County Notes (Feb. 7, 2018)

Sheriff Tom Allman’s Measure B Advisory Committee got off to a faltering start Wednesday of last week. It appeared that none of the eleven “commissioners” had come prepared, even though they all supported Measure B and supposedly had strong interest in Mendo’s very own psych unit and associated facilities. No one, apart from Allman, seemed familiar with the core provisions of the ground-breaking Measure.

Allow me, class, to summarize what we’re supposed to be after here:

First: Provide supplementary mental health services “by developing: 1) a psychiatric facility and other behavioral health facilities; and 2) a regional behavioral health training facility.”

Second: Develop “the necessary infrastructure to support and stabilize individuals with behavioral health conditions.”

Third, supplementary services: “For a period of five (5) years a maximum of 75% of the revenue deposited into the Mental Health Treatment Fund may be used for facilities, with not less than 25% dedicated to services and treatment; thereafter 100% of all revenue deposited into the Mental Health Treatment Fund shall be used for ongoing operations, services and treatment.”

That’s all. Very simple. Those three things: facilities, infrastructure, and supplementary services (associated with those facilities). Nothing else. (The rest of the measure is about oversight, accounting, audits, taxation, legalities, etc.)

Sheriff Allman said that he still wanted Mr. Kemper (whose “Kemper Report” a couple of years ago formed the basis for dumping the widely criticized Ortner of Yuba City’s private mental health services, to whom Mendo’s severely mentally ill had been dispatched for dubious services rendered), or someone like Kemper to do a “needs assessment.”  Behavioral Health Board Chair Jan McGourty duly made a motion to recommend a Needs Assessment to the Board of Supervisors.

But more cautious Measure B commissioners thought they should take a breath and wait a month before jumping to a needs assessment.

If the “commissioners” had given their mandate any thought, we think they would have first drafted an outline or framework to achieve the Measure’s specific objectives to present at the first meeting. But they didn’t. (One commissioner, Fort Bragg electrician Mark Mertle, proposed that each commissioner prepare their own “mission statements” for the Commission, even though their mission statement is right there clearly spelled out in Measure B.)

So, again, allow me to offer a framework or roadmap:

First prepare an inventory of existing facilities for the five categories of mental health facilities in each supervisorial district/area. (I.e., Fort Bragg, North County, Willits. Ukiah, AV/South Coast.

Those five facility categories are:

Five Levels of Care – Locked and Unlocked Psych Facilities

1. Acute Inpatient (for 5150s); Locked facility.

2. Sub-Acute. Also a locked facility. For conservatorships where someone else is calling the shots, which can be the Public Guardian (PG) or a family member.

3. Institute for the Mentally Ill (IMD). Also a locked facility for patients that are higher functioning than a sub-acute level, but still require a locked setting. Conservators still make decisions for them.

4. Enriched Board and Care. An open setting. Not locked. Not necessarily conserved (i.e., voluntary or court ordered).

5. Regular Board and Care – Open setting. Basically, transitional housing for some number of days. Less intense treatment.

Facilities to be inventoried and assessed would include hospitals, clinics, care homes, etc. for their current capacities and capabilities. Added to the existing resources, would be facilities in the pipeline such as the pending jail expansion and the planned new crisis facility on Orchard Avenue in Ukiah.

Next: Population estimates of people to be served in each facility category with forecasts of future numbers.

1: Existing clients (which Mental Health Director Jenine Miller says is five times larger than when Ortner was the County’s mental health care service provider).

2: Currently unserved clients (uninsured, drunks or addicts who might voluntarily or be court ordered to come in).

Presumably, most of this initial survey or inventory data is available from existing county sources. In fact, Commissioner Jenine Miller, Mendo’s Mental Health Department Director, specifically confirmed when asked that most of this information is available from County records.

To save time, the Measure B Commission should break up into parallel sub-groups with specific tasks and deadlines to complete this inventory and survey.

