Fort Bragg Advocate-News
Hospitals and clinics in Mendocino County are involved in a behind-the-scenes process both to recreate mental health care and respond to Mendocino County”s efforts to privatize mental health services.
At the request of the Mendocino County Mental Health Board, Susan Era and Sharon Kichli provided information about the new group at MHB”s March meeting.
“There is a group of people who are meeting. There is no name to the group. ? We have invited everybody we could think of who is currently providing mental health services,” said Kichli.
“I call it the Mental Health Planning Group,” interjected Era, a long-time public employee and now private consultant in Ukiah. The Mental Health Planning Group started out with three programs that deal with children”s mental health issues, including Tapestry Family Services in Ukiah, of which Kichli is executive director.
The two women said the Mental Health Planning Group is now composed of 25 people, including the CEOs of all three county hospitals, representatives of the clinics, tribes and others invited.
“The vision is how to work toward having an integrated collaborated, cost effective co-ordinated system of mental health services throughout Mendocino county, which reaches into the various communities and is integrated and connected, so all the various components of any services are talking together,” said Era.
Neither Mendocino County mental health nor the Mental Health Board have been invited into “The Group” as of yet. One reason is the county is working on a Request for Proposals (RFP) in order to privatize some of the mental health services now provided by the county. Contractual rules mean the county can”t play favorites and discuss the RFP with anyone who might bid.
“The only reason we don”t have county mental health sitting at our meetings is we don”t want to jeopardize our ability to respond to the RFP, and we want to do that,” said Era.
The intention is eventually to bring the public, county and mental health board into the process, Kichli said.
The Mental Health Planning Group was actually initiated by The Community Foundation, in an effort to get government, nonprofit and private providers to work together to solve serious problems with mental health and homeless services. The legal inability of the county to talk about its RFP and the mystery about when the RFP might be coming out derailed the initial public-private effort in favor of nonprofit and private agencies working as a group. County mental health also has a track record of having difficulty with including other private and government agencies in its processes. The three children”s services agencies then started the community study process rolling, inviting in every group involved in mental health.
Nobody at the mental health board meeting, including Tom Pinizzotto, recently moved from temporary to permanent head of the mental health branch, could say when the county”s RFP might be coming out, or what currently public services it might put to private bidding.
“I”ve been hearing that the RFP is coming out since I joined the board,” said Fifth District Supervisor Dan Hamburg, who is the board”s representative on the Mental Health Board.
“It”s been a year and a half and we still don”t know when this RFP is coming out,” Hamburg said.
The RFP originated in County CEO Carmel Angelo”s office. Mental Health Department advised the Mental Health Board in April 2011 that an RFP was being prepared, but so far there have no details about its contents, nor who envisioned what should be in the RFP. It is now being worked on in the county office of general services, the legal and financial branch.
Hamburg said if the MHB doesn”t get to see the RFP until it is released for responses “it”s almost too late” to shape it. The MHB is hoping for an advanced peek. County Mental Health Boards are intended under state law to have special powers above other advisory boards.
The RFP is now just one part of the work of the Mental Health Group. MendoFutures has been facilitating its meetings. MendoFutures helps community groups come to the same table to create community solutions. For example, MendoFutures helped create community food plans for the Coast, Ukiah and Willits.
There have been two meetings of the entire Mental Health Planning Group so far and many meetings of smaller committees, Era said. In response to Hamburg”s question about a timeline for the Group”s process, Era said members have committed to working for the long term. The Mental Health Planning Group will help service providers respond to a variety of challenging issues, such as health care reform and the complex array of funding issues related to federal and state funding.
“Commitments of people participating are for the long run. It”s a big vision for a long-term. In the meantime is this RFP issue,” Era said.
She provided some examples of big questions they are grappling with.
“What would it look like if we had an integrated system? What could it look like? What has really worked? What isn”t working?” she said.
At an upcoming three-day conference, invited members of the Group, mental health board and public will hear from speakers, mostly from other areas, especially where services have been redesigned successfully. The event is not open to the public.
“[The Mental Health Planning Group] is very intimately involved in looking at examples of best practices,” said Judith Harwood, facilitator of the Group for MendoFutures.
It is unclear whether providers of services for the developmentally disabled or substance abuse are among the members of the group at this point. Harwood deferred those questions to group members. This reporter is waiting for responses to questions emailed.
Several people raised the question about whether the RFP and the entire process of shifting county mental health services to private agencies could favor local nonprofits, clinics and hospitals.
Hamburg said that was his preference.
“We have tremendous amount of talent here in Mendocino County. I want to keep it as local as possible. I don”t know about this RFP, but we do have a local preference built in to some contracts,” Hamburg said.
MendoFutures has gotten widespread community support and has hundreds of people in its network. The unpaid facilitation process is led by Harwood from her Branscomb home.
Studies of mental health privatization in other states have found care quality declining when it has moved from the public to private sector. One reason for this is that big managed care corporations often bid on RFP”s then provide extremely minimal services, studies show. These managed care firms are expert at finding ways to do the minimum and have no experience in the community, yet often win out over those who provide local services, audits and studies have found. These managed care companies often had not done business in the areas until RFP”s came out, studies show. In the end, larger efforts to let market forces run mental health departments costs more than the old fashioned way of doing it, several Southern states have learned the hard way, according to official audits in those areas.
Mendocino County privatized its mental health transportation services, using a contractor in Napa, Black Talon. Some children”s services have also been privatized, without the controversy that accompanied the costly Black Talon contract, which Pinizzotto slashed deeply upon arriving at the county more than a year ago.
