County’s New Mental Health Chief Emerges From the Battle a Winner

When Areta Crowell walked into San Diego County’s mental health division in May, she stepped into a no-win situation that could have toppled the best of bureaucrats.

What should have been the new mental health chief’s administrative honeymoon turned out to be a battle for the program’s future. Her new bosses, the county supervisors, were proposing to cut the budget for treating the mentally ill by $7.5 million, and it was up to Crowell to figure out how to proceed.

Maybe it’s those sensible shoes she wears, for Crowell walked away from the fracas respected and admired by virtually everyone involved in the budget controversy.

Furthermore, $4.3 million of the proposed cut was restored to her budget.

‘The Bottom Coming Out’

“I have come to look at this person with a tremendous amount of respect, that she walked into (a situation with) the bottom coming out of it and has dealt really effectively with this situation. She has done a wonderful job of bailing it out,” said Hobie Hawthorne, executive director of the Community Research Foundation, which contracts to run several mental health programs for the county.

And Crowell’s strong emphasis on planning already promises to give the county’s $56-million mental health system the clear sense of direction that critics said was missing under the administration of Kathy Wachter-Poynor, who quit in November amid criticism that she lacked the administrative experience and clinical savvy to run a system beleaguered by overcrowding and underfunding.

“I didn’t realize how much we really missed the kind of leadership that (Crowell) had to offer until she got here,” said one prominent mental health treatment official, who asked not to be identified.

Brown eyes twinkle behind Crowell’s glasses as she laughingly recalls the hectic pace since May 13, her first day on the job:

Three weeks to define criteria for the cuts and to write an unusually blunt position paper detailing the devastation they would cause. A standing-room-only hearing June 8 before the county’s Mental Health Advisory Board. An even bigger crowd at a county supervisors’ hearing on the cuts June 21. Restoration of most of the money July 1. Then development of guidelines for the remaining cuts, which will be implemented by Sept. 30.

Yet during those first two months on the job, Crowell still found time to visit all but one of the more than 50 mental health programs the county sponsors.

May Not Agree, But Listens

“Quite a few people said, ‘We’ve never met a mental health director before,’ ” Crowell said. “That’s important to me, that people know that I’m a real person and that I really care, and that I want to listen. I don’t always agree, but I listen enough to help shape the policy to reflect the local reality and the local needs.”

That message appears to be making a difference to a system that has lurched from one crisis to another over the past few years. Problems peaked in 1985 when four deaths at the county’s mental hospital in Hillcrest were linked to substandard care.

Principals throughout the mental health community agree that Crowell’s gentle style is healing old wounds.

“She’s making us all feel better,” said Helen Teisher, a longtime advocate for the mentally ill in San Diego and herself the mother of a schizophrenic son. “The morale among the people that I know is very good.”

At 5-foot-3, Crowell hardly presents a commanding physical presence when she walks into a room in those sensible, low-heeled shoes. Practicality is her style, from the close-cropped hair to the understated executive ensembles she wears to the office.

But what stands out most about Crowell--and what appears to be a key to her success--is character. She radiates sincerity, openness, commitment, personal warmth and a passionate belief that individuals can make a difference. She transforms phrases that could seem like political platitudes into an invitation to help her change the world.

And make no mistake about it: Areta Crowell has that at the top of her agenda.

‘Values Drive the Public’

“We learn in our professional training something about technology and something about administration, but nothing about values. And it’s values that drive the public sector,” Crowell said.

“That’s why it’s so important to have public education and information to shift the values of the community at large to the point that they can be supportive and understand the need for mental health programs. Most people, I think, still don’t understand that.”

Witness the recent fuss over whether presidential candidate Michael Dukakis had ever sought psychiatric help because of grief over his brother’s death and over disappointment at an election loss, she said.

“How typical of our country. People don’t understand how important this is to one’s health--to be able to acknowledge that you need help.”

But even as Crowell is critical of societal ignorance, or as she complains about someone who “knew damn well” he was violating a county policy, there is conciliation in her tone.

It is this same ability to deal with conflict while robbing it of its divisive potential that stood out in her handling of the budget problems.

Despite her support for critics of the county’s plans, she managed to please the county executives and supervisors who had ordered the cuts. Patients and health-care providers came away from public hearings elated at having been heard. In fact, everybody ended up on the same side of the fence.

In contrast, the Los Angeles County mental health system that Crowell left--which faced similar budget problems--was sued over its cuts.

Arlen Versteeg, director of mental health services for San Ysidro Mental Health Center, said, “This is one of the first times that I’ve been involved in this kind of issue where you had virtual unanimity of approach--the providers, the patients, the board aides, the patient management staff, all the professional groups.

“All were unified in their approach to try to reduce these cutbacks. It was very well done.”

Yet Crowell also deflected suspicion among patients and their doctors that the county was merely grandstanding with the mental health budget, overemphasizing the problem to win points in a dispute over state funding. (The county is suing the state, contending that state support to county programs is too low, by $18 million a year.)

“I don’t play games. I refuse to play a game around that,” Crowell said. “I wouldn’t make it the worst that I could to make the most impact. And some people would. Some people believe you should do that.”

Consistency Important

Likewise, it is important to be consistent, she said.

“I’ve always felt that you have to be straight and honest, and you don’t put forward a plan that you would do something and then if you still have to cut, you change your mind and do something else,” she said.

Still, the original proposal for drastic cutbacks did “put some of the screws on Sacramento” by calling attention to the state’s underfunding of mental health services in the county, she said.

Did Crowell expect such a large public response?

“I hoped for it,” she said with a laugh. “You can never, never expect something good. You just hope for it. I’d have been disappointed if it hadn’t happened, but I couldn’t say I expected it.”

A manager who values the process of consensus building, Crowell labels as “wonderful” the administrative tone set for the county by Chief Administrative Officer Norman Hickey.

“I think the CAO is trying to create an atmosphere of collaboration and cooperation and joint problem-solving among the departments,” she said. “That is so refreshing to me, and something that I value very much and love to see happening as a value in this system.

“They’re really trying to put an end to the back stabbing, individual, power turf system that is so common in large bureaucracies.”

Crowell, 52, has a doctoral degree in psychology from McGill University in Montreal, with an emphasis on decision-making. In 15 years in mental health administration for Los Angeles County before coming to San Diego, she used that expertise in planning and policy development. She was seen there as a compassionate but no-nonsense manager skilled at coping with financial hard times, a reputation that followed her when she moved to San Diego.

Today, she continues to be active among administrators statewide in lobbying Sacramento for better mental health funding. In San Diego, she is examining policies for ways to increase money garnered from programs such as Social Security.

She also is placing her mark on a long-range planning process for the mental health system that was under way before she arrived. Chiefly, observers say, Crowell’s influence has been to pull together disparate planning efforts to give a coordinated look at the total system. She also has brought mental health contractors and the Mental Health Advisory Board into the process.

These planning efforts, as well as the support that comes from substantive public involvement in the process, are especially important as money remains short, Crowell said.

“You do the best you can within what you’ve got,” she said. “We juggle the best we can, but at some point we have to say, ‘OK, we’ve got a real tough bottom line to live with.’ ”