As Mentally Ill-Homeless Crisis Grows, State Aid Lies Unspent

Even as San Diego County sues to gain parity in mental health funding with other California counties, more than $3.3 million in state money intended for impoverished, mentally ill San Diegans has gone unspent within the last year because of administrative delays within county government.

The county has yet to spend any of the $1.5 million sent here by the state to reimburse board and care homes that take in chronically mentally ill patients, county mental health officials confirmed this week.

Yet San Francisco, which is often cited by local officials as a county that receives far more than its share of mental health funds, was able to get the same program off the ground so quickly that the county spent its entire allocation for the 1985-86 fiscal year and then requested, and received, additional funds for that year from the state.

These disclosures come on the heels of criticism of San Diego County’s mental health division for taking too long to spend $1.28 million in state money intended for the mentally ill homeless, including a $640,000-a-year program that will not open its doors until at least 13 months after the money for it first became available.

Together with other, ongoing problems within the San Diego County division of mental health services, frustration over the spending delays has prompted members of the county’s Mental Health Advisory Board to consider tonight a vote of no confidence in Kathy Wachter-Poynor, who has directed the division since 1980.

Dr. Jay Shaffer, a psychiatrist and chairman of the advisory board, declined to discuss the mounting displeasure with Wachter-Poynor’s administration, other than to confirm that the matter is scheduled to be considered by the board tonight. But Shaffer said he, too, is frustrated by what seem to be undue delays in translating state funds into local programs for the mentally ill.

“The county is tremendously underfunded, but that’s not an excuse for not using the funds we already have as quickly as we can,” said Shaffer, whose tenure as chairman ends today. “It appears that there are unnecessary delays, and that is something we ought not to countenance, not to stand for.”

Municipal Judge Robert Coates, a key advocate in getting more funds for the homeless, said he was equally frustrated.

“If the ordinary person on the street saw a four-alarm fire in a chemical factory, they would not think it tolerable to take a whole year to let a contract for someone to go put the fire out,” Coates said, calling the situation of the homeless “absolutely inconsistent with our idea of civilization.”

County officials point out that they are already spending hundreds of thousands of dollars on the mentally ill homeless and $2.5 million on residential treatment facilities. They say a variety of factors contributed to the delays that have kept the two new major programs from getting under way.

The county in January received $1.28 million for the mentally ill homeless and an additional $513,000 to supplement payments to operators of board and care homes who agree to take difficult patients. Those monies were for the 1985-86 fiscal year and, by August, the county had received another $1.3 million for the homeless and $1 million for the board and care homes.

As of this week, more than 10 months after the first money arrived for the board and care program, none of it has been passed on to the homes.

Steve Harmon, associate director of mental health, said the county had trouble recruiting a person for the job of certifying the board and care homes and reviewing the clients to decide which would be eligible for the supplemental funding. That task was completed in June, Harmon said, but since then, negotiations between the county and the local board and care home industry have been stalled over the question of how much insurance the homes should be required to obtain.

Harmon said six homes have signed agreements with the county and 23 more are expected to do so soon. In all, about 60 home operators have expressed interest in the program. Harmon said the county will be able to pay retroactively to June many of the homes that were certified by that date.

San Diego’s experience with the board and care issue contrasts sharply with that of San Francisco, the county most often cited by local officials who contend that San Diego has suffered greatly by receiving far less money for mental health services than other California counties.

Like San Diego, San Francisco was eligible to receive the funds on Jan. 1. But unlike San Diego, which took until June to inspect and certify the homes that applied to join the program, San Francisco health officials began checking board and care homes even before the money was available. Then, when that county was able to get agreements signed with the home operators, the operators were paid retroactively to the date the program began.

As a result, San Francisco used its entire $275,000 allocation for the 1985-86 fiscal year and received an additional $195,240 on top of that.

