State Audit Finds Lack of Care for Mentally Ill

The state Department of Mental Health is recommending that Ventura County be stripped of $5.4 million in annual funding unless it fixes what auditors say is a troubling deterioration in services for people suffering from mental illness.

Mental health care for children and adults has declined so much in recent years that Ventura County no longer qualifies as a state leader in providing mental health services, a standing that would entitle it to $5.4 million in extra funding each year, according to an audit released Tuesday.

Other major findings in the 30-page report include:

* A climate of “fear and intimidation” exists between top management and other employees in the county’s mental health agency.

* An “exceedingly high” number of patients are hospitalized in the psychiatric ward at Ventura County Medical Center instead of receiving less restrictive and less costly care.

* The role of psychiatrists has eroded, leading to “misunderstandings” about their role.

* And, the county’s attempt last year to merge its mental health and social services departments contributed to “significant stress and chaos,” but is not the primary reason for deteriorating services.

State Sen. Cathie Wright, who called for the audit in March, said the report underscores her belief that organizational changes in the mental health department earlier this year have damaged the county’s once-sterling reputation.

The Simi Valley Republican says she lays the blame on Health Care Agency Director Pierre Durand, who took control of the mental health department and other health care units in 1995. Durand could not be reached Tuesday for comment.

“He has massacred a program for individuals who need help the most,” Wright said. “Ventura County was a star, and it’s not anymore.”

But Ventura County Supervisor John K. Flynn, a supporter of Durand, says the report simply points out areas where the county needs to improve. The county should not “play bureaucratic red tape” in an attempt to please the state, Flynn said.

“We ought to look at it as a healthy report,” he said. “We need to look at the good parts and try to find a system that suits Ventura County. If it doesn’t fit the requirements of the state . . . we’ll find other money to fund the system.”

Significantly, the audit did not find that money was improperly funneled out of the mental health department to pay for other public health programs--a charge that Wright and other critics have leveled at Durand.

Auditors found that all transfers of money were done within the authority of the Board of Supervisors and that costs charged to the mental health department were allowable. In fact, the team found that more county funding to support mental health programs is provided than is legally required.

Even as auditors found fault with the county, the review team noted that the state has not given counties clear guidelines for providing mental health programs.

The next step is for the county to tell the Department of Mental Health by July 1 whether it plans to fix the problems mentioned or risk losing funding for the next fiscal year. Additionally, it must submit a written plan outlining how it will correct problems by Nov. 1 and agree to allow state monitoring of its mental health programs.

Warring camps have been struggling over the direction of the mental health department for months. One camp, led by Wright and Supervisors Susan Lacey and Kathy Long, believes that mental health services should be offered by teams composed of psychiatrists, psychologists and social workers who have equal say in how treatment is delivered.

But the other camp, led by Durand, Flynn and Supervisor Frank Schillo, has pushed to give psychiatrists a greater leadership role, saying that is what federal officials require. A separate federal audit is underway to determine whether the county followed Medicare billing guidelines, which mandate that doctors have direct authority over medical decisions.

The differing opinions came to a head after a disastrous attempt last year to merge the county mental health and social service departments. The merger was rescinded after nine months, in part because federal Medicare reviewers said it violated federal billing guidelines.

Former mental health chief Stephen Kaplan was ousted for his role in the attempted merger. Kaplan supported the merger, and Durand, his boss, opposed it.

When Durand proposed making other changes in top management, Wright called for the state audit.

The review team, made up of mental health professionals and consultants from across the state, was highly critical of changes in the county’s mental health programs in the past few years.

To qualify for special funding, the county must follow the state’s “Systems of Care” program, which was designed by Ventura County in 1984 and was copied statewide. The program calls for patients to receive services from a team of mental health professionals and to treat patients in the “least restrictive environment” possible.

However, auditors found that hospital inpatient days increased from 260 to 2,408, a whopping 826% jump, during a three-year span ending last June. The patients could be better served in residential treatment facilities on a voluntary basis, a move that would also free up more money for other mental health services, the reviewers found.

Auditors agreed that psychiatrists need to play a larger role in leading the county’s mental health teams, a position long supported by Durand. But the report adds that the doctors must be knowledgeable of the principles of Systems of Care to be effective.

The report also determined that other mental health services had been eliminated or diminished over time. Auditors cited vacant team leader positions, rising caseloads and the inability of patients to get appointments with psychiatrists as evidence of an erosion in quality.

Among other findings, the report states:

* There is no way to evaluate whether adult programs are working or have resulted in lower costs, which is a state requirement.

* Top management “does not understand” programs for mentally ill adults and has not included the Mental Health Board, a community advisory group, in its reorganization plans.

* And, each team should have a full-time psychiatrist.