Privatizing Mendo’s Mental Health

Mental health services in Mendocino County are at best very limited and underfunded, and several high-profile examples of inadequate responses have come to light in recent months and years. The question — or more accurately the done deal — before the Board of Supervisors last May 21 was whether privatizing or contracting out Mental Health Services is an improvement.

Several things make us skeptical of the contracts the Board approved, not the least of them the fact that County School Superintendent Paul Tichinin and a member of his Special Ed staff thought the privatization was a great idea.

Tichinin, apparently thinking that that naming a few obscure Ukiah organizations somehow made the contracting idea worth pursuing, said, “This proposal that has come together is the result of many ongoing discussion within this county by groups such as Impromptu Mustard Seed, like Mendocino Futures, like school districts and superintendents. The Youth Project was actually started with an original grant to the County Office of Education over 30 years ago. So to me the efforts that have gone forward in making this a partnership, in making this something where people are working together, building relationships, working with law enforcement, working with medical professions in the community and with the staff and all of my review of this proposal leaves the mental health department or the County of Mendocino in charge of the upper level management, goal setting and direction for the service and instead you are utilizing the strength of local partnerships to bring forward a type of services that we all deserve to have.”

Everyone else who stands to benefit from the privatization, including the two therapeutic outfits that the County is contracting with, are also enthusiastically on board, of course, and on May 21 they all came forward to publicly congratulate each other on their wonderful accomplishment.

County Mental Health Manager Tom Pinizzotto, a former Mental Health contractor himself and one of the key officials who was hired a few years ago specifically to set up the private contracts, told the Board, “We strongly feel that with this collaboration and with the entities coming together that our services will be more comprehensive, more flexible, more bidirectional referral; we'll see more collaboration care management, we will have levels of care management from assertive to other types, our services will be more coordinated and more community-based.”

Thomas Ortner whose company, Ortner Management Group, will get the contract for mental health services for adults 21 and over, told the Board, “This contract includes a multi-tiered crisis response service. Multilayered bidirectional and assertive care management system, a ‘no wrong door’ access system, comprehensive and collaborative system of care, robust quality management system, expanded housing and housing support program. We will work in partnership with the county and act as an extension to the county to serve the needs of the mentally ill adults in Mendocino County.”

Josephine Silva, a Willits woman who has attended most of the recent Mental Health Board meetings but who is not on that board nor is she among the beneficiaries of the contracting, was one of the few speakers not to join the cheering. “The proposals indicate that there is about $8.8 million available for the population under 21 years old which is about 25% of the population of Mendocino County,” said Ms. Silva. “The second proposal for adults 21 years and older is worth $6.7 million which is about 75% of the County’s population. It seems to me we should have at least three times that amount for the adult services. I don't know the details of how this works but you have frequently first-time mental-health episodes happening in the early 20s which means you will need money and a lot of services in the adult contract. But that's not there apparently. I don't know how that interfaces with the children's services contract. I have complete faith in Carmel Angelo. I am sure she will work something out to work with this. But I think the Board needs to address that. Also, with the new healthcare laws, I would expect that primary care services will involve more Medi-Cal people who need mental health services. Also, the grand jury report says that we need to hire more qualified people for mental health services. I have observed many different facilities of the Ortner group in the Northern California area, including their facility in Willits. In Willits, I noticed that there were inadequately trained staff who were not paying attention to people, that there was poor case management, not much interface with families and in addition, there was a very poor interface with Manzanita Services. In Yuba City [where Ortner also has offices] I saw the same situation. I would like to see in this contract a client-to-case-manager ratio written in so that we are guaranteed a certain number of people who will be working with these clients that you are responsible for.”

Dave Eberle, President of the County’s moribund employees union, the SEIU local, was also critical of the contracting, but some of his claims missed the mark, such as his claim that the Board had somehow violated the Brown Act in preparing the contracts.

But Eberle’s complaint that the contracts were developed by insiders without much public involvement was essentially true, although most of “the public” probably knew that they would have fallen asleep in the face of the jargon-laden discussions of the contract provisions that the bureaucrats spent months hammering out.

Eberle also complained that the contracts were the result of a conscious effort to undermine the County’s mental health staff to make it look like contracting out was the only solution. “The argument that the County is incapable of providing the needed services is a self-fulfilling prophecy of your own policies and the outcome of your deliberate actions dismantling the department over the last few years. Just seven months ago in November 2012 the mental health apartment had 93 funded positions, but less than half, or 45 of them, were filled. This is part of a pattern of understaffing that has gone on for at least the last two years. You crippled the department, declared it incapable, and then moved to sell off its functions to private bidders. Legally, the county has an obligation to provide quality health services to its residents. The contracting is an abdication of that responsibility. The county can only contract out “special services.” Dismantling its own mental health system does not convert the work into a special service. The law does not let the county used this self-inflicted wound as an excuse. Going through with this now without waiting for these issues to be debated and resolved will only cost the county taxpayers more. On behalf of the Mendocino County citizens and employees we urge you to vote no and instead address these issues in a public forum.”

County Counsel Tom Parker responded that the County was “not contracting existing services,” that what was contracted for was “enhanced and additional special services, therefore there’s no need for meet and confer.”

Parker may be narrowly correct about the legal necessity to meet and confer, but the over $15 million dollars worth of mental health dollars being contracted out is not new money. Health and Human Services Director Stacy Cryer made it clear that she plans to dismantle and transfer most of the existing mental health line staff to positions that were held open in other branches of her department. Cryer also said that Mental Health positions were not intentionally left vacant, that recruiting was going on, just not very successfully. Nevertheless, Eberle had made a good point, albeit ex post facto.

Ms. Cryer also agreed in passing that the idea to specify client to case worker ratios was a good idea that might be talked about later. But given the givens in Mendo, that’s highly unlikely.

In the end, after a few minor nitpicks of the legalese in the two contracts from Supervisor John McCowen, the Board voted unanimously to approve the contracts with very little Board discussion other than heaping more praise on those involved. After the vote the roomful of privatization proponents erupted in applause.

The disproportionate value of the contracts on juvenile services which have historically been the most lucrative aspects of mental heath service funding makes us think that the contracts were tweaked via input from the prospective bidders to farm out the most well-funded services and programs. After all, those companies are in the “business” of Mental Health and are not about to bid on services they’ll lose money on.

Sheriff Allman was on record supporting the contracts, although he wasn’t on hand on May 21 to participate in the cheering section. It remains to be seen if the well-publicized gaps in adult crisis management services which have put much of the first-line mental health job in the hands of local cops will be improved by Mr. Ortner and his admiring cadre of well-paid, jargon wielding helping professionals. ¥¥