“Our board and care operators have been suffering for a number of years,” said Reiko True, director of the mental health division for the City and County of San Francisco. “We just put this as our No. 1 priority and put our staff to the task.”

To further save time and resources, San Francisco has now contracted with a private agency to help manage the program. That agency will receive the funds from the county and reimburse those certified homes that provide the care to the seriously ill patients. Through this method, San Francisco works with just one agency rather than the 60 individual homes, which, as San Diego is now learning, can be an administrative headache.

San Francisco, for instance, required only its intermediary to carry a special insurance policy for the program; the question of special insurance for the board and care homes never arose there, True said. In San Diego, by contrast, the question of what kind of insurance the homes will be required to provide has been the major stumbling block to getting the program moving.

John Ornelas, chairman of a committee of board and care operators that has been negotiating with San Diego County, said San Francisco’s ability to get the same program running months ahead of San Diego is evidence of incompetence in the administration of the local mental health program.

“I have the feeling that in top management, you have people who may want to do the job, but don’t know how. . . ,” said Ornelas, who plans to speak before the advisory board tonight. “They’re inept. They just can’t do the job right. Not that they are deliberately doing it, but they just don’t know what to do. That is the bottom line, the blind leading the blind.”

But Chief Administrative Officer Norman Hickey, in a letter to Supervisor George Bailey, blamed the delay on the stalemated negotiations, which he said were not the county’s fault.

“The county awaits only the execution of the purchase order agreement by the community care facilities who wish to participate,” Hickey wrote. “The purchase order agreement addresses all the legal, purchasing, insurance and programmatic concerns of (the) county staff. The ball is now in the community care facilities’ court to get this program started.”

San Diego County’s money for the homeless, meanwhile, went unspent for different reasons. By the end of the last fiscal year in June, the county had spent only $11,000 of the $1.28 million in state money it received Jan. 14 for the homeless mentally ill. That amount went to a private agency to recruit volunteers to work one-on-one with the homeless mentally ill. Since then, a county-run program and two more contracts with private agencies have been established.

But the major program, a $640,000-a-year downtown residential center that will provide psychiatric treatment, will not get under way until at least February, and even then only if the city permit process goes smoothly.

The contract for that program, to be operated by Community Research Foundation, was tied up for several months while county officials investigated allegations about the foundation’s management and the handling of the bid review process. Even without that delay, county officials say, it would have taken as long as six months to award the contract.

It takes this long, officials claim, to solicit proposals from private agencies, give those agencies time to respond, and then review their bids and recommend a choice to the Board of Supervisors. The mental health division takes longer than other county units because major contracts are reviewed by the Mental Health Advisory Board before requests for proposals are sent out and after the final contract is negotiated. In addition, county contracting procedures have been lengthened since a major scandal in the awarding of a microwave communications system contract in 1982.

Hobie Hawthorne, executive director of the Community Research Foundation, said he “felt bad” about the length of time it took his agency to secure the contract. But he said he understood the burden carried by county administrators who contract with the private sector.

“If you expedite the process too much, something horrible is going to happen,” Hawthorne said. “Someone is going to take the money and run and then the media are going to come in and beat them (county officials) over the head for it. They go too fast and they make a mistake. They go too slow and it takes too long. They’re between a rock and a hard place.”

Frank Landerville, head of a regional homeless task force who formerly worked for the county, agreed that contracting procedures may be difficult to speed up.

“Each step seems reasonable at the time, but looking back, it doesn’t seem to be reasonable to require more than a year to get into place a service that everyone agrees is a top priority,” he said.

But Landerville said the county should have anticipated that it would have money it wouldn’t be able be spend on the program, given the rule of thumb that six months or more is required to get a contract into operation. If it had done so, the county could have had simpler, easier-to-fund programs ready to put into operation with the unspent money, such as buying additional beds in homeless shelters.

Instead, the county mental health division just now is drawing up a final list of such easier-to-fund programs on which to use last year’s unspent monies.