I just noticed that we seem to be using the Santa Rosa facility a lot more. Is that true? OMG less? Is that just something that's trending? Because of Santa Rosa? Or we like the service better? Or what?

Camille Schrader, President of Redwood Quality Management: “We don't have a contract with the North Valley Hospital. We are unable to have a contract with North Valley Hospital.”

Hamburg: “Why is that?”

Schraeder: “Because the North Valley Hospital does not want to have a contract with us.”

Hamburg: “Okay.”

Schraeder: So we have [illegible]. Which is in Redding.”

Hamburg: “But it looks like we are using that and Aurora quite a bit.”

Schraeder: Right. Aurora is a Medi-Cal certified site which in the age range they are in Santa Rosa, less than an hour away, we can get family members there, we can get our team. We have a very close working relationship with Aurora. For a wide variety. If they do not have Medi-Cal, — there are age ranges that don't qualify and therefore can't get to Aurora. We try to find the biggest, the closest available hospital. But those are our two primary resources.”

* * *

The reference to "North Valley" is the name of the Ortner facility in Yuba-City. Ortner is apparently refusing Mendocino County’s business now. And the board does not seem interested in why. Presumably, it's because Mr. Ortner is still smarting from the county having terminated their contract with Ortner and petulantly will not even contract for conventional hospitalization services even at their premium $800 per day rate.

HAVING GOT NOWHERE with that one, it was on to the County’s continuing failure to find housing for mental patients.

Hamburg: “I was wondering if perhaps Director Chandler could talk a little bit about the RCHDC [Rurual Communities Housing Development Commission] opportunity. Is there any update on that?

County Health and Human Services Director Tammi Moss-Chandler: “There's actually going to be an update at this next coming Behavioral Health Advisory Board meeting on Wednesday. We are looking forward to coming back to your board in the next two months concerning several aspects of housing including the RCHDC project. There's certainly been a lot of discussion and strategy around this. We are trying to look at that. Long-term, the opportunity to expand the housing stock in Mendocino County along with some of the short-term housing needs that we are experiencing in the mental health transition and come back to you with a comprehensive report in the next couple of months of those housing needs. If that answers your question.”

It didn’t, of course, but that’s the norm, so Hamburg applied a layer of blather.

Hamburg: “Yes. I just don't want that opportunity to get by us. RCHDC seems very committed to it. We have talked about this outside this meeting. There do seem to be some opportunities out there to secure property and these grants come and go but this is a big one as you well know.”

Moss-Chandler: “I think there is a nice opportunity for us to come back to your board in two months in order to leverage the next round of tax incentives at the state level later in the spring so that coming back two years to your board with those next steps in the next couple of months for the next opportunity.”

* * *

The “opportunities” had suddenly and conveniently morphed from housing and housing sites to more meetings.

The reference to RCHDC is another missed opportunity that no one would come out and speak to directly. A few months ago the board heard a presentation from the RCHDC director about their attempts to find a location for a modest mental health residential facility using a $1 million housing grant. But the presentation that they gave to the city councils made it sound like it they were asking for housing for bums, transients and street people, not mental patients, and the board complained about the presentation and told the housing group to revise their presentation and run it by the Board first. But obviously nothing came of it and no “opportunities” were uncovered. Mendo has no comprehensive system of finding and developing housing of any kind and has not had one for decades as their Housing Element fiasco proved years ago. (Mendo designated a few acres for “affordable housing” which wasn’t even zoned for housing, then when they were sued over it, they realized that they couldn’t rezone those commercial properties because they didn’t have adequate sewer and water. They eventually forced a re-zone on a Ukiah vineyard owner on the outskirts of the sewer district, but that owner has no intention of any housing development. And that was for ordinary housing, not mental patient housing…) These grants come and go and lots of helpers pretend like they're working real hard on finding something but nothing is ever found, nothing is ever built, no progress is ever made and now Ms. Chandler is reduced to congratulating herself on finding opportunities for more meetings, since there are no housing opportunities anywhere in Mendo’s feeble capacity.

SUPERVISOR GJERDE tried to bring up an important point: “When was the last time that mental health funding was audited by the state and how would a member of the public get a copy of that audit?”

