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Oxymoron Of The Week: ‘Incomplete Continuum’

Last Wednesday, Mental Health Consultant Lee Kemper summarized his recently completed $40k indictment of the County’s badly broken mental health “continuum” for the Measure B Advisory Committee meeting in Ukiah: “There are two continuums of care for mental health and for substance abuse disorders. Both of them are incomplete.” 

Which is putting it gently.

This of course flies directly in the face of claims of HHSA management and mental health contractor/manager Camille Schrader. To hear her and her cozy circle of lieutenants, both county management employees and her own, the small army of the deranged wandering around the County talking to themselves are all being "served" by a continuum of care.

So when the subject comes up at the Board of Supervisors meeting on September 11, look for the Schrader Gang to be in full damage control mode. (E.g., Ann Molgaard: “We have great respect for Mr. Kemper and we really really respect his opinion and appreciate his report, we really really do, but he didn’t talk to US personally so he doesn’t understand how wonderful we are and how many wonderful services we offer.”) And not one person in official Mendo — including the members of the Measure B Committee on Wednesday — will go on record agreeing with Kemper’s professional assessment of the “incomplete continuum.”

Kemper: “With regard to substance abuse disorders, it's a very small set of services and it doesn't really represent a continuum of care. … And with respect to the mental health continuum, we also see that it is incomplete because it is missing some key ingredients for the residents of the County of Mendocino. Specifically, the lack of a crisis residential treatment facility, the lack of any kind of treatment programs, the lack of partial hospital programs, and in particular the lack of a more robust set of wellness and support services that reach the various communities across the county.”

But millions of annual public dollars are being spent on these "services."

Kemper went on to say that the County’s “continuum” is focused mostly on crisis response and does very little to keep people from reaching crisis stage. Using data he obtained from Ms. Schrader’s Redwood Quality Management Company, Kemper said that rates of crisis assessments have gone up dramatically in recent years.

“What we see is there is a growing level of crisis mental health assessments and it is placing an increasing burden on the local delivery systems that are providing services. Specifically, the hospital emergency rooms where this occurs and the crisis access center that RQMC operates.”

“We believe that the [Measure B] revenues need to be dedicated to the full spectrum of services to build out a more comprehensive continuum of mental health care in the county. I believe that a goal you should focus on is reducing the need for and the utilization of inpatient psychiatric care whether that's in the county or out of county.”

“With regard to the substance abuse treatment services, we recommend that 10% of the [Measure B] funds be allocated to services related to substance abuse disorders in the county. We do this with the understanding that there are so many steps to be taken there and we think you should be if you get going right away on substance abuse service expansion and we think that's an appropriate use of the funds and it would represent an important investment.”

Mr. Kemper agreed that a Psychiatric Health Facility (PHF) was necessary, but only in conjunction with expanded upstream services to keep a lid on the number of people who would need it.

Another point of contention was Kemper’s estimate of the cost of a new 16-bed PHF — based on his discussions with managers of similar facilities in other NorCal counties, Kemper said a new PHF facility would cost substantially less than the estimate provided by the consultants employed by Margie Handley and the Howard Hospital Foundation to remodel the old Howard Hospital. In other words, instead of just handing over Millions to Margie, maybe more money should be spent on helping people and less on low-security incarceration at the old Howard Hospital.

“The county should take this opportunity to make the behavioral health treatment more complete for mental health and substance abuse,” said Kemper. “Focus on remediation at the earliest possible time and reduce the need for inpatient psychiatric facility use. But at the same time we acknowledge that you need some kind of inpatient psychiatric facility.”

“These are basically good government kinds of concepts,” said Kemper, perhaps not realizing he was talking to a County that has never done even the most minimal level of service oversight and reporting for any of its departments.

Kemper also said that the Measure B funds should be used to “supplement not supplant” existing services. “Sometimes there are some clever maneuvers that can occur with those new dollars,” said Kemper as Behavioral Health Board Chair Jan McGourty could be seen conspicuously scoffing and smiling.

