Sheriff Gets His Needs Assessment

Margie Handley, Chairperson of the Howard Hospital Foundation, opened the meeting by telling the Measure B (Mental Health Facilties and Treatment) Advisory Board that the Old Howard Hospital is “a viable option.” She said some state staffers had looked at the facility (evaluation cost covered by the Hospital Foundation) and it is a feasible mental health facility option. They concluded that it would cost between $11-$14 million to remodel facility to medical standards, depending on which option was chosen. (Apparently, they didn’t consider using only part of the facility.)

A good sized chunk of the two-hour meeting was a presentation by County Mental Health Director Dr. Jenine Miller. It’s depressing listening to her presentations because she always points out that the bottom line for mental health treatment is the bottom line — whether the “patient” can generate reimburseable revenue for the system by either qualifying under strict government or private insurance standards or paying out of pocket. She noted that only “seriously” mental ill people qualify for Medi-Cal reimbursements — if you’re not certified as seriously mentally ill, there’s no money for the system to treat you, much less help you — which in the Measure B context means that the non-centralized, lower-security facilities which the County “needs” would typically not house reimburseable patients — so for your typical low-income patient those facilities have to survive financially on the patient’s social security benefits.

Committee Chair Sheriff Tom Allman repeated his call for a “needs assessment” several times during the meeting, hoping that a committee member other than himself would make such a motion. Several members thought that before a consultant is hired, the County should first assemble what data it has; others said that before a consultant RFP is written, the committee members should submit the kinds of questions they’d like a consultant to address. After several faltering attempts at proper wording of a motion, County CEO Carmel Angelo (a committee member) moved to simply ask the Board of Supervisors to authorize the needs assessment without specifics and have County staff write the RFP. Board member Mike Mertle suggested that members prepare questions they’d like answers to in parallel with the RFP process so they can have them ready before the RFP is released.

The continuing preference for an outside (“independent”) needs assessment and the level of resistance to asking County staff and/or their well-financed service provider (Redwood Quality Management Company) to assess their own needs, shows that Mendo doesn’t really know much about its Mental Health Services, who they serve, what they do or don’t do, or how effective it is. That’s no surprise; based on Ms. Miller’s presentation, “need” has nothing to do with what they do: it’s all based on whether the mental health service is reimburseable. (The state won’t reimburse the County for services that don’t qualify, creating pressure to either upgrade the seriousness of the patient’s problem, or turn them down for service out of fear of not being reimbursed.)

Willits physician Dr. Ace Barash pointed out that the primary objective of any new facilities should be to keep mentally ill people out of jail and out of emergency rooms. But the funding has nothing to do with that. It’s true that some of the Measure B funds (25%) are supposed to go to “services,” but unless that funding is clearly earmarked as a “need” for the walking wounded now going to the jail or emergency rooms (but usually not to costly out-of-county facilities) — an unlikely outcome — the new Measure B facilities won’t make much of a dent in the more overt — but not immediate 5150 — candidates for treatment: developmentally disabled, chronic substance abusers, and the famously difficult “dual diagnosis” patients suffering from drug-related mental illness. If the “needs” are only defined as addressing facilities for the currently “served” (i.e., reimburseable) population, Measure B won’t help much.

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Two AVA readers, one who calls himself “Lazarus” from Willits, and the always insightful Betsy Cawn of Lake County, offered their own assessments of the Measure B meetings:

Lazarus: “I watched some the meeting over coffee, besides Marge Handley hawking her crumbling HMH facility to the tune of $11 to $14 mil, it seems these experts had trouble coming up with a basic mission statement, If they can’t even do that, how in world can they agree on how to spend the people’s tax money on this crazy house? I had to quit, it’s to painful to listen. As always, Laz”

(Note: They already have a mission statement, it’s right there in the Measure’s voter-approved language.)

