After more than eight years of dithering, and without much fanfare, ground was officially broken for the County’s new Psychiatric Health Facility on Whitmore Lane in Ukiah on Tuesday, August 20. There was no advance notice; no press release.
The next day, former Sheriff Tom Allman, the presumptive father of Measure B funds from which are funding the project, posted the following on his facebook page the next day:
“After eight years of gathering signatures, voting, meeting and planning, the ground breaking for the new state of the art Mendocino County psychiatric health facility happened Tuesday. Over 82% of our voters supported the tax which will soon allow us to greatly improve the quality of life for our citizens who are victims of mental illness. In the world of dark and dreary news, this is a great day for Mendocino County. The facility will be located on South State Street near Whitmore Avenue. To all of the supporters who voted for Measure B, from the bottom of my heart, thank you for allowing us to get to this day. This facility will be open in 14 months and will allow our hospitals and first responders more resources by getting better and faster services to those who truly need it. Thank you.”
The “meeting and planning” had nothing to do with the PHF. In fact, the meeting and planning had nothing to do with anything involving the PHF. The credit, if that’s what it is, goes to former CEO Carmel Angelo, who engineered the Covid-funded acquisition of the Whitmore Lane nursing home that was destroyed to make way for the PHF, and Dr. Jenine Miller, whose early take-over of the Measure B process and wizardry with byzantine mental health funding, greased the skids for the project.
Tuesday’s event featured forlorn-looking Second District Supervisor Maureen Mulheren who posted an unannotated facebook video of herself standing alone on the Whitmore Lane vacant lot with a microphone reading to an admiring, small assemblage of county staffers from a prepared but ridiculously exaggerated statement which included incongruous Kamala-infused words and phrases like “inspiring,” “a testament to this community,” “jobs and opportunities,” “a symbol of resilience,” “building a brighter future,” “everyone has access to the care they need,” etc.
Mental Health Director Dr. Jenine Miller was also on hand, but her remarks, if any, were not recorded.
It was all standard issue inflated rhetoric which, like the comically self-congratulatory speeches accompanying the construction of the Crisis Residential Unit the County gifted to the Schraeders a few years ago, glossed over lots of not-so-inspiring stuff.
For example, the claim that “everyone [will have] access to the care they need,” is belied by the County’s mental health financing system which provides millions of dollars worth of “care” via the Schraeders’ local mental health monopoly only to people they deem to be “severely mentally ill” and therefore reimbursable through MediCal. If they say someone is not quite crazy enough to be “severely” mentally ill, or retarded (“developmentally disabled”), or drug-addled (aka not “mentally ill”), the prospective patient and his or her family are not reimbursable and basically on their own. That’s because millions of Measure B dollars that were required to be spent on mental health and drug treatment services — a minimum of 25% of the revenue according to the text of Measure B — have not been spent on those services, but have instead been eaten up by overpriced, overdesigned buildings like the PHF.
The PHF has been designed to handle 16 beds, although Mendo has nowhere near that many “severely mentally ill” people at any given time. So the facility will have to import at least half the patients to keep the beds occupied and the operation in the black.
The facility has the side benefit of housing some local mental patients closer to their family than the out-of-county facilities they are currently dispatched to. But those patients are already declared “severely mentally ill” and sent out of County, and do not represent any kind of expansion of services. And the PHF certainly won’t do a thing to help the street people that Measure B was sold to us with.
Of course, we don’t know many the particulars associated with the PHF because no one has done any kind of staffing plan or proposed budget for the operation of this $13 million-plus facility which is expected to be completed toward the end of 2025. The preliminary estimate of something like 40 staff members is based on an unpublished and unreleased study by a Bay Area mental health services outfit called “TeleCare” which Mental Health Director Dr. Jenine Miller contracted with a couple of years ago to presumably staff the facility.
Sheriff Allman and others have speculated that some of the PHF staffing could come from an as yet-unestablished Psych Tech program at Mendocino College. But that program has not gone past the fantasy stage, even though the new 16-bed PHF facility is scheduled to be open long before any such program could produce licensed psych staffers, if ever.
In laying out the parameters of the 16-bed Psychiatric Health Facility, Dr. Miller’s consultant noted that almost 40 trained, licensed staffers will be required to run the Whitmore Lane Psychiatric Health Facility (at a likely cost of more than $4 million a year). Dr. Miller’s pre-chosen staffing contractor, Bay Area-based TeleCare, is not part of Redwood Community Services which employs nearly all the licensed psych staff in the County at present. There’s no mention of where Telecare Corporation will obtain the 40 additional professional “full-time equivalent” psych staffers.