Repeating his earlier calls for oversight and reporting (back when Kemper did a review of the woeful Ortner mental health service delivery), Kemper tried again, “We recommend a bi-annual (every six months) review process on the new revenues and their expenditures and how they are improving the continuum of care. We recommend a prudent reserve. We recommend ways to account for the money and report on it so that so that the taxpayers understand where their resources are going to improve the system. We also recommend that the data be provided to you in a more discreet way regarding the utilization of services across the county so that you have a better sense of how people are being served in various parts of the county.”

Lee Kemper, Jenine Miller

This of course will simply never happen. Kemper is wasting his breath. The Mendo mindset is: “Here’s the money — please spend it. Come back next year for more money. Next subject.”

To improve the upstream services and reduce crisis calls Kemper recommends a distributed or mobile system that would go to the patient, not require the patient, many of whom are barely functioning, to travel for hours to a central location.

For years we have proposed a version of the “Crisis Van” program which would respond to mental health calls (along with law enforcement if called for) and then take charge of a person with a mental health problem and decide where that person should go, be it back to family, some kind of Measure B funded supportive housing, residential crisis treatment or the PHF. This idea, which works well if in limited form in Sonoma County and Contra Costa County, has never been seriously considered in Mendo.

The other concept that would help (as we have also noted several times before to no avail) would be for the County to finish the long-delayed Memorandums of Understanding with the outlying service organizations such as law enforcement, clinics, hospitals, ambulances, etc. and use the MOUs to fund those organizations with some of the Measure B money to help them provide assistance to patients and their families close to where they live.

None of this came up during the Measure B Committee discussion of course. All they did was nitpick some of Kemper’s numbers and approve a formal motion to pass Kemper’s report on to the Board of Supervisors — which, as Sheriff Tom Allman and CEO Carmel Angelo pointed out, they already have. 


  1. Eric Sunswheat September 5, 2018

    New York, NY – Vireo Health of New York (“Vireo”) and Local 338 RWDSU/UFCW announced the State’s first medical marijuana union discount program for more than 2.5 million union members and retirees throughout New York State.

    Beginning Labor Day, Monday, September 3rd, union members and retirees living and working in New York will be eligible for $25 off their first purchase of medical marijuana products and a 10 percent discount on all future purchases at Vireo’s four dispensaries or through the Company’s free home delivery service.

  2. John Sakowicz September 5, 2018

    To the Editor:

    In the absence of real care, perhaps HHSA management and mental health contractor/manager Camille Schrader would like to know what really happens to our county’s “dually diagnosed” patients — those who are both seriously mentally ill people and who are also addicts or alcoholics.

    They get incarcerated in the county jail.

    They get jailed in solitary confinement in the Administrative-Segregation (Ad-Seg) Unit for 23 1/2 hours a day.

    Then they get loaded up on Seroquel or Zyprexa, so they can sleep in a deep coma for most of those 23 1/2 hours.

    “Seroquel and Zyprexa are the drugs of choice among the mentally ill and substance abusers behind bars”, said researchers at the annual meeting of the American Academy of Psychiatry and the Law in 2011.

    “An atypical antipsychotic with potent sedative and anxiolytic properties, Seroquel, is, along with Zyprexa, one of only two agents in its class to have a ‘street value'”, said Dr. Amanda Pearce Roper and Dr. Leonard Mulbry Jr., from the Medical University of South Carolina, Charleston.

    “In any given institution where Seroquel is available, there will be hundreds of guys trying to get it,” Dr. Mulbry said in an interview.

    And jailers are happy to have it prescribed. Why? Because Seroquel and Zyprexa make troublesome inmates “compliant” — they sleep in a deep coma for most of those 23 1/2 hours they’re locked down alone and miserable in their tiny cells.

    Inmates loaded up on Seroquel or Zyprexa don’t have to get a higher level of care (too expensive), don’t need constant suicide watch (too labor-intensive), and don’t get written up on disciplinary charges for assaults on other inmates or staff (too dangerous).

    Seroquel and Zyprexa are the perfect solution.

    I’m sure HHSA’s Chief Operations Office, Ann Molgaard, and the Schrader Gang agree. It’s a good business decision for them.

