Revisiting The Kemper Report Hearing

At the day-long Supe's meeting of February 16th devoted to the Kemper Report's long, sad song about privatization of Mendocino’s mental health program, the most cogent public comment was from Behavioral Health Board member Nancy Sutherland:

“I am a current member of the Behavioral Health Advisory Board (formerly the Mental Health Advisory Board). Today I am addressing you as an individual informed by my experience as a Board member and my experience in the delivery of substance abuse treatment and services. Regarding the Kemper report comments about financial reporting: The Behavioral Health Board has tried for years without success to obtain data and a coherent explanation of the mental health budgeting process. We consistently met with delays, excuses and inaction. The Behavioral Health Board repeatedly requested and never received mental health and ASO quarterly financial reports. We again request those financial reports be presented quarterly at a publicly noticed meeting of the Behavioral Health Board.

“Additionally, it is clear to me that an outside financial audit of the ASOs should be conducted prior to any contract renewal. Regarding substance abuse and co-occurring disorders treatment, despite the high incidence of substance abuse and mental health disorders, Mendocino County has no viable treatment options for the mentally ill with co-occurring substance abuse disorders. For the health of the mentally ill and our community the county must provide implementation of a countywide plan for the integration of mental health and addiction treatment — plan that prioritizes a revitalized substance abuse treatment program.

“Regarding the Mental Health Behavioral Board, or the Behavioral Health Advisory Board as it's now called, the Kemper report recommended county and mental health leadership take the lead in efforts to renew a spirit of cooperation and transparency with the Behavioral Health Board. Almost every issue addressed in the Kemper Report has been raised at the Behavioral Health Board meetings. We consistently met with a lack of cooperation. This often resulted in an ineffective and sometimes adversarial relationship instead of the supportive partnership that it could be. …  We need and deserve the support of the county and the HHSA leadership to fulfill our state mandates as an advisory board.

“Finally, for reasons that remain largely unexplained the Board of Supervisors and upper management pre- and post-privatization failed to require accountability, ignored numerous red flags, tolerated unclear decision-making and accepted inadequate reports and presentations. Change comes from the top, precipitated by a change in the attitudes and behavior of leaders. It appears to be time for a change. I support the recommendations of the Kemper report and encourage you to draft a plan of implementation.”

We did not hear a promise from the Board or the CEO to prepare the implementation plan Ms. Sutherland called for. Such a plan would address, if miraculously adopted, all the major components of mental health in Mendocino County, including the Sheriff (patrol and jail), the Sheriff’s doc-in-the-box program at the jail, the existing County mental health staff, the existing county drug abuse program (such as it may be), the two mental health courts, the drug-abuse court, Laura’s Law, the outside contractors and whatever plans may be under consideration for local mental health, residential facilities.

It would be nice (sic) if the plan was properly integrated based on a common database of clients (including the well known frequent flyers, not just the obvious insurables) so that redundancy and overlap is minimized. As it is, there’s way too much administration and way too little service.

The implementation plan should have as its primary focus the delivery of outpatient and crisis services, plus the development of local facilities such as those being proposed by Sheriff Allman or one making use of the old Howard Hospital in Willits. It should also layout exactly what kind of monitoring and oversight will be done and by whom. (Yes, we know it’s probably bordering on fantasy in Mendocino County but we live in hope.)

The only item in Ms. Sutherland’s comments we had trouble with was her statement that, “The Behavioral Health Board repeatedly requested and never received mental health and ASO quarterly financial reports.”

Something like that may have been requested and not delivered, but it's more likely it did not occur. Or occurred once. Or whatever was provided didn’t come close to what was requested. We have read the Behavioral Health Board meeting minutes for hours on end looking for just that point and we don’t recall any specific unanswered requests being mentioned, other than in very general terms.

Those minutes, by the way, reflected mucho time wasted on people introducing each other. This kind of smiley-faced fascism is routine at Mendo public meetings. They're designed by management, and the Nice People generally, to cool out dissent. "Gee, Mr. Scaramella, here we are being nicey-nice and you stand up and lob all these turds at us? Geeeeeeeee." And there's always the "hush muffins"  — government-paid donuts and other neg food value viands, one bite of which means, fatally, "You're one of us."

The behave yourself board itself and its very, very, very nice Chair, Mr. Wexler, and its Board rep, the even nicer Dan Hamburg, so nice he borders on groovy, made little if any effort to document the Board’s displeasure with the Ortner reporting and made no proposals about how to fix it.

We recall Ms. Sutherland bringing it up (and being totally ignored) during public expression at previous board of supervisors meetings. But she was the only one who did. Supervisor Dan Hamburg, as Board rep to the Mental Health Board has never uttered one word of dissatisfaction with Ortner’s reports or functioning at any meeting of the Behavioral Health Board or the Board of Supervisors. (Hamburg, incidentally, carries a dwarf comfort dog with him to all public meetings to ward off, we understand, anxiety attacks. I guess without the dog the supervisor might disappear in a trembling mass underneath the table.)

In fact, there was never even a follow-up or answers to Supervisor Dan Gjerde’s bracingly specific questions about why Ornter’s admin cost was double Redwood Quality Management’s admin rate (to the tune of almost $1 million). It was not brought up in the Kemper report (other than to say that “admin” was ill-defined), and nobody mentioned how it would be fixed or even if it would be examined.

All the Board did at the end of the day-long Kemper report meeting on the 16th was ask staff to work with Ortner to improve the contract language here and there while simultaneously preparing a Request For Proposals from other providers if Ortner proves uncooperative. Gjerde correctly suggested that staff members who were involved in screwing things up not be involved in the contract rewrite, but nobody even acknowledged that this would be done. (Although Ortner agent Pinizzotto is now gone and Cryer has announced her resignation, so at least we can assume they won’t be involved.)

Without the comprehensive implementation plan requested by Ms. Sutherland (including the identification of options like taking the admin portion of the privatization back in house and farming out the billing to an experienced MediCal billing outfit) there’s not much hope that things will improve — and even if they do prepare one, nobody would be able to tell unless it includes a requirement for the necessary “coherent” reporting — something Official Mendo has consistently refused to even attempt for years.

Speaking of local mental health facilities, we understand that the specific language of Sheriff Allman’s proposed mental health facilities initiative has been submitted to the County Counsel’s office for review. The initiative would put a half-cent sales tax increment toward construction or purchase of local mental health facilities with a sunset clause after a certain funding level is achieved. It will require a two-thirds vote however, and it is by no means an easy sell.

Sheriff Allman is also working on an innovative, if limited, work release program involving a local contractor, a carpenter’s union instructor, and the jail to give up to six inmates hands-on training and experience at the contractor’s facility and on small public works projects in carpentry work leading toward something like the existing bread baking certification program which has helped a number of inmates who applied themselves to it. The details are net yet fully developed, but commitments have been made and we expect to see a press release with the details soon.

Odd, isn't it, that in the County that constantly congratulates itself on how "progressive" it is that it's the Sheriff who constantly comes up with genuinely progressive ideas?