Los Angeles County supervisors voted Tuesday to move toward consolidating three departments dealing with different aspects of public health. But they did so over the objections of mental health advocates who worry that those services will get buried in a larger health agency.
The move, proposed by Supervisor Michael D. Antonovich, would integrate the departments of public health—responsible for controlling disease outbreaks, managing substance abuse programs and conducting health inspections—and mental health with the Department of Health Services, which runs county hospitals and clinics.
The proposed restructuring comes at a time when several other parts of the nation's largest local government are in transition. Since two new supervisors were elected in November, the board has begun to reconsider the county chief executive's role, revisit decisions made by the previous board, shuffle key administrative employees and renew a search for someone to oversee the troubled child welfare system.
The health agencies were once a unified department, but mental health was separated in 1978 and public health in 2006, to allow them to focus more on their specific missions. Antonovich said combining the agencies now would streamline costs and provide a more comprehensive service to patients. The federal healthcare overhaul also encourages integration of health services.
Proponents of the plan — including health services director Mitch Katz, who would probably be tapped to run the consolidated agency — said the three departments would maintain separate budgets and have their own directors but would be overseen by a single director.
"I believe that having the three health-focused departments working more closely together will provide better services to patients and result in less bureaucracy and better efficiency across the county," Katz said.
Dozens of mental health service providers, advocates and people dealing with mental illness expressed concerns at Tuesday's supervisors meeting.
"Mental health, addiction medicine and population health … are as important to the overall health of the community as good physical health, and need to be equal partners in the dialogue," Richard Van Horn, president emeritus of Mental Health America of Los Angeles, told the board.
Others said mental health would inevitably become a "stepchild" in a larger agency. Some advocates also complained that the proposal appeared to be getting pushed through without sufficient discussion with the people who would be affected.
Larry Gasco, chairman of the county's mental health commission, said the volunteer commissioners found out about the proposal last Thursday.
"Blindsided is a kind word," he said.
As a result of the public pushback, supervisors agreed to include public health and mental health officials — as well as officials from the Sheriff's Department and agricultural department, and stakeholders in the community — in the process of coming up with a proposed structure.
Officials in the mental health department learned of the impending vote last Tuesday, although mental health director Marv Southard said he had been told late last month that the board might consider consolidation in the coming year. Southard told the supervisors his staff would work to provide good service regardless of the department's structure.
In an emailed response after the meeting, Southard said, "I appreciated the support for mental health services articulated today by the public and feel that the discussion clarified for me my biggest concerns."
The supervisors also sought to allay the fears of some county employees and labor leaders that the consolidation would mean job and service cuts.
"A consolidation done right could help cut through the bureaucratic delays that impact patients on a daily basis," said Bob Schoonover, president of Service Employees International Union, Local 721, which represents about 55,000 county employees, including healthcare workers. "But if done wrong, there is a potential to end up with cuts to essential services, including communicable diseases, mental health assessment, as well as reduced access to care and fewer healthcare providers."
Supervisor Mark Ridley-Thomas told the critics, "This is not about cutting dollars for services.... What it is about is better coordination and integration."
A report is due back in 60 days on the proposed structure for a consolidated health agency and potential benefits and drawbacks of moving ahead.
Katz sent a memo to the board members this month outlining his proposal for a restructured health agency. County officials would not provide The Times with a copy of the memo as of Tuesday. Initially a spokesman for the health services department said the memo was confidential. Katz later said that he did not object to releasing it, but referred The Times to Patrick Ogawa, the acting executive officer for the Board of Supervisors, who said it had to be reviewed by county attorneys first.
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