Mendo’s New Mental Health System

by Malcolm Macdonald, September 11, 2013

In August, the California State Auditor’s office issued a performance review on the Mental Health Services Act. Its summary stated: “Providing effective services and treatment for those who suffer from mental illness or who are at risk of mental illness is an issue of great statewide and national importance. Recent statistics by the US Department of Health indicate that approximately 11 million US adults, or 4.8% of the population, had serious mental illnesses in 2009. Critical incidents, such as the school shooting in Sandy Hook, point to the seriousness of these issues. Over time California has attempted to serve its mentally ill population through a variety of services and programs, and in 2004 the voters approved Proposition 63, the Mental Health Services Act (MHSA), to expand on these services and to use innovative methods more likely to identify, mitigate, and treat mental illness. The MHSA stresses that mental illnesses are extremely common, affecting almost every family in California, and that failure to provide timely treatment can destroy individuals and families.”

The first 32 years of my life were affected by mental illness; the mental illness of my late sister, Muriel. In another sense I got a bird’s-eye view of mental health care in California and this county in particular because my mother was a psychiatric social worker, employed first at Mendocino State Hospital in Talmage, then out of downtown Ukiah offices that serviced Mendocino County, and by the time of her retirement a small handful of psychiatrists and psychiatric social workers were responsible for all the mental health cases in both Mendocino and Lake Counties. In the 1960s dozens of psychiatric doctors and social workers were employed at Mendocino State Hospital. Proposition 63 would have been unnecessary if the state government had not gutted mental health services under Governor Reagan.

As of this summer, Mendocino County’s system of mental health care for adults has been placed in the hands of a private company, Ortner Management Group (OMG). The entire state of North Carolina privatized its mental health care system in 2001. A recent comprehensive study of that effort found: “The quality of care that North Carolinians with mental illness have received has declined while allegations of fraud and waste have increased.”

The proof will be in the pudding. Here is one local case study, in progress: William is in his early 30s. He suffers from schizoaffective disorder (a condition that causes a loss of contact with reality [psychosis] and mood problems). William’s mother, Carole, states that William has threatened suicide many times, including specific locales and methods. William has leapt onto roadways in front of oncoming traffic. He has been picked up by law enforcement at least half a dozen times. Carole is at her wit’s end with William. He can no longer return to her home.

During the first week of August, Carole went to the county mental health office in Fort Bragg to try to get crisis care for William. She was told that they didn’t perform that service anymore. She was given an 800 number to call.

Carole called the 800 number and spoke to a woman named Sarah who asked, “Is he currently a threat to self?”

Carole responded, “He always is.”

Sarah said that William needed to call her. Carole got him to do so. Sarah took William’s number and told him that she would have someone call him back. The day went on with no call back.

Carole went to the Fort Bragg Police Department, asking Chief Mayberry to take her son to the Emergency Room the next time he got picked up. She told the chief that William was suicidal and needed professional help.

The next day Carole called the 800 number again. Sarah told her that a referral would be sent to a crisis worker. Apparently the crisis worker was in a meeting most of the day because neither Carole nor her son received a call back.

Another day later, Carole called the crisis line number and spoke to a different woman, Stephanie, who asked if William was in crisis. Once again Carole replied, “He always is.”

Carole also wanted to know why the crisis worker had not returned her call. Stephanie responded that the crisis worker had a lot of referrals on her desk and that the crisis worker returned calls in the order they came in.

A week after making her initial call Carole was told by a Mendocino County employee that they had lost all record of her calls (those described above) to the Mental Health Crisis Line. Fortunately, Carole had documented the calls.

Carole does not take such obfuscations lying down. She sent out an August 12st email, decrying the lost records, to her supervisor and Tom Pinizzotto, director of Mendocino County Mental Health. Carole also sent copies of the email to Jim Shaw, the chair of the Mendocino County Mental Health Board, as well as most of the members of that board, Mendocino County Sheriff Tom Allman, Fort Bragg Police Chief Scott Mayberry, and the National Alliance on Mental Illness (NAMI).

