Is Mendo’s Department Of Mental Health About To Disappear?

by Mark Scaramella, September 9, 2010

Whatever drives people nuts, more and more people are being driven there. And when they arrive, what do they get?

In Mendocino County pretty soon it could be nothing.

Our mental health services are in danger of disappearing, which means the cops, who already do much of mental health's work when they arrest and then house at the County Jail the ever increasing number of volatile crazy people.

Mendocino County owes millions of dollars back to the state for expensive mental health services that are technically not reimbursable. At some point, a point arriving soon, Mendocino County will not be able to help the growing number of troubled people who need help by providing unreimbursable services.

To get an idea how bad it is listen to this description of options from a September 1st memo by Health and Human Services Interim Director Stacey Cryer: “Meet with the State Director of Mental Health to determine the absolute minimum mandates of mental health, to inform the state that we do not have the funds to continue providing mental health services and to discuss the consequences of closing the doors on mental health services.”

Ms. Cryer's other options, such as they are, include asking the state for permission to use Prop 63 money, currently restricted to “new” mental health programs, even though that pittance would only make a small dent in the problem, or “laying off 200 to 300 staff within Social Services and Public Health and direct that Agency to cover the costs of mandated Mental Health Services.” (Prop 63 added a 1% surcharge on income taxes for those making over $200k/year.)

That’s right, one option is closing the doors on mental health services and another is laying off hundreds of others to make up the County's Mental Health deficit.

How did we get from crisis to emergency so fast?

Mental Health funding in California is one of the most bizarre systems imaginable. It’s got Medicare and Social Security federal components, plus a good sized state component from state “realignment” funds — funds which partially substitute for property taxes taken by the state — a little from vehicle license fees, government and state grants, a small amount of County reserves, and a small amount from the County’s General Fund to cover mental health services at the County Jail.

Mental Health doesn’t get an upfront budget allocation, but must provide the service and then submit a bill for services rendered. The relevant state and federal agencies then decide what is reimbursable, what isn't. The County can be left on the hook for a whole lot. Which has happened.

A lot of mental health services are provided by very expensive out-of-county psychiatric facilities in the Central Valley and the Bay Area. These private outfits are funded by general contracts, not by individual bills. In other words, Mendo has to pay the out-of-county psychiatric facilities to treat our mentally ill people (including some “severely emotionally disturbed” children) up front, then turn around and apply for reimbursement with the significant risk that the state or feds will disallow it.

As Supervisor Kendall Smith said last week, “The system is broken.” Not that she and her colleagues have done anything to fix it locally.

From a high at the beginning of this decade of around 140 staffers, the Mental Health “branch” as it’s now called is down to about 69 people. Public Health is down to 126 workers and Social Services is down to 348, most of whose services are not paid out of the General Fund.

But Mental Health staffing is difficult to project because you have to provide the service and then bill for it to get funding. If you build up staff and increase costs, you should have a high confidence that the bills will be paid. Unfortunately, for years Mendocino County limped along with ongoing mental health deficits caused by high staffing levels and unmonitored outside contract services. Instead of dealing with these unsustainable hazards to fiscal well-being, the County used money and reserves from other Health and Human Service Agency funds to cover it up.

Before 2008 when the economy went south and the budget crunch started to seriously squeeze all government funding except that required to kill distant Mohammedans, Mental Health’s ongoing deficits were covered by the slush in the rest of the system.

Instead of asking why so many of Mendo’s Mental Health bills belatedly came back stamped “denied” and unreimbursed, Mendo continued to pretend all was not too bad.

This year’s Mental Health deficit is now estimated to be $2.4 million. That’s this year.

In other words, Mental Health overran their current budget by $2.4 million. According to the Mental Health Branch numbers, $860k of that was due to “FY 2004/2005 EPSDT audit findings,” $1.3 million was due to “unreimbursable out of county placements,” and $240k was from “non-MediCal services.” But budgetarily, those are all basically equivalent: no money.

And what percentage of the Mental Health Budget does the $2.4 million represent? Thanks to consolidation and the County’s fancy new “system of care” approach to helping services, it’s blended into the overall Health and Human Services budget so nobody knows how much is just Mental Health. Two years ago when Mental Health still had its own budget it was about $20 million. There are now 10% fewer Mental Health staffers, so the budget now is probably down to around $18 million, still a large number.

