A report commissioned by the Santa Barbara County Board of Supervisors has delivered a scathing assessment of the embattled Department of Alcohol, Drug and Mental Health Services.
“Dysfunctional” and characterized by “significantly suboptimal performance” are phrases used to describe ADMHS in the report, which was released last week. The supervisors had authorized the review last year to evaluate the changes needed in the department.
After years of complaints from mental health consumers and families, the recommendations offered in the report could signal a sea change for quality of care if approved by the supervisors. The board has set aside two hours to look at the issue at its Tuesday meeting.
The company behind the report is TriWest Group, which was hired by the county to examine how ADMHS was using its limited resources to serve patients.
The report looked at everything from the department’s clinical operations to its billing systems, and the team made more than 400 contacts to interview department leadership, contractors, law enforcement and others in the course of the review.
“In spite of many excellent programs, clinicians and physicians, and in spite of significant successes improving core functions in the fiscal and compliance areas, the ADMHS adult and child systems of care are not producing the clinical outcomes for the citizens of Santa Barbara County that would demonstrate the most effective utilization of resources,” the report states.
The county should move “as quickly as possible” to reform the system for better patient outcomes and fewer costs, it says.
The department also must overcome the perception — internally and externally — that ADMHS is “crisis driven,” the report says, adding that it must become service-driven to better assist patients.
Much of the improvements will rely on cultivating leadership within ADMHS, instead of relying on the “top-down” approach the department has embodied historically, according to the report. Building on the existing strengths of staff and the leaders of contracting associations will be key, the report says.
The report also calls on ADMHS to continue reaching out to Hispanic patients. While more than 50 percent of its patients are Latino, only 37 percent of the staff speak Spanish.
A lack of strong relationships between the department and other county agencies prevents funding from being leveraged across departments, the report states.
According to the report, “critical gaps” also exist with more complex patients, like people involuntarily committed to the county’s Psychiatric Health Facility, homeless people or others in the criminal justice system.
How mental health workers classified patients as “5150” — the state code qualifying that individuals can be hospitalized against their will if they are a danger to themselves or others — has also been inconsistently applied, the report states.
Progress has been made in that area, the report says, and the legal definitions of 5150 have been reviewed among staff.
Access to psychiatric services is also lacking, according to the review. The report found it takes an average of 66 days for a first-time adult patient to see a psychiatrist, and 73 days for children.
The department’s Medi-Cal reporting process of the department is sound, the report states, although the county depends more on Medi-Cal than most California counties.
The report warns that ADMHS could face additional financial risk as the Patient Protection and Affordable Care Act is implemented next year and services are expanded.
Most of the comparison counties also spent more money per capita on mental health and alcohol and drug programming than Santa Barbara County, the report finds.
Another assessment was also commissioned by supervisors last year, when the board hired Health Management Associates to explore the possibility of consolidating a mental health treatment center at Marian Regional Medical Center.
That facility may include geriatric psychiatric beds, voluntary and involuntary acute psychiatric beds and crisis residential services. Substance abuse and medical detox services are also being discussed. HMA found that the facility could be fiscally sound if it provided up to 20 beds.
Marian Regional Medical Center representatives are currently 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.
Because the Psychiatric Health Facility, located in the county complex at 315 Camino del Remedio in Santa Barbara, has just 16 beds, the county pays for five additional beds in Ventura County — at an annual cost of $1.1 million. That contract was recently increased.
“The Marian facility will provide both voluntary and involuntary beds, likely diminishing the out-of-county contract demands,” the HMA says in a letter to supervisors.
The report looks closely at the Psychiatric Health Facility and acknowledges the challenges the unit has faced, most notably .
Along with “the legal ramifications, Detty’s death led to state audits and a Centers for Medicare and Medicaid Services audit that revealed the unit had been functioning under an acute hospital certification without meeting the required criteria”, the HMA report states.
Staff worked hard to update policies that were lacking, but the unit continues to face challenges, according to the document. The report also notes that some federal guidelines still haven’t been met, including the hiring of a dedicated medical director for the PHF.
The report also outlines other critiques, including the lack of active treatment, “with patients often wandering the halls or sleeping.”
Terri Nisich, the county’s assistant CEO, will be presenting the report to the Board of Supervisors on Tuesday, along with Andrew Keller, a TriWest Group partner, and Dr. Takashi Wada, director and health officer of the county Public Health Department.
Supervisors will be asked to approve the organizational structure plan, which includes keeping Wada as a dual supervisor of public health as well as ADMHS, and bringing in someone else as a temporary CFO of the department during the transition.
Nisich said the board will also hear a recommendation to retain TriWest for a six-month period to supervise the transition.
“This first year is going to be really important,” to the restructuring effort, she said, adding that there’s been a positive attitude about moving the department forward.
A CEO Advisory Committee was formed to give input on the process, and it met for a total of 30 hours to review the findings.
Another group, the “Tiger Team,” was also formed to help develop the policy direction of the Board of Supervisors resulting from the consulting team’s work.
Both groups will remain intact as the transition proceeds, and Nisich said a number of community members have expressed an interest in being a part of that group.
“We may expand that,” she said.
Although the supervisors were briefed a month ago, the board saw the reports in their entirety for the first time Thursday.
Tuesday’s meeting begins at 9 a.m. at the County Administration Building Board Hearing Room, 105 E. Anapamu St. in Santa Barbara.