Uneven Staffing Plagues Mental Patients : Psychiatry: Workers say mismanagement has left west county clients dangerously underserved and has reduced state funding.

Uneven staffing at Ventura County’s mental health clinics is producing markedly different levels of treatment for the seriously mentally ill across the county, psychiatric workers say.

The workers charge that staffing mismanagement by the Department of Mental Health has left some clinics in western Ventura County short of staff, patients short of care and the department itself short of Medi-Cal revenue.

There are 10 regional teams set up throughout the county that provide care for more than 1,500 mentally ill adults on a regular basis.

In the western end of the county, where most of the patients are concentrated, Oxnard has four teams with a combined caseload of 632 patients as of June.

The Ventura and Ojai Valley areas have three teams, with a combined caseload of 526 patients.

In contrast, the county mental health team in the Conejo Valley handles only 113 patients in the communities of Thousand Oaks and Camarillo. The team that covers Santa Paula and Piru treats 120 patients. And the combined patient load in the Simi Valley and Moorpark area is 160.

Each team is staffed by 10 people--a mix of social workers, nurses and a psychiatrist--except for the Conejo team, which has nine, and north Oxnard, which has a temporary vacancy. One of the three Ventura teams has been authorized to expand to 11 members.

Department officials argue that staffing is properly balanced among county clinics, from the Conejo Valley treatment team’s headquarters in Thousand Oaks to the west Ventura clinic.

“There’s no question that mental health in general, Ventura County included, is underfunded in terms of providing the best and broadest range of help to people who have mental illness,” said Cathy Geary, adult services director for the department.

“I would love to do more. I don’t see that happening,” Geary said. “This is probably the single most discussed thing among the teams, is how to make it as equitable as possible.”

However, mental health workers and members of the county Mental Health Advisory Board accuse the department of inaction. They said recently that the department has failed to adjust staffing to meet the caseload shifts that some regions experienced after the mental health system was decentralized and broken into the 10 regional clinics in 1989.

Rents are cheaper in apartments and single-room-occupancy motels in Ventura and Oxnard, and the mentally ill who want to duck authority often drift to encampments on the dry Ventura River bottom, they said.

As a result, the patients cared for by western Ventura County clinics are sicker and more numerous, while their staffing is virtually the same as at east county clinics, they said.

Department of Mental Health statistics back this claim.

The 10-member team now handling the west Ventura area, for example, is responsible for a caseload of 196 patients. That is almost 20 patients per member. In comparison, the 113 patients cared for by the Conejo Valley’s nine-member team amount to fewer than 13 per team member.

A graphic illustration of the imbalance occurred in August:

A Santa Paula clinic worker had time to take six mentally ill patients from a day-treatment program on a long morning outing to view the wreckage of a fatal plane crash at the Santa Paula Airport.

That week in west Ventura--where nearly twice as many patients vie for the attention of the same number of staff, and day treatment has been canceled because of the shortage of personnel--weary clinic workers complained they are too busy to even log in all their patient visits.

Some east county clinics also complain of staff shortages.

“I think we’re all understaffed. The demand is bigger than the supply,” said Simi Valley team supervisor Hector Trevino. The Simi team’s rosters are swelling with clients relocating to live in six recently opened board-and-care homes and two semi-independent-living homes, he said.

Further, the Simi Valley team must often dispatch two workers for most of the day to usher a single mentally ill patient to the inpatient unit in Ventura, Trevino said.

But psychiatric workers and members of the Ventura County Mental Health Advisory Board said the staffing shortage is worse in the western cities, and worst at the west Ventura clinic.

West Ventura workers say their staff of 10 sometimes must drop routine case management so they can handle emergencies, such as a patient who displays psychotic behavior, gets evicted or needs hospitalization.

“Everyone complains periodically that they have to put out fires, when there’s a lot of smoking going on elsewhere that needs attending to,” said Dick Moore, a veteran mental health staffer there.

Geary, the adult services director, said she transferred an 11th staff position to the team in May from the Conejo Valley team. “I thought there was considerable inequity in terms of the west Ventura team,” she said.

However, a month after the Board of Supervisors lifted the countywide hiring freeze, the position remains vacant because officials have been unable to find a qualified worker who can afford to live in Ventura County, she said.