But it can't continue operating in the red. There’s no more slush in the system to mask deficits. Not only that, but the $860k the state wants back now for unreimbursable services in 2004/05 will soon balloon by an additional estimated $2 million for 05/06 and 06/07.

And that will be on top of the ongoing structural deficit in Mental Health as revenues go down, fixed costs go up.

Last week the Board of Supervisors finally got around to focusing on the Mental Health deficit — years after the fact, which is why the options are so drastic. And that was when options including “closing the doors” came up. Several Supervisors asked Ms. Cryer what she’d have to do eliminate the deficit.

At first Ms. Cryer said that Mental Health has belatedly “improved” their billing processes to mitigate the large amount of unreimbursable expenses but that it would take a good deal of time for the Mental Health branch to come back into balance given the state's slo-mo audit practices.

Unmollified, the Supes pressured Cryer into saying that closing the doors is now an option.

Mendocino County Mental Health, functionally intertwined with a multitude of related services, is facing at least a $4.4 shortfall likely to become shorter soon.

No decisions were made last week because Cryer got permission to approach the state to ease up on the downhill accelerator a bit.

But California’s broke and the feds are squeezing all forms of social program reimbursements to the state.

Meanwhile the mental health branch is about to be declared economically 5150.

If County Mental Health closes its doors, the only emergency mental health care that will be offered in Mendocino County will be provided by the Corrections Officers at the Mendocino

County Jail.

And then, going back to the August 17 Board of Supervisors meeting, there's Fourth District Supervisor Kendall Smith, a kind of functioning outpatient herself, who again demonstrated that she seems to be suffering mental health issues of her own.

August 17 was the day that the three-person majority of Supervisors — Carre Brown, John Pinches and John McCowen — voted to privatize the County’s five small garbage transfer stations, turning them over on a 15-year contract to Jerry Ward’s Solid Waste of Willits. The busiest transfer station in the county at Caspar is still operating under a Fort Bragg-Mendocino County joint powers arrangement; it is not yet privatized as local libs continue to portray Ward as somehow the equivalent of the Bechtel Corporation as Bechtel attempts to privatize the water of a Third World country.

Ordinarily, when dumb exchanges between public officials occur at public meetings, the rest of us chuckle and move on — there they go again. But at the August 17 meeting, an exchange between District 4 Supervisor Kendall Smith and Board Chair Carre Brown, prompted primarily by Smith's extreme arrogance and thin skin, took supervisorial dumb to a new level. Smith destroyed any chance she may have had to influence the privatization decision which Smith herself thought was important enough to argue about.

By way of background, two Supervisors, Smith and Fifth District Supervisor David Colfax, arguably the lamest lame duck in County history, were on record in strong opposition to the trash privatization contract with Jerry Ward and Solid Waste of Willits. Supervisors John McCowen and John Pinches, who negotiated and brought the finished contracts to the Board for approval, were of course strongly in favor of the proposal.

In theory, then, there might have been some chance to convince the possible swing vote, Ms. Brown, to vote against the deal.

But to have any chance at all to convince Brown, Smith would have needed a succinct presentation ready in advance with arguments designed to change Brown's mind. Instead, Smith again revealed herself as not only a crackpot, but as an unserious crackpot. (Most of our other crackpots, cf. The One True Green, Richard Johnson, are serious crackpots.)

* * *

Smith: Well, Madam Chair, just for the record, I, I kept track of the time that Supervisor McCowen took to take us through this, this “intro,” [sarcastically], uh, to this issue. He had 21 minutes, from 2:22 to 2:43. I just want to make sure that we each, on the board, get equal time to discuss the issue.

Brown: Um, I… How long did Supervisor Colfax take?

Smith: I didn't keep… I didn't keep time.

Brown: Ok. Well.

Smith: 21 would be the highest at this point.

Brown: Well, I don't think individuals should have that. It should be a shared thing. I know that Supervisor Pinches also took time as well. Please go forward, but I think 21 minutes per person is a very long time and we do have public comment. So please go forward.