From the study by the high-priced Sacramento-based architectural consulting outfit who designed the PHF: “Facility Staffing: A component of the study was to understand the staffing requirements for the psychiatric health facility to determine functional area requirements for staff and parking needs. The consultant was provided with the proposed staffing pattern from TeleCare Corporation, the prospective operator for the new facility. The staffing pattern indicated that 39.4 Full Time Equivalent staffers are needed for a 16-bed facility.”
Even though the PHF is now scheduled to open in late 2025 (maybe), no one has raised any questions about who will manage and administer the facility, who will decide which people are assigned to it, how it will be integrated with the new “mental health wing” of the jail (to be staffed with an expanded contract with NaphCare, the jail’s current medical contractor which will also need to hire more local psych staffers), how it will be staffed around the clock, or where they’ll find 40 new mental health staffers (plus whatever other support and security staff may be required), what its operation will cost, or how it will be funded. There’s been no discussion of the protocols for determining who will go to what facility under what conditions, or what priority scheme will be used to accept the out of county mental patients which will be essential to its budget.
The facility is outside Ukiah’s City Limits, so it will fall under the Sheriff’s jurisdiction when law enforcement is inevitably called in for problem patients.
Despite Supervisor Mulheren’s grand/bland claims about how wonderful the new facility will be, neither she nor her Board colleagues have raised a single question about what planning is being done to safely and efficiently operate the facility.
But maybe that’s intentional. Such planning would only highlight the problems. Better to just ignore them. If they build it, Dr. Miller will make sure that the reimbursables will come.
A picture, they say, is worth a thousand words.
The Supervisor looks like nothing so much as a lone tree prematurely planted for landscaping purposes.
That shot contrasts sharply with the flying Superdog image at the top of her Facebook page.
And those hard hats lined up on shovel handles make an inspiring backdrop.
The PHF …. although is needed to give people immediate and necessary treatment for those experiencing Mental Crisis and disturbances is an illusion of care. It is an intervention measure to stabilize a persons mind through high doses of meds. The problem is in the community infrastructure that does not allow room for treating people based upon individual illness, circumstances and conditions.
The 16 bed minimum is the IMD exclusion …
If we like the statistics and go by the PIT count .. 779 homeless peeps and 30 percent of those people have a Mental Illness thats 233 people which obviously does not include people in homes with jobs who suffer these illness’s and also will need PHF services. The rate of Mental Illness is high and increasing and with the implementation of prop 1 which is yet to be utilized in any significant manner here in Mendo should make it easy to fill up those 16 beds all the time.
https://www.naco.org/resource/overcoming-barriers-equitable-care-access-how-imd-exclusion-impacts-counties
Policy Summary
Section 1905(a)(30)(B) of the Social Security Act prohibits Medicaid funds from covering an individual’s care at an institution of mental disease (IMD), defined as a facility with more than 16 beds with the primary function to diagnose or treat people with behavioral health disorders. This policy, referred to as the IMD exclusion, limits a county’s ability to build healthcare systems that have the capacity to adequately serve their communities, while also perpetuating patient inequities by limiting access to services in the most appropriate settings.
Background
The IMD exclusion was created as part of the deinstitutionalization movement, shifting responsibility for funding inpatient psychiatric services from the federal level to individual statesi. An IMD is defined as any facility with more than 16 beds with the primary function to diagnose or treat people with behavioral health disorders, including substance use disorder (SUD). This rule applies to beneficiaries between age 21 and 64 ii, barring Medicaid from covering mental health care if the individual is a patient at an IMD.
Specifically, IMDs are defined by the U.S. Department of Health and Human Services (HHS)
a licensed or accredited as a psychiatric facility;
a facility that is under the jurisdiction of the state’s mental health authority;
a facility that is specialized in delivering psychiatric or psychological care and treatment. (specialization can be determined by reviewing patient records, noting if a significant portion of the staff has specialized training in psychiatry or psychology, or if the primary purpose of the facility is to care for and treat individuals with mental illnesses)
or has more than 50 percent of all its patients admitted based on a current need for institutionalization as a result of mental diseases
mm 💕