Could contractors provide better adult mental health services than Mendocino County?
How much could the county save by turning treatment of the mentally ill over to nonprofits and medical firms and entering into joint partnerships with private agencies and other governments?
Those questions are the subject of a process the county has launched to obtain proposals for further privatization of county mental health services. County employees were briefed in late January about a “request for proposal” process in which public and private agencies can pitch new ways to provide adult services. The issue has not been announced publicly or even to the Mendocino County Mental Health Advisory Board (MCMHAB).
The county already contracts out 80 percent of its youth services and the critical job of transporting patients to mental hospitals.
“The Request for Proposal (RFP) is being finalized by the county”s General Services Agency. Upon release of the RFP, we will know how prescriptive or generalized the request for proposal is and after reviewing proposals, have a better understanding of which services may be contracted out,” said Tom Pinizzotto, director of the mental health branch.
The process is expected to take at least one year.
The RFP has raised questions from employees, county supervisors and mental health service consumers. When will the public, the MCMHAB and employees hear details about which services or whether all services will be contracted out? Will people living in remote areas be required to make the arduous and sometimes impossible trek to Ukiah for some services?
Fourth District Supervisor Kendall Smith said she won”t support any plan that calls for travel by Fort Bragg mental health consumers to Ukiah.
While Pinizzotto isn”t yet willing to identify what may be contracted out, he says now is the time for action. He says further action is needed even after the mental health branch budget was balanced under his leadership, a red-ink problem past administrators had called unsolvable.
“During this period of great economic uncertainty and under funding, new ideas and solutions are needed. Past strategies and old routines aimed at managing deficits are not effective or sustainable. It is no longer business as usual. A paradigm shift is needed. Mendocino County Mental Health Services is ahead of the curve as the county explores other options to deliver services, Pinizzotto said.
Critics of the department mostly agree with Pinizzotto that change is still needed and trust him but wish for more open and public process.
Massive privatization of mental health services began in southern states about 2000 and has spread to much of the country as government budgets have bled more and more red ink. Georgia is currently involved in a process to close its state hospitals and privatize the entire mental health system, which would be a national first; it would be in defiance of cautionary tales from Texas and other southern states.
California is closing its mental health branch, selling everything down to the office furniture as part of internal efforts to save money.
Contracting out children”s and youth services has been done successfully in Mendocino County over the past few years.
“The consideration to contract out mental health services is not new or unique to Mendocino County. The majority of counties, contract out a percentage of services. Youth services is an example where counties establish contractual partnerships with community based organizational providers to serve youth?.. In our region the following counties contract out a percentage of youth services: Trinity, Lake, Humboldt, Napa and Sonoma,” said Pinizzotto.
Yet audits of many privatization efforts has revealed many unintended consequences and hidden expenses. North Carolina made life much worse for mental health clients and wasted $300 million through privatization, its own audits show.
Audits from efforts across the nation have shown real financial and treatment quality benefits from privatization, especially allowing patients to be better integrated into their communities when community groups are more involved in the process.
“The county has not been able to effectively offer mental health services to the residents it was designed to serve. As each day passes and dollars spent, it seems more and more apparent the county is better off to privatize its mental health services since it cannot perform the functions to a very diverse array of client/consumers of our county,” said Perry Two Feathers Tripp, a member of the Mendocino County Mental Health Advisory Board. “This isn”t a bad idea, however the lack of local accountability of the MHSA funds and direct oversight is the biggest issue in all of this.”
Pinizzotto has an example from the MHSA of how privatization of services can work through Joint Powers Agreements (JPAs).
“During the past four months, Mendocino County has collaborated with five other counties [Lake, Napa, Sonoma, Marin and Solano] forming the North Bay Suicide Prevention Collaboration. The synergy of six counties working together on a specific service is economically powerful. In addition, the ability to timely implement services through a proactive process is priceless. Barely four months after the contract was executed by California MHSA, the Lifeline Calls function of the North Bay Suicide Prevention Collaborative was implemented,” Pinizzotto said. “JPAs enhance economies of scale and most importantly reduce and eliminate redundancies.”
One of Pinizzotto”s accomplishments was saving hundreds of thousands of dollars by renegotiating a privatizing effort three years ago with Black Talon of Napa.
The county in that case literally ran out of qualified drivers, then had to hurriedly negotiate a contract that turned out to be very expensive and wasteful to the county.
Documented problems in other mental health privatization efforts include flight of qualified professionals from the area, loss of many services that were not properly described by government officials in RFPs and “cherry picking” of services in which the least sick clients were given full services and the most ill consumers were neglected. Fraud has also been found to have taken a big jump under privatization in several audits.
The American Academy of Child and Adolescent Psychiatry (AACAP), representing over 7,400 child and adolescent psychiatrists released a position paper about how privatization can and has sometimes led to such unintended negative consequences.
“In these instances, it has led to the fragmentation of treatment services by eliminating interdisciplinary teams and interagency programs. It has shifted service burdens and costs to other child serving agencies [such as education, child welfare, and juvenile justice], while diminishing the quality of services for children and adolescents. Children who are dependent on publicly funded health services [particularly poor and underserved] are disproportionately affected,” the position paper states.
Audits have also found that RFPs have been prepared without adequate public input and without adequate instruction to nonprofits and hospitals on how and what services to provide.
Pinizzotto said, so far, no RFPs have come from the Coast. The MCMHA board had not heard of the RFP process, although the thinking and planning is currently under way. Several Coast nonprofits contacted were not aware of the process or what services they might provide.
Criticism continues about the county”s lack of openness and reluctance to provide details about its plans, especially financial details. This reporter is still seeking financial details about where Mental Health Service Act (MHSA) dollars have been spent.