Then come up with a list of the types of facilities in each of the five main county districts, what kinds of people they would serve, how many, where… (One could imagine a table listing the types of facilities down the left, and Supervisorial districts across the top with numbers/forecasts of beds or clients in each cell showing how many in each category in each district.)

Last would be a list of facility recommendations and descriptions (i.e., number beds by category, types of services) in each district, sized according to the numbers in the table.

The likely resulting initial report would probably show fewer beds in the first three (higher, locked) facility categories, and more beds in more places for the bottom two categories. No one facility should be that big; the objective should be dispersal of lower level facilities. (Obviously some facilities could house more than one category, with probably two or three locked facilities, in Ukiah, Fort Bragg, and/or Willits.)

Options for “infrastructure” would include:

What training programs and accompanying facility(ies) (presumably at one of the two or three locked facilities) would support the facilities and services and where.

Where to put crisis vans, with a minimum of one inland and one on the Coast.

Necessary transportation requirements between facilities with accompanying maps and routes. (Here one could imagine a hub-like arrangement with locked/training facilities in central locations.)

How much extra capacity should be developed for future expansion or other county imports as space/services permit.

Once this basic framework is laid out, questions of what levels of services should be provided within the framework at each facility could start being addressed. And possible locations or existing buildings in each category and area could be identified.

One could take this several steps further, but a decent initial outline in this format would get them off to a good start and insure that the recommendations stay focused on those three primary purposes of Measure B.

At all times and in all meetings, the commissioners should focus primarily on what those facility and infrastructure recommendations would look like and what information would back up those recommendations. At every meeting Commission Chair Allman should ask, “Where are we on the facilities list?” and “What’s the facilities and services map looking like?” And constantly remind his fellow commissioners not to drift off topic.

If not, he runs the risk of his beloved Measure B Committee devolving into another aimless chat session like the current Behavioral Health Advisory Board, at which point his creation would be co-opted by the CEO-Molgaard Axis, and absorbed into the existing ineffective mental health apparatus.

* * *

HERE’S THE KIND of after the fact move Mendo makes all too often, compounded by a lack of even a basic description of the work to be done, the amount of money involved or a reason for the nearly five months of services not contractually approved. (Recall that as far as official Mendo is concerned, Assistant CEO Alan Flora was unceremoniously dismissed without notice because official Mendo said he approved a couple of routine contract amendments without asking the Board of Supervisors or CEO Angelo (“Mommy may I”) first. (We hear rumors that Flora is about to sue the County for his precipitous firing.)

“AGENDA ITEM 5a. Mendocino County Board of Supervisors, Feb. 6, 2018: “Discussion and Possible Action Including Approval of Retroactive Amendment to Purchasing Agent Agreement 17-149 with Allvest Information Services Inc., dba Assessments.com, dba Vant4ge.com, Extending the Termination Date from September 30, 2017 to September 30, 2018. (Sponsor: Probation)”

THAT'S IT, the entire item.

THIS UTAH-BASED COMPANY, Allvest Information Services Inc, aka Assessments.com, aka Van4ge.com, is “one of the nation’s leading providers of software and other services to help state and county probation agencies more effectively and efficiently manage their day-to-day activities. Juvenile justice departments in states like Washington, Florida, Wyoming and Montana, and counties like Los Angeles, San Diego and many others find the features and benefits of Assessments.com juvenile justice software to be the ideal solution for their intake, risk and needs assessment, case management and reporting requirements.” The software allegedly performs “scientifically validated risk and needs assessments.”

A COUPLE OF MONTHS AGO, Mendo hired a very expensive retired Sonoma County Probation honcho as a consultant who came with reams of professional credentials. Yet here we are several months later and his Probation Department is asking the Board of Supervisors to approve a blank check for mystery “services” without explanation or amount. The fact that this item even made it onto the consent agenda in this vague form is a good indicator of the attitude of the CEO and her staff: “Hell, just throw it up there. They'll approve it. They’ve approved worse. They approve everything. No problem.” And, sorry to say, she’s probably right.