Cawn: “I watched a chunk of the first meeting; excruciatingly incompetent, orchestrated by Carmel Angelo’s assistant, endured by Sheriff Allman (who successfully campaigned for the measure on the grounds of having a feasible approach, if not a “plan”) — and attempted to parse the online information published by the Mendocino County Behavioral Health Advisory Board — all of which appears to serve as an effective buffer zone shielding half-hearted administrative services. It seems likely that the Sheriff’s Office would have the most specific current “data” about the individuals needing “mental health” services, some of which could be medically ameliorated, some of which cannot. Proposition 63 (2004) funding, under the Mental Health Services Act, is administered by multiple layers of quasi-professional associations and councils whose business is conducted elsewhere (Sacramento, LA, Redding?) but whose hustle and bustle result in little actual knowledge that can be applied to local planning. A lot of tax dollars go into these bureaucratic regimes, leaving the actual delivery of services to those on the ground — cops and docs — with little supporting “data” to analyze for project design purposes. Meanwhile, figure-heads and self-certified experts in the delivery of minimal assistance (aka, “treatment”) perpetuate the public service myth that licensed family therapists and counselors are effective at alleviating the conditions fundamental to mental illness — while white-coated administrators in ‘clinical settings’ are remunerated for so-called professional services under government contracts, with no performance measures or functional audits. At the state level, the Press Democrat reported a few years back that the California Mental Health Planning Commission (and the Mental Health Services Oversight and Accountability Commission) could not explain what had been done with nearly $11 BILLION in revenues achieved from Prop. 63; and this is the spending authority that is supposed to ensure local effectiveness of Mental Health Services Act funding. Throw in a few million dollars of local sales tax revenues, give the county Administration the oversight and management, and hand the design process to local wannabe civic masterminds — and here we are “waiting for Godot” as usual.”

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NOTEBOOK

Tuesday morning's Leadership Team presentation before the Supervisors was so larded with bureaucratic buzzphrases and trite run-on sentences that they ran out of time before they even got to the only Team that had the slightest touch of potential value: the Performance Planning Team. After an hour of “team” talk of surveys and employee empowerment, and anonymity, and action plans and “moving forward,” and so forth ad nauseum, Supervisor Carre Brown declared, “That was a wonderful presentation!”

Just as sadly, Supervisor Dan Gjerde asked the “team” to consider handling credit cards more efficiently and Supervisor John McCowen suggested that a person from the Planning Department be added, just to make sure that nothing remotely substantive happens. The other two supes, Croskey and Hamburg, didn’t even bother to comment. "Performance Planning," a watered down idea in the first place and way down the list of “teams,” wasn't even discussed. The “team” promised to do more teaming and stuff and everybody declared victory and went on to the next subject which had drawn quite a crowd, many from Anderson Valley.

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One of the provisions of Mendo’s Pot Tax policy is a minimum tax per year. On Tuesday, County Tax Collector Schari Schapmire ran down a series of questions that have come up about the minimum tax and if it applies when for one reason or another a grower doesn’t grow or sell his crop.

Schapmire asked: What if a grower takes a year off?

Supervisor John McCowen replied that as long as they have a statement to that effect on file, no minimum tax, but no statement? — Yes, a minimum tax applies.

What about crop failure?

Supervisor Hamburg asked, How do we prove that? Not resolved. (Although later someone suggested the fabled Track & Trace program would include that somehow? Or maybe they need some kind of crop notice to the Ag Department.)

What if a grower’s pot is eradicated by law enforcement?

Not resolved. Not discussed.

What about indirect crop loss from the Redwood Complex fire such as ash or fire retardant damage?

Not resolved.

And should the “gross receipts” (not net profit like most other businesses) that the tax is based on include the value of property which has been traded in lieu of cash payment?

Answer: Value of propety is to be counted, but how do you establish that value? Nobody knows.

At this point Supervisor McCowen declared that he thinks the minimum tax applies in all cases of permitted grows because, McCowen said, Mendo already has “the rock bottom” tax compared to other jurisdicitons, “Whatever we do to make concessions to this particular industry, it’s never enough,” said a clearly irritated McCowen. But then he calmed down a bit and suggested that no minimum tax be charged for 2017; it will start in 2018. Everyone agreed.

Tax Collector Schapmrie replied that in that case, they can deal with the remaining minimum tax questions later. McCowen generously added that he was in favor of waiving the minimum tax for total crop loss.