Head of County Mental Health Services Quits

Kathy Wachter-Poynor, whose seven-year tenure as head of San Diego County’s public mental health system was marked by controversies over patient care, long-range planning and personnel matters, will leave her post next month, county officials announced Wednesday.

The county’s mental health program caromed from crisis to crisis in the 1980s, and Wachter-Poynor, 40, has been under increasing fire from mental health professionals and advocates for the mentally ill, but county administrators said Wednesday that her departure as deputy director of Department of Health Services for mental health was a mutual decision.

“This was very much a joint decision,” said Dr. J. William Cox, director of the county Department of Health Services. “It was absolutely not a forced resignation.”

However, top county officials admitted that there was dissatisfaction with Wachter-Poynor’s performance--in particular, questions over her abilities as an administrator.

“Kathy’s a very capable person in her field, but the general conclusion is that she’s not a good manager,” said one county supervisor who requested anonymity. “My personal feeling is that she was not capable of doing the job and was in way over her head. I’m sure each supervisor told (Chief Administrative Officer Norm Hickey) their opinion. It may have been one of those cases where both sides decide it’s time for a change.”

Positive Developments

Other officials, noting that the controversy surrounding Wachter-Poynor had subsided somewhat in recent months amid several positive developments, speculated that she had simply decided that now was a good time to leave. Last month, a team of 11 state examiners praised the county’s mental health services, using phrases such as “best seen in the state” and “well-organized quality program” to describe particular programs.

“She’s been at the wrong end of a bazooka for seven years,” one county administrator said. “With the mental health department on an ascent, I think she probably thought this was a good time to get out.”

Cox added, “With this very laudatory finding on the job she’s done under very difficult circumstances, we sat down and decided, ‘OK, you’ve been exonerated, so now maybe it’s time for a change in coaches.’ ”

Wachter-Poynor characterized her decision to leave as “what’s best for me and best for the county.”

“I’ve never been one to run away from controversy and conflict,” said Wachter-Poynor, who joined the county mental health department in 1970 and rose through the ranks to become director in 1980. “But things have calmed down a bit lately, and that’s always the best time to make a change.”

Cox praised Wachter-Poynor for “getting this program back on its feet,” and credited her with helping to develop programs aimed at minorities, senior citizens and the homeless mentally ill, residential treatment programs and improving conditions at the County Mental Health Hospital in Hillcrest--all at a time of “considerably inadequate funding.”

But some mental health professionals and activists were less charitable in their assessment of Wachter-Poynor’s performance.

“I think it’s great news,” said Bob Haack, president of the San Diego Alliance for the Mentally Ill. “I felt she wasn’t competent to do the job in the first place. There has been some minor progress, but the problems still are there. It’s like when a baseball team is losing--it’s the manager who’s got to go.”

Best Job Possible

Wachter-Poynor countered the criticism by saying she did the best job possible, given the lack of money and attention devoted to the mental health department by the Board of Supervisors and the public during most of her tenure.

“It’s like driving an old jalopy . . . that’s held together by baling wire and falls apart every few blocks,” Wachter-Poynor said. “The board has now made a major commitment to mental health, but funding is still a major, major problem.”

Betty Snyder, executive director of the San Diego Mental Health Assn., concurred, adding: “When you look at what she had to work with, I think she did a fine job. You can’t get blood out of a turnip.”

Even her detractors acknowledge that Wachter-Poynor labored under seriously inadequate funding for mental health programs. However, they complain that under her leadership, funds that were available were not spent wisely, noting that the number of beds at the Hillcrest facility, also known as CMH, declined from 92 to 60--in part to improve the level of patient care--even as demand increased.

In addition, Wachter-Poynor’s critics fault her for what they viewed as insufficient long-range planning and ineffective supervision of existing services.

“At some point, you’ve got to stop using the lack of money as an excuse and say a better manager could find ways to make the money go farther, to find more beds, to solve some of these problems,” Haack said.

Cox, however, said that Wachter-Poynor has “taken a real bum rap” for problems beyond her control in the county’s mental health program.

“She’s done a remarkable job of taking ‘Mission Impossible’ and patiently and efficiently turning things around,” Cox said.

Much of the criticism of the county’s mental health program focused on CMH, which the state nearly closed out of concern for patients’ health and safety. In early 1986, the federal government revoked the hospital’s eligibility for Medicare funds because of the substandard patient care.

Turned the Corner

The 32-bed reduction at CMH, combined with an increase in the hospital’s staff, have since helped to improve the level of treatment at Hillcrest. Last summer, the state Department of Mental Health gave the facility a positive report. Despite hailing that report as evidence that CMH had turned the corner, the county subsequently gave up its battle to regain Medicare funding; the $1.5 million in lost revenue now comes out of the county’s general fund.

However, the solution to one dilemma worsened another problem, because the reduced capacity at Hillcrest eliminated beds from an already overburdened system, resulting in chronic overcrowding that sometimes forces CMH to temporarily close its doors to new patients. That, in turn, forces private hospitals to keep indigent mental patients in their own emergency rooms for longer periods before they can be transferred to CMH.

Wachter-Poynor, however, described the changes at CMH as “day and night . . . compared to a couple years ago,” including that development among “a whole pattern of progress” that occurred during her service.

“Ten years ago, we were basically providing an outpatient service,” Wachter-Poynor said. “Now we have a continuum of services, from care for the homeless and seniors to residential and outreach programs. On balance, I’m very pleased.”

Wachter-Poynor’s resignation is effective Nov. 12 but because of unused vacation time she will officially remain on the county payroll until mid-January. She said she plans to remain in San Diego but hasn’t “started seriously thinking about” other public and private opportunities in the mental health field.

“I’m just going to decompress for a while, and then I’m going to see if there’s life after mental health,” she said. “I’m sure it’s out there somewhere.”