Moss-Chandler evaded this question too: “We have a couple of different audits. Our mental health funding I think Ms. Miller [mental health director] knows. We may have to follow up and bring it back. We have certain pots of money that are audited through Medi-Cal. We also have our Mental Health Services Act which is a different auditing process. We also just recently had our EQRO of our clinical services which touches on mostly our clinical services. So we are actually working closely with the Behavioral Health Advisory Board with a comprehensive review of the mental health services and I hope to provide that during your joint meeting with the Mental Health Advisory Board in December that it's currently anticipated for December 20 that we would have a comprehensive report. As to the audit reports, we could actually make those available at any time, I don't know if you have seen that.”

Gjerde: “Yes I have. I just request that it go online so when the public asks they don't just ask us, they can go online and see that.”

Moss-Chandler: “Yes definitely. To be clear from the Behavioral Health Advisory Board certainly the EQRO audits are very transparently provided.”

Gjerde: “Where are they provided?

Miller: “They are under behavioral health. If you go under behavioral health website and you go to mental health under quality assurance improvement page, if you go to that page all of our audits are listed under the tri-annual Department of Mental Health Services tri-annual report and all our reports are listed there.”

Gjerde: “So obviously they are looking back, so are the reports still looking back at when Ortner was here?”

Moss-Chandler: “That is correct. Right now for our Department of Health Care Services clinical audits, they are in real time. Fiscal audits are actually on a five-year look back over that range.”

* * *

Supervisor Gjerde’s initial question about the mental health financial audit was never directly answered. The "clinical audits" (EQROs) are nothing more than the usual rubber stamps. What Gjerde was obviously getting at was how much the County is liable for during the three years of Ortner’s inadequate mental health services which the County may not be reimbursed for. But for reasons that remain unclear, Gjerde didn't press the point. No one said where those five year audits are or when they will be posted or whether Ortner’s bills qualify for reimbursement. In fact, these audits will never be online nor will they be explained or reported on. No one knows how much liability the County has regarding Ortner’s three years of unsupervised, failed service, and nobody will worry about it again until a multimillion dollar bill appears at the supervisors’ doorstep in a year or two. And everyone will pretend to be shocked.

IF THE SUPERVISORS and staff can't speak clearly about the mental health situation, they certainly can’t expect it to improve.

After lots of self-congratulatory baffle-gab about cooperation and understanding and challenges and coming together and how amazing and great everyone is and so forth — and we assume Redwood Quality Management is doing a somewhat better job than Ortner even though Ortner set the bar so low that practically anything would be better than Ortner — they can't get direct answers to direct questions. And the Supervisors won’t push for direct answers because their hard-earned reputations as Nice People would be jeopardized.

Pathetic. Truly pathetic.


  1. james marmon November 30, 2016

    Your last paragraph is exactly what I thought after I watched the video. I actually thought that the BOS members went out of their way to add some substance to a very uninformative presentation. As a former Mental Health Specialist for 3 Northern California counties, Placer, Lake, and Sacramento, I can tell you right now that the loss of North Valley is big. There are only so many beds available in California. I can only imagine the nightmares that local crisis workers and Hospital Emergency Rooms are experiencing right now, but mum’s the word. Schraeder made a couple of snide remarks about the Sheriff claiming his department was the current default mental health program, so, knowing her like I do, things are not wonderful in fantasy land and “Politically Correctness” continues to rule over rational thought and appropriate action.

    As for Audit results, I can’t wait. I’m looking at filing a freedom of information request for all audit exemptions for the past 10 years. RCS has been doing Children’s Mental Health Services and billing the State for 10 years, I want to know the truth. Even the numbers we got on prior audits a few years ago did not break down where the exceptions came from, Adult or Children’s. It is my thesis that RCS/RQMC are not without culpability.

    I hate to say I told you so about Ortner going away mad, but I told you so.

    • james marmon November 30, 2016

      I don’t know how much Ortner could possibly owe the County as far as any future audit exceptions, I don’t think it will be much. According to Kemper’s report they had only approximately 3 million dollars of approved MediCal payments for the 2014-2015 fiscal year while during the same period, RQMC had nearly 7 million dollars of approved MediCal payments.

      Before we beat on Ortner anymore than we already have I suggest we consider what a comprehensive audit might break down to. The question as to RQMC’s possible billing practices has been ignored by everyone but me, me, me. Its the same don’t ask don’t tell “Angelo bullshit” that drove poor Woodhouse nuts. This Mental Health fiasco is far from over, it has only just begun.

      In the 13-14 fiscal year Ortner had a little over a million in billables while RQMC had over 3 million

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