Smith: Well, Madam Chair, I don't, I mean. 21 minutes each? I don't— I think that that's— that's reasonable. I mean we've got all the time that we need and we certainly aren't going to limit the public's input. I just have a series of questions that I would like to ask of staff and they're rather lengthy and detailed and I have a number of other pieces I'd like to read into the record so I just want to make sure that we each get our fair share of time. I just don't want to be cut off.

Brown: Well, I think you're wasting time. You can have 21 minutes, Ms. Smith.

Smith: Ok. Thank you, Madam Chair. I, I would prefer to hear from the public and then, um, I have questions of staff. [Nods, folds her arms. Purses her lips. Sits back. Stifles a yawn. Nods some more at Brown. Waits.]

Brown: No! Please go ahead right now. Because I'm sure the public wants to hear.

Smith: Well!

Brown: Please go forward and you have—

Smith: Madam Chair, I'm sure…

Brown: You have 21 minutes.

Smith: Madam Chair, I'm not ready to speak yet, I'd like—

Brown: Then you won't get 21 minutes after. Take your time now.

Smith: Well!

Brown: That way the public can hear exactly what you want to say.

Smith: Well, can you explain to me why I won't get 21 minutes when we have all the time we need? [Smith grins as if she'd just scored a zinger.]

Brown: Because we're talking about an introduction. Supervisor McCowen, as Chair of the ad hoc, gave the introduction. You have your opportunity. Supervisor Colfax has had his opportunity. Supervisor Pinches has had his. Please go forward. Then we'll hear the public.

Smith: So this is part of my 21 minutes, correct?

Brown: This is your 21 minutes. Go forward.

Smith: Madam Chair!

Brown: Supervisor!

Smith: Wait a minute! Wait a minute! I think we need to go to the procedure! I certainly would be able to comment publicly after we hear from the boards. So.....

Brown: And we will go to Rule 19 at that point for all five supervisors. So please go forward.

Smith: So you'd like me to have the 21 minutes now and we'll still have the Rule 19 after?

Brown: We will have the Rule 19 after.

Smith: OK. Then maybe the clerk could start keeping track of the time.

Brown: I'm keeping track of your time. We've been on this for four minutes now. So.

Smith: Mr. Sweeney, I have some questions of you, please.

* * *

Smith then expressed her “concerns,” to County Solid Waste Czar Mike Sweeney saying “something has gone terribly terribly wrong. The process was wrong.” And on and on in a series of scattered, disjointed, and mostly incoherent “questions.” Smith attempted to discuss contract details with Sweeney who can be as tedious as Smith but, whatever else you may say about the guy, and we've said it all including accusations that he tried to murder his ex-wife Judi Bari, Sweeney is always on task. And coherent. If you're going to argue with Sweeney you better be ready.

But even Sweeney was irritated with Smith, sarcastically asking the supervisor at the end of one of her disjointed rambles, “Was that a question?”

Another typical Smith “question": “So you're talking about a downward trend with respect to those rates and I believe that's the contract that expires in 2013, I said that… you said that, the County would be, in other words, otherwise in a position the tre— if the trend's going downward to be in a negotiating position if this did not go forward today to possibly save consumers in the South Coast in this case, money.”

Sweeney, like everyone else in the room, had no idea what Smith was talking about. After a long pause, Sweeney said, “I'm sorry. Could you repeat that?” Then even the man who never laughs, laughed.

Fort Bragg and North Coast voters must be as wacky as Smith. They not only elected her, but RE-elected her in 2008 against the very capable challenger Paula Deeter in the face of Smith's incompetent job performance and her $3,000 travel money theft. (She and Colfax ripped off a lot more than the sums the Grand Jury said they'd chiseled, but Colfax was better at covering his tracks. Smith's records were nearly as hazy but the GJ documented at least $3,000 she willfully took in reimbursements that she clearly wasn't entitled to.)

At the end of the meeting, Pinches, McCowen and Brown voted to approve the privatization of the five small County-operated transfer stations; Smith didn't even bother to ask what would happen at Caspar which, at least for now, will still be a joint County-Fort Bragg operation at her doorstep in the Fourth District.

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