Tuesday’s Santa Barbara County Board of Supervisors meeting was nothing short of historic as the supervisors listened for almost three hours to detailed findings and public comment about the county’s defunct Alcohol, Drug and Mental Health Services Department, a hearing that may have signaled a renewed interest from leadership in revamping the department.
In the past, county leaders have primarily addressed the ailing department through budgetary hearings, looking for ways to keep the department’s $78 million budget in line instead of examining its clinical operations.
That changed last year, however, when the supervisors commissioned two independent reports of the department, the results of which were released last week.
The findings bolstered what many community members and even the county’s grand jury have said in the past, calling for the department to more effectively serve people with mental illness and substance abuse.
Tuesday’s meeting was met with encouragement from the community, and mental health commissioner Ann Eldridge may have summed it up best.
“This report is the first time since I’ve been around that the board has really learned in great detail what goes on in this department,” she said. “I feel optimistic that great changes will occur.”
The next six months will be critical to get those changes under way, and Dr. Andrew Keller of Tri-West, one company behind the reports, outlined the changes to be made.
Keller said multiple times that while many of the department’s programs and staff are impressive, the organizational dysfunction is still there.
In 2008, the department discovered that bad billing practices meant the department owed millions of dollars to the state, which “was a tremendous blow,” Keller said.
Clinical systems atrophied as a result, and as clinical improvements advanced elsewhere over the next five years, the department was left behind, he said.
Santa Barbara County spends more on high-risk people than other counties, with 35 percent of Medi-Cal funding, or $10 million going to pay for services for 22 people.
Spending of 25 percent on this group is the average from other counties, making Santa Barbara County the outlier, he said, but adding that just because they are spending more for services doesn’t mean those people are getting better.
“The evidence doesn’t point there,” he said.
Over the next few months, the county has “an opportunity to do a new way of doing business,” he said, and must empower and better train front-line clinicians.
The financial processes of the department are sound, he said, but implementation of the Affordable Care Act will allow more people to qualify for Medi-Cal and staff will have to be increased to deal with that.
“You’re going to have to have clinicians helping them,” he said. “We believe there is more pent-up demand than what the county is expecting.”
A leadership vacuum is still present — the organization still needs a full-time medical director.
After Tuesday’s unanimous decision to move ahead with the changes, Dr. Takashi Wada, director and health officer of the county Public Health Department, will be a dual supervisor of public health as well as ADMHS. A temporary CFO of the department during the transition. TriWest will also stay on for a six-month period to supervise the changes in the department, many of which have already begun.
“There are culture changes that need to be made,” Supervisor Salud Carbajal said.
Small things, such as returning phone calls within 24 hours, need to be done right away, he said, and the department should remember to pay attention to customer service.
Leaders also spoke about making the county’s Psychiatric Health Facility, or PHF, more financially sound.
The way the PHF is licensed puts a cap on the amount of beds it can have, limiting any economy of scale advantage it might have. It also is unable to treat mentally ill people with more complex issues, such as people detoxing from drugs or alcohol, because it isn’t a full hospital.
Community hospitals aren’t actively engaged as partners, Keller said, and if a hospital stepped up to take on the role that the PHF has played, “we would recommend that you go with that,” he said.
A request for information is forthcoming to study whether contracting PHF services instead of continuing to employ county staff would be more effective.
Marian Regional Medical Center representatives are exploring building a mental health facility, and are working with the state on the facility’s licensure requirements and are also developing construction cost estimates for the project.
The Board of Supervisors is expected to receive updates on the progress later this year, and Supervisor Steve Lavagnino has been working with Marian officials during the talks, which are ongoing.
“Everybody say a prayer about that one,” Lavagnino said Tuesday.
Todd Cook, representing Cottage Health System, also spoke, and commended the report, saying they wanted the department to know “we’re there with them in the task they have before them.”
About 20 people spoke during public comment, many using words such as “hope” and “opportunity” during their comments.
“We’ve known for a long time there are very serious problems in the department,” Supervisor Doreen Farr said, adding that the report exceeded her expectations.