Mental Health Board On Privatization: “We Don’t Know What’s Going On”
by Malcolm Macdonald, October 23, 2013
Mendocino County’s Mental Health Board met on Wednesday, October 21st in Willits. They met and they met and they met, nearly six full hours, with only three five-ten minute breaks to stretch your legs, go to the restroom or take your dog outside. That’s right; Supervisor Dan Hamburg had his dog with him for the entire meeting, an extremely well behaved canine that uttered ten seconds worth of noise during the lengthy process.
In the last five minutes of the monthly meeting, Board Chair Jim Shaw announced his resignation, “for personal reasons.” At least one source hinted that it was actually for health reasons.
What went on for the rest of the six hours? It’s tempting to say that it could be summed up by a comment from Board member Vonna Kindred Myers, “I don’t think we know what’s going on at this point.”
That statement was made in the last half hour of the meeting. It came near the end of an elongated discussion on the merits of the Board responding or not responding to a letter authored by National Alliance on Mental Illness (NAMI) member, Sonya Nesch (a 1990s era member of the Mendocino County Mental Health Board). Nesch’s August, 2013, letter to the editor, published in the AVA and elsewhere, was actually directed to the Board of Supervisors, as her opening line asserts, “Here are questions for the supervisors that citizens of Mendocino County deserve answers to: (1) Why did the supervisors allow the mental health privatization adult contract to go to the former employer of the Mental Health Director, instead of to the immensely more qualified and experienced Optum? (2) Where are the promised Fort Bragg and Ukiah Crisis Residential facilities? (3) How can contractors, inexperienced in tiered crisis care provide this for our County with just a portion of the federal and state money coming in annually? (4) Why do we now have eight crisis phone numbers? (5) Why do the supervisors allow administrators to make medical decisions to hospitalize someone in psychiatric crisis? (6) Why do supervisors allow Crisis Workers to overrule medical decisions by physicians? (7) Why do people have to hire lawyers to get their sick, vulnerable and gravely disabled loved one conserved? (8) Why don’t supervisors see that state and federal money for mental health patients is used for crisis care with early intervention and for recovery programs in all our communities? What have you done with all that money (up to $25 million/year)? (9) Why is Ortner’s North Valley Behavioral Health called a “warehouse” by people whose loved ones go there? (10) Why does Fort Bragg Mental Health turn people away and say we don’t do crisis here — call this 800 number? (11) Why did the supervisors not require a medical provider license for the last five Mental Health Directors? (12) Where is the informed moral leadership and courage that we have a right to expect from our elected officials?”
The more or less unanimous consensus of the Mental Health Board, present on October 21st (three of the fourteen members were absent), was that answering any of these questions would set them up to be perpetually answering such questions. A phrase heard from several members of the board concluded that it was a time “to move forward,” not dwell on the negatives of the past.
Nesch’s questions alluded to the first months of Mendocino County’s adult mental health care system being run by a for-profit company, Ortner Management Group. The Mental Health Board seems satisfied to give Ortner a pass for its first three months on the job, though Nesch’s August questions could now have additions such as why did the Ford Street Project in Ukiah recently drop its contract with Ortner or why subcontractors are just now being trained in how to correctly document MediCal billing?
No one on the Mental Health Board asked Ortner’s Vice President of Operations Mark Montgomery to return its first fiscal quarter payment from Mendocino County. This would appear to be a reasonable request, given that the first three months of Ortner’s service has been less than a smooth transition. The county and the Mental Health Board seem content to give Ortner a “do-over.”
In the morning half of the meeting, Montgomery said that Ortner’s next big challenge would be engaging with the “far rural communities.” Montgomery went on to state, “We haven’t done so yet.”
One might wonder, why not?
At the time of the October 16th meeting it seemed that funding for the only mental health peer counseling program for seniors was still in limbo, three months after Ortner took over. Representatives for the Hospitality Center, the coastal access point for adults with mental health problems, left just before noon without a word spoken. Another question would be: Why hasn’t Ortner fully implemented a crisis access center in the county’s second most populous city, Fort Bragg?
