Mental Health Director’s Optimism Will Be Tested in L.A.

Three years ago, when Areta Crowell took over as director of San Diego County’s mental health services, more than one person warned her that the system was a shambles.

She was determined to see for herself, and, during her first two months, she doggedly visited all but one of the county’s more than 50 mental health programs. Amid the disorder and fragmentation, she says she found pockets of creativity and dedication that convinced her there was hope.

“It was just a matter of helping people reaffirm their mission and find ways in which they could get more mileage out of what they were doing,” she said this week, looking back on 40 months during which, some say, she restored respectability to the San Diego system. “You can’t pretend everything’s fine. You have to be realistic about the unmet needs. . . But it does no good to go around beating our breasts.”

This week, when Crowell, 55, agreed to head Los Angeles County’s beleaguered mental health system, she applied that same optimism to what she acknowledges is an even bigger challenge. Under the constant threat of budget cuts, Los Angeles’ huge mental health operation suffers from low employee morale and, many say, lack of direction.

“It’s probably the biggest, toughest job in California,” said Crowell, who spent nearly 20 years working in mid-level management jobs in the Los Angeles County Mental Health Department before she came to San Diego. “For a long time, I said, ‘Who needs it?’ But I’ve been given assurances of support. If it can be done, I have as good a chance as anybody in helping L.A. get itself together.”

The Los Angeles County Board of Supervisors, which voted to offer the job to Crowell, is scheduled to formally approve the contract Tuesday.

Early next year, when Crowell returns to Los Angeles to begin her $120,000-a-year job, she will bring with her a reputation as a coalition-builder whose door is always open. The Canadian-born woman, who holds a doctorate in psychology, is known as a positive thinker who fights fiercely for resources but who doesn’t let lack of money immobilize her.

Crowell is praised by those who remember her previous stint in the Los Angeles County system. Guido DeRienzo of the American Federation of State, County and Municipal Employees, Council 36, which represents about 300 mental health workers, said that Crowell’s psychological training enables her to understand clinical problems as well as administrative ones.

“She listens to everyone, whereas prior administrations would simply dictate rather than develop a consensus,” DeRienzo said.

A confidential assessment of Crowell prepared for Los Angeles County by Korn/Ferry International, an executive recruiter, described her as organized, effective and politically well-connected, with a special knack for bringing together disparate interest groups.

“Her relationship with the mental health advisory and consumer groups is reported to be outstanding,” the report said. “She has been described as being very effective in getting past the emotions of the individuals in the community and moving these groups to productive working relationship. References agreed that she is determined to make a difference . . . and that she can be very directive and persistent when those qualities are needed to get the job done.”

In San Diego, Crowell has been credited with making sense of a chaotic, divided bureaucracy while championing the rights of patients, or “clients.” A strong advocate for involving clients and their families in treatment, Crowell has been outspoken about the need to reach people in their communities, before a crisis lands them in the hospital.

Under her leadership, the county began an intensive case management program that focused on clients who used the hospital most frequently. The program hired former patients, as well as trained professionals, to meet the clients on their own turf and help them address their needs independently. By helping avoid hospitalization, the program saved money and helped spare clients the disruption of being placed in an institution.

“We’re not acting on inanimate objects. We’re working with people who need to take charge as much as possible of their own destiny,” she said. “People (may be) sick, but they’re not dumb.”

She also helped win a $3-million grant to combine housing with treatment for the mentally ill homeless. The unusual program, funded by the National Institute of Mental Health, is designed to try to determine the best plan for mentally ill people who often become homeless because their bizarre behavior gets them evicted.

Crowell acknowledges that there is “a big difference of opinion” among mental health professionals about whether acute care hospital beds or community outreach programs should take priority. During recent budget battles in San Diego, some of Crowell’s own staff criticized her for not fighting hard enough to preserve existing bed space. She responds that often her battles were fought behind the scenes.

Crowell’s bargaining skills have been honed in San Diego, but her financial savvy will surely be tested in her new post. Under her leadership in San Diego, the county mental health budget grew from $58 million annually to $72 million, with 850 employees.

In Los Angeles, by contrast, she will take over a department with a $335-million budget and 1,200 employees. Among her first tasks might be simply trying to keep the system from deteriorating further, with more budget cuts looming.

In recent years, for example, state budget cuts have forced the Los Angeles County department to make drastic cuts in services to the mentally ill, including closing nine of 30 county-run clinics. The department recently came under attack for spending $864,000 on office renovations after closing clinics.

The system’s financial situation is so dire that some say Crowell will have difficulty implementing new ideas.

Roberto Quiroz, who resigned in June after seven years as Los Angeles County’s mental health director, said that, although new leadership creates an opportunity for change, “no matter who is there, it is the lack of dollars that hang over the system.”

Crowell, too, laments the “tragic” cuts and speaks bluntly about the need for increased mental health funding across the state.

“We needed twice what we had 10 years ago, and we’ve even lost from there,” she said. “I would never say to any Board of Supervisors that I could do better with less. That’s not honest. That’s not right.”

But Crowell says she believes that, by encouraging her staff to think creatively and to allow for flexibility, she can make the best of the resources available. She plans to begin her new job as she did in San Diego: with a tour. By meeting people and hearing their concerns, she hopes to lay the groundwork for cooperative change.

“We got into a problem thinking one way, and we’re not going to get out of it thinking the same old way,” she said. “I think (the) L.A. (system) has lots and lots of good, dedicated people. But there’s been an atmosphere of hostility and negativism that has evolved. I hope we can get away from that.”