Hoping For Transition

The Board of Supervisors, at their Tuesday meeting, again discussed the status of the transition of privatized mental health services from Ortner Management Group (OMG) if Yuba City to Redwood Quality Management. There was no formal presentation, just a meandering discussion of a few questions from the Supervisors. By far the most commonly used word during the discussion was “hope.”

Supervisor Dan Gjerde wanted to know about the status of the mental health “patient advocate” position which he said was “one of the most important positions” the County should provide and which had either not been filled or not effectively filled or filled by an 800 number, or there were gaps in coverage, or if filled no one knew about it… “Now I’ve been told that the contract for the first live body we’ve had has expired,” said a frustrated Gjerde. “Without that position, the public contacts us, the Supervisors, and asks for help, or to intervene. But that’s not our job, managing county staff. Our job is to develop policy.”

Behavioral Health (the merger of Mental Health and Substance Abuse) Director Janine Miller replied that the position had been contracted out for years — the “patient advocate” wasn’t even a county employee? — but that “in 2015 they retired at end of the contract. Then we filled that with county staff as an Acting position. Then we filled it with another contractor… We are doing another contract. … We have a candidate for this fiscal year, starting in July.”

Gjerde: "I’m not getting those complaints now. If it’s someone else, I hope we’ll notice."

Miller: “I hope they’ll be visible to community; it will be part of the contract to do that.”

After the usual rambling statement about how he had endured years of criticism, and how “hopeful” he was about the transition, and how much he wanted to help, Supervisor Tom Woodhouse finally got around to asking how hiring and staffing were going, adding, gratuitously, “I know it’s really tough.”

Regarding County staffing, Ms. Miller of course agreed that the transition was the bureaucratic equivalent of an Everest expedition, agreeing with a martyred, “We have struggled. We have hired two new people since the start of the transition. We’ve done interviews. We are hopeful with some job offers. But we’re not where we want to be. We are hopeful that by July 5 we will have more. We are more short than we hoped to be, but we have done more than we expected. We are making our timelines. RQMC has been fabulous. RQMC has been helpful. But there’s lots more to do. RQMC has ramped up hiring eight or nine psych staff.”

Gjerde then complained about the tone of the recent presentations to the Fort Bragg and Ukiah city councils by Mike Pallesen, head of the local Rural Communities Housing Development Corporation. “The Fort Bragg Council was given a stark picture of what could be coming their way,” said Gjerde. “Housing for 30 or 40 homeless people? But Mental Health housing is not for just homeless, so why say that? The grant only requires that people be in jeopardy or homeless. It’s broader than that. So I question the way it was presented. The cities need more specifics about what is required, not the way the grant writer may think about it. That’s not necessarily what the pubic wants or what parents want. They want an apartment for their child so he’s not at their house. They should check in with us and validate the requirement and the latitude of potential residents. We should be able to move ahead with city support, but there’s no reason for them to narrowly define this. The project could be dead on arrival if they do not recalibrate.”

Ms. Miller said she’d be happy to have the team come back to the Board for clarification and that there would be no more city council presentations “until we are more clear.”

Supervisor John McCowen: “This kind of project requires political will by people who are susceptible to public concern and public comment. But critical needs are not being met. If not here, then where? If the answer is nowhere, we’re not doing our job.”

Gjerde finally made it bluntly clear what he meant: “We want housing for low income residents of this County, not those who have moved here for some reason.” (I.e., transients and street bums.) If you tell the City Councils that the County wants them to help provide housing for transients and bums, the cities probably won’t cooperate.

Supervisor Woodhouse asked about the crisis line and the “access” line and about which functions the County was doing in-house post-Ortner and which were in RQMC’s contract.

Ms. Miller replied that the County has assumed oversight of 25 adult conservatorships through the public guardian’s office. She added that she plans to change what was a confusing situation with access and crisis lines which were sort of combined under Ortner. The access line is required to be available 24/7 and is supposed to provide advice on how to “access” services and what people’s rights are. The “crisis” line will be changed just to deal with people who are having an urgent mental health breakdown of some kind. (But, she added, cops will still do 5150s.)

Ms. Miller also intends to upgrade the “access” line to cover all social services, not just mental health so that a larger pool of county employees can be drawn from to staff it.

Staffing these two lines remains a problem though. However, when it’s up and running she will issue a clarifying press release and that she hopes to be able to respond to calls somewhat like an emergency dispatch center.

Ms. Miller noted that the County will also be taking over medication management for adults 25-and above. This seemingly simple task is harder than it seems because there are often difficulties in getting “clients” to 1. Buy their meds. 2. Arrange transportation to and from a clinic or hospital for injection or dispensing. 3. Take the meds. And 4. Follow-up.

Supervisor McCowen wanted to know why so few of the Memorandums of Understanding with other agencies and organizations were completed.

Ms. Miller replied that they were being assembled piece by piece with each organization and it’s time consuming because they are taking it seriously and the other organizations have to be willing and able to meet their side of the agreement. “So some sections are not filled out yet,” Ms. Miller said.

Asked how things were going, Camille Schrader, owner of Ukiah-based Redwood Quality Management Company, shrugged and said, “Good. We are finalizing contracts. Putting language in subcontracts and including reporting. Changes to electronic health records are very technical. Cash flow projections have to be set up so they work because we have to pay before we are reimbursed. All our adult providers have been trained on Mental Health Plan and how charts are filed and the way we work. Hospitality Center and Manzanita Services are staffed and have started to accept new adult referrals. The County has been very helpful.”

Then there was a discussion of Mental Health Services on the Coast, an historically more difficult area to provide services.

”We are looking for space on the coast,” said Schrader. “We met with the cops, the clinics, the city. We have tentative MOUs. There are just lots of specifics which can’t be worked out in two months. So some will be left outstanding. We hope to have it all in the MOUs before it’s presented to Supervisors. The adult need on the Coast is proportionally higher. We hope to ramp up the Youth Project and Hospitality Center to full running on the Coast including substance abuse and serious mental illness. But we need to build up space. Inland preparation is going well. We hope to take over the old Sizzler building for crisis residential. We are talking to the hospital about when that building will be demolished. We’re very anxious. We will provide support to providers and the county on medication appointments, transportation, purchasing, etc. Those partnerships are in work.

Supervisor Gjerde proposed some kind of big confab in Fort Bragg on the Coast in September to bring all the issues, agencies and family members together to see how things are going.

Ms. Schrader agreed, adding, “the hospital and police in Fort Bragg are overwhelmed. Should substance abuse be included? I don’t know. But we have to pay attention to it. And Round Valley — we need to find out what they need. It’s not easy.”

Ms. Miller summed up tentatively: “Maybe some goals we will not meet, but we are hopeful.”

* * *

Unfortunately, two subjects were not discussed:

No mention of the status of the data the County has demanded from Ortner — a bad sign.

And no mention of how the cost of all this will be worked out. If the County is assuming responsibility for large parts of what Ortner was doing, how much will that reduce the RQMC contract? And what will be the overall privatized cost after all the “hoped for” changes are made?