Almost at the stroke of noon, October 16, 2013, Montgomery said, “As we begin to launch adult services.” Ortner Management Group (OMG!) has been receiving Mendocino County money for services supposedly rendered to adults who need mental health care since July 15, 2013.
Obviously, some work has been done by Ortner, but the transition period is woefully behind in many areas. Some hospitals and law enforcement agencies have balked at working with Ortner or have not been successfully communicated with them yet.
Montgomery used the phrases “move forward” or “moving forward” so many times in his presentation that I lost track of the tally I was keeping. By repetition or perhaps osmosis, those phrases became the buzzwords of the afternoon session when the Board was left to its own devices. For the last two hours I remained the only outside witness as the Board along with Hamburg, the Board of Supes representative to the Mental Health Board, and Mental Health Director Tom Pinizzotto discussed Ms. Nesch’s letter then turned their attention to how to actually move forward. Board member Dina Ortiz brought up Ortner’s lack of adult mental health services statistics for Latinos. The Board, as a whole, agreed that the problem should be corrected; however, much of the last hour was spent on the matter of how to best re-introduce Laura’s Law to the Board of Supervisors. A special public meeting of the Mental Health Board is tentatively set for 10am, October 31st at 221 S. Lenore St., Willits, with new presentations and discussion about Laura’s Law as the central topic. Laura's Law allows courts, after extensive due process, to order a small subset of people with serious mental illness, who meet very narrowly defined criteria, to accept treatment as a condition of living in the community. Counties have the option to implement Laura's Law and most have not.
Mendocino County’s Board of Supervisors turned down Laura’s Law over 15 months ago. The supposed trade off was the establishment of a so-called 11 O’clock court program which would serve mentally ill persons accused of minor crimes. The Mental Health Board, on October 16th, discussed the pros and cons of the 11 O’clock court in Ukiah, with Board member Jim Bassler praising the outcomes and Board Chair Shaw questioning what criteria is used in deciding which cases qualify.
Mental Health Board Chair Shaw also presented emails he’d sent to County District Attorney David Eyster and Eyster’s somewhat disingenuous reply concerning the inability to establish an 11 O’clock court calendar in Fort Bragg’s Ten Mile Court. Eyster’s response amounted to this: “When this was in the planning stage I made a commitment — pending sufficient staffing — to ultimately participate in the coast version of Ukiah’s once-a-week 11 O’clock calendar. I have not wavered from that commitment but an unplanned staffing deficit (resulting in one overworked attorney in a two attorney office single-handedly handling at least a two attorney caseload) have made an earlier in time implementation not possible. The coast staffing will be bolstered starting on or about October 15th when a second attorney joins my Fort Bragg staff. Given the need for that attorney to acclimate and learn how I require our business to be conducted, I stand by my prior prediction (shared with Supervisor Hamburg) that my side of the equation will be ready to join in the coast version in January 2014, assuming everybody else is ready to go. That having been said, please keep in mind that the DA’s representative is only one spoke in the wheel and any timing of the coastal implementation will require green lights from the courts and the Public Defender’s Office.”
Chuckles pretty much all around the Mental Health Board at the idea that it would take the new coastal assistant district attorney nearly three months to “acclimate” to the job. Eyster’s response was viewed as the obfuscation it is.
The Mendocino County Mental Health Board is largely made up of retirees. One board member was already married when this writer was born, and I’m no spring chicken. Board members volunteer their time. They appear to be well intentioned, if sometimes a step or two out of touch with what is really happening on the streets. Most have, or had, a pet project, and may not be overly interested beyond that. John Wetzler is still relatively young and only a year and a half into his Mental Health Board tenure; he asks the most questions, goes on multiple fact finding trips, and, along with Jim Bassler, is spearheading the new push for Laura’s Law implementation.
Perhaps this board can help to affect real changes that move this county’s mental health system forward, but they will need to roll up their sleeves and prove it.
Perhaps Ortner Management Group can do the same, but wait a minute… In July, 2012, Supervisor Hamburg said that when he sought help for his son it was difficult to find an access point into the mental health care system, the only way to get him help was for him to be arrested. We are now three months into Ortner’s contract for adult mental health services, and for much of Mendocino County, law enforcement remains the access center.