Oxymoron Of The Week: ‘Incomplete Continuum’

Last Wednesday, Mental Health Consultant Lee Kemper summarized his recently completed $40k indictment of the County’s badly broken mental health “continuum” for the Measure B Advisory Committee meeting in Ukiah: “There are two continuums of care for mental health and for substance abuse disorders. Both of them are incomplete.” 

Which is putting it gently.

This of course flies directly in the face of claims of HHSA management and mental health contractor/manager Camille Schrader. To hear her and her cozy circle of lieutenants, both county management employees and her own, the small army of the deranged wandering around the County talking to themselves are all being "served" by a continuum of care.

So when the subject comes up at the Board of Supervisors meeting on September 11, look for the Schrader Gang to be in full damage control mode. (E.g., Ann Molgaard: “We have great respect for Mr. Kemper and we really really respect his opinion and appreciate his report, we really really do, but he didn’t talk to US personally so he doesn’t understand how wonderful we are and how many wonderful services we offer.”) And not one person in official Mendo — including the members of the Measure B Committee on Wednesday — will go on record agreeing with Kemper’s professional assessment of the “incomplete continuum.”

Kemper: “With regard to substance abuse disorders, it's a very small set of services and it doesn't really represent a continuum of care. … And with respect to the mental health continuum, we also see that it is incomplete because it is missing some key ingredients for the residents of the County of Mendocino. Specifically, the lack of a crisis residential treatment facility, the lack of any kind of treatment programs, the lack of partial hospital programs, and in particular the lack of a more robust set of wellness and support services that reach the various communities across the county.”

But millions of annual public dollars are being spent on these "services."

Kemper went on to say that the County’s “continuum” is focused mostly on crisis response and does very little to keep people from reaching crisis stage. Using data he obtained from Ms. Schrader’s Redwood Quality Management Company, Kemper said that rates of crisis assessments have gone up dramatically in recent years.

“What we see is there is a growing level of crisis mental health assessments and it is placing an increasing burden on the local delivery systems that are providing services. Specifically, the hospital emergency rooms where this occurs and the crisis access center that RQMC operates.”

“We believe that the [Measure B] revenues need to be dedicated to the full spectrum of services to build out a more comprehensive continuum of mental health care in the county. I believe that a goal you should focus on is reducing the need for and the utilization of inpatient psychiatric care whether that's in the county or out of county.”

“With regard to the substance abuse treatment services, we recommend that 10% of the [Measure B] funds be allocated to services related to substance abuse disorders in the county. We do this with the understanding that there are so many steps to be taken there and we think you should be if you get going right away on substance abuse service expansion and we think that's an appropriate use of the funds and it would represent an important investment.”

Mr. Kemper agreed that a Psychiatric Health Facility (PHF) was necessary, but only in conjunction with expanded upstream services to keep a lid on the number of people who would need it.

Another point of contention was Kemper’s estimate of the cost of a new 16-bed PHF — based on his discussions with managers of similar facilities in other NorCal counties, Kemper said a new PHF facility would cost substantially less than the estimate provided by the consultants employed by Margie Handley and the Howard Hospital Foundation to remodel the old Howard Hospital. In other words, instead of just handing over Millions to Margie, maybe more money should be spent on helping people and less on low-security incarceration at the old Howard Hospital.

“The county should take this opportunity to make the behavioral health treatment more complete for mental health and substance abuse,” said Kemper. “Focus on remediation at the earliest possible time and reduce the need for inpatient psychiatric facility use. But at the same time we acknowledge that you need some kind of inpatient psychiatric facility.”

“These are basically good government kinds of concepts,” said Kemper, perhaps not realizing he was talking to a County that has never done even the most minimal level of service oversight and reporting for any of its departments.

Kemper also said that the Measure B funds should be used to “supplement not supplant” existing services. “Sometimes there are some clever maneuvers that can occur with those new dollars,” said Kemper as Behavioral Health Board Chair Jan McGourty could be seen conspicuously scoffing and smiling.

Repeating his earlier calls for oversight and reporting (back when Kemper did a review of the woeful Ortner mental health service delivery), Kemper tried again, “We recommend a bi-annual (every six months) review process on the new revenues and their expenditures and how they are improving the continuum of care. We recommend a prudent reserve. We recommend ways to account for the money and report on it so that so that the taxpayers understand where their resources are going to improve the system. We also recommend that the data be provided to you in a more discreet way regarding the utilization of services across the county so that you have a better sense of how people are being served in various parts of the county.”

This of course will simply never happen. Kemper is wasting his breath. The Mendo mindset is: “Here’s the money — please spend it. Come back next year for more money. Next subject.”

To improve the upstream services and reduce crisis calls Kemper recommends a distributed or mobile system that would go to the patient, not require the patient, many of whom are barely functioning, to travel for hours to a central location.

For years we have proposed a version of the “Crisis Van” program which would respond to mental health calls (along with law enforcement if called for) and then take charge of a person with a mental health problem and decide where that person should go, be it back to family, some kind of Measure B funded supportive housing, residential crisis treatment or the PHF. This idea, which works well if in limited form in Sonoma County and Contra Costa County, has never been seriously considered in Mendo.

The other concept that would help (as we have also noted several times before to no avail) would be for the County to finish the long-delayed Memorandums of Understanding with the outlying service organizations such as law enforcement, clinics, hospitals, ambulances, etc. and use the MOUs to fund those organizations with some of the Measure B money to help them provide assistance to patients and their families close to where they live.

None of this came up during the Measure B Committee discussion of course. All they did was nitpick some of Kemper’s numbers and approve a formal motion to pass Kemper’s report on to the Board of Supervisors — which, as Sheriff Tom Allman and CEO Carmel Angelo pointed out, they already have.