    Here’s how their thinking goes: 1.) Incarcerate your clients. 2.) Reclassify them as inmates. 3.) Make them Sheriff Allman’s problem. 4.) Load them up on powerful anti-psychotics and make them compliant. 5.) Pocket most of the many millions of dollars the county has budgeted for caring for our seriously mentally ill.

    How do I know?

    I worked for four years as a corrections deputy in the County Jail’s Ad-Seg Unit.

    And I was a grand juror for three terms.

    If elected as the 1st District County Supervisor next year, I’ll work with my friend, presumptive 3rd District Supervisor, Johnny Pinches, to fire the bums, and rebuild from scratch our county’s broken mental health system.

    The first to get fired should be County CEO Carmel Angelo.

    As the county’s head honcho — the Board of Supervisors work for her, not the other way around — the county’s mental health crisis should be laid right at Angelo’s feet.

    But Angelo never takes the blame.

    Angelo threw her former HHSA Director, Stacey Cryer, and former former Mendocino County Mental Health Director Tom Pinizzotto under — both of them — under the bus to protect her own job.

    She disappeared Cryer and Pinizzotto. Has anyone heard anything about either of them?


    It’s why them call Angelo the “Tony Soprano of Mendocino County”. She not just the boss. She is The Boss.

    John Sakowicz

    • james marmon September 6, 2018

      She disappeared Bryan Lowery too, he was Pinizzotto’s privatization counterpart and was responsible for handing over the children’s system of care contract to his friend and colleague, Camille Schraeder. Old friends, both worked together at Trinity Group Home in the 90’s. He also was one of Camille’s Foster Care providers for many years in the 2000’s. The Grand Jury when they went after Mr. P. regarding a “conflict of interest”, should have gone after Lowery as well. He was one of the scorers on the mental health RFP and also broke all kinds of laws as a child welfare worker in order to keep the Schraeder’s foster care business thriving.

      James Marmon MSW

      Where’s the money Camille?

    • james marmon September 6, 2018

      Does the movie “Groundhog Day” come to mind to anybody?
      Deja Vu

      Mental Health Merry-Go-Round

      by Mark Scaramella, October 28, 2015

      Last Tuesday the Board of Supervisors heard a short presentation from consultant Lee Kemper about the mental health system audit CEO Carmel Angeo has hired him to do.

      Angelo: “There has been interest and obvious concern regarding our ongoing mental health services, particularly the changes that have been made over the last couple of years. With that interest the executive office has moved to hire Kemper Consulting to do a review of the mental health system. We have made such a substantial change in our service delivery and we are two years into that change so it is a really is a good time to ask for expertise to come in and do a review and give us some recommendations on our system as a whole…”

  3. John Sakowicz September 6, 2018

    Mr. Marmon. Oh yeah. I forgot Bryan Lowery.

    I’ll have to edit my letter.

    BTW, Mr. Maron — you’re the mental health veteran — why are the guys in our county’s mental health scenario so small? Bryan Lowery and Tom Pinizzotto were midgets.I don’t think either Lowery or Pinizzotto was taller than 5″2″.

    And why are the women so big? Carmel Angelo, Camille Schrader, and Ann Molgaard are beasts. The three of them together must tip the scales at six hundred pounds.

    Just asking.

    I have nightmares about this stuff. (Really.)

    — John

    • james marmon September 6, 2018

      You’re on to something there Mr. Sakowicz. Because of my size, staff and administration claimed they were afraid of me, I posed a threat to them. If you remember A.J. Barrett hardly reached 4’11”. When I demanded that he and Lowery stop their criminal acts “or else”, they just about shit their pants. They testified that I pointed at Lowery. You can bet that if I had to physically defend myself against the big 3, Angelo, Schraeder, and Molgaard, I could hold my own, but I’m not a violent man.

      James Marmon MSW

  4. John Sakowicz September 6, 2018

    James Marmon,

    I’m a big guy – 6’4″, 260 lbs – and I worked at the MCSO, and I played varsity sports at Johns Hopkins University, but I’m not so sure I could physically defend myself against the “Big 3” — Angelo, Schraeder, and Molgaard.

    Right there, you have three quarters of any defensive line in the NFL.

    Big. Strong. Aggressive. Mean.

    Big players who love to make big plays.

    I’ve seen their scouting reports.


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