By this time Ortner Management Group was fully in the saddle as the purveyors of mental health service in Mendocino County. At the August 21st County Mental Health Board meeting, chaired by Jim Shaw, an Ortner representative said there was no multiplicity of phone numbers to call, that the Mendocino Coast Crisis Line number was still 707-964-4747.

As of September 4, if someone in crisis can navigate the County of Mendocino web pages through the Health and Human Services home page to the Behavioral Health & Recovery Services page, bold print tells you that the Crisis Line is 800-555-5906. Scrolling down the page brings you to more specific crisis lines for Ukiah, Willits and Fort Bragg (which is 964-4747). Nowhere on the page does the name Ortner Management Group or OMG appear.

It seems that there is something of a rift within the Mendocino County Health Board. Near the end of the August 21st meeting, Chair Jim Shaw made a statement to the effect that the Mental Health Board serves the Board of Supervisors. Board member Dina Ortiz, a licensed clinical social worker (LCSW), demurred, “I thought we work for the people.”

Board member John Wetzler then read the Board’s “mission statement” aloud, “To be committed to consumers, their families and the delivery of quality care with the goals of recovery, human dignity, and the opportunity for individuals to meet their full potential.”

Wetzler added, “Doesn’t say anything about the Board of Supes.”

Chairman Shaw squirmed a bit as did Tom Pinizzotto, who is essentially in charge of mental health services for the county. Pinizzotto squirmed some more a few minutes later when the public comment section of the meeting brought to the surface the letter written by NAMI member Sonya Nesch; a letter directed to the Board of Supervisors, but with tough questions concerning the Supes awarding the adult mental health services privatization contract to Mr. Pinizzotto’s former employer, Ortner Management Group, instead of Optum Health, which Nesch describes as more qualified and more experienced in mental health care services. Nesch’s letter also asked why the Board of Supervisors has not required a medical provider license for the last five county mental health directors. Nesch raised more than a dozen questions, one of them directly pertinent to the earliest stages of William and his mother Carole’s dilemma. The question: “Why does Fort Bragg Mental Health turn people away and say we don’t do crisis here — call this 800 number?”

William was arrested again in August. The Fort Bragg Police did honor Carole’s request, taking William to the Emergency Room at Mendocino Coast District Hospital. Within a couple of hours, William was assessed in the the Emergency Room by Lisa Burtis, a licensed marriage and family therapist (MFT). By that night William was being driven to Ortner owned North Valley Behavioral Health in Yuba City, the same place Supervisor Dan Hamburg’s adult son was transferred to, presumably with far less advocacy required on the part of the family.

After a few days, North Valley wanted to ship William to the Ford Street Project in Ukiah. Carole objected, primarily on the grounds that Ford Street provides help for the homeless and would not be able to give William the professional psychiatric care he needs. The best case scenario for William right now would be for him to be legally “conserved” within a locked facility with truly professional psychiatric care on a daily basis that might help him get on the road to recovery.

Instead of the Ford Street Project, William was sent to the Redwood Creek care facility in Willits. Redwood Creek was recently purchased by Ortner Management Group. At present it still maintains several elderly residents under its previous incarnation as a board and care unit.

So what you have now is mental health patients like William being warehoused at Redwood Creek along with the elderly residents who cannot be removed because they are literally grandfathered in by law.

There really is very little professional psychiatric care for William at Redwood Creek in Willits either. And what’s to keep him from walking away? Nothing. He did just that late last week, arriving at Carole’s house Thursday night. Friday morning she drove him back to Willits, but the situation isn’t much better than it was when Carole first started documenting those “lost” phone calls to Mendocino County’s mental health system.

(Author’s note: William and Carole’s real names have been changed to protect their privacy and anonymity.)

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