But Moore said one unfilled position is not enough, and the clinic has been forced to shut some less seriously ill patients out of the system.

“Finally, since they are not going to give us extra help, we make up our own (admission) criteria because we have to weed some out so we don’t get swamped,” he said.

This means the clinic has a sicker clientele than most--patients who have fallen out of the care of families or regional clinics and drifted to the county’s western end after suffering psychotic episodes, said Moore and others.

“Not only do we have larger numbers here, but the acuity level is higher,” Moore said. “When they blow out they have to go somewhere, and they either go to the hotels in Oxnard, Ventura and west Ventura, or they go to the river bottom.”

Nine mental health patients have committed suicide since July, 1991. All but one in Simi Valley were patients of west county workers, said Randall Feltman, county mental health director.

One former west Ventura caseworker said: “When I was at that clinic, out of a caseload of 22, probably 15 were suicidal. Some had feelings of being homicidal. That is the most stressful thing to deal with, for our safety and the safety of the community.”

Such patients require more care, said the worker, who asked not to be identified.

“When you’re seeing somebody who’s suicidal or homicidal, it entails seeing them several times a week for assessment and monitoring and treatment,” she said, adding that there is not always enough time to do what is required.

Stress finally drove her to transfer recently to another clinic. Several other west Ventura workers are on the verge of leaving the clinic too, she said.

“That’s why I left. There’s not enough time to do the paperwork on some patients, and you have this push (from the department) to generate revenue, charting everything you have.”

Without proper documentation, Medi-Cal will not reimburse the county for treating the patients, Moore and the caseworker said.

Lacking adequate staff time for proper documentation, the west Ventura clinic is losing about 10% to 15% of its Medi-Cal funding, they said.

A similar problem exists in the east Ventura clinic, said Marcia Miller, a social worker there.

“It’s become very difficult to try to meet their needs and to do the kind of documentation you need to do to get the funding,” Miller said. “It’s very stressful because you’re aware that the people work is what’s generating the funding to support the other programs.”

The department has twice adjusted the Ventura clinics’ service boundaries, expanding east Ventura’s area and shrinking west Ventura, and recently excused west Ventura from treating the mentally ill homeless, Geary said.

But Geary said the Board of Supervisors will not grant the department any more positions, and she refuses to transfer any more workers from east county teams to west county teams.

Doing that, she said, would leave the east county without “a critical mass” of staff members needed to provide full services, from psychiatric help to job counseling.

In a memo last month to mental health Director Randall Feltman, the west Ventura clinic’s staff pleaded for more workers.

But Feltman said his department cannot cut staffing levels at other clinics to help west Ventura.

“We’re in a very divisive position of basically deciding where to cut back, not where to increase staffing,” Feltman said. “I don’t think it is a good idea to remove basic services for . . . adults in Thousand Oaks and Simi Valley. I don’t think our staff in Ventura, hard-pressed as they are, understand the pressures for the people out there.”

Feltman and Geary admitted that without proper record keeping, the county is losing Medi-Cal reimbursement for some patients who would provide vital financial support to the system.

But Geary said that the department’s mental health workers have complained for years of having too little time for paperwork.

Members of the county Mental Health Advisory Board have called for a cure--a balancing of staff so that the number of mental health workers better matches the number of patients.

“I think they probably need a readjustment,” said Henry Settle, chairman of the board, which oversees public psychiatric care for the county.

“It appears to me they don’t want to have a major realignment or to change their team structure,” Settle said. “I think they’re afraid if they make a change, they’re liable to have less than they did before, of staffing.”

“I know that there’s an inequitable distribution all across the 10 teams,” said board member Mark Florio. “More and more clients are coming in.”

But Feltman and Geary said their hands are tied by budget restrictions.

The Board of Supervisors could restore only $450,000 of the $1.5 million in state budget cuts imposed on the department after the fiscal impasse was broken in September, forcing officials to do more with less, Feltman said.

“Is it not enough?” Geary asked. “Yes, I’d say it’s not enough. Are there people we could serve better if we had more staff? Yes, of course that’s true. But actually, gosh, given the state and county budgets, I don’t see that happening.”

However, Settle concluded, “I think they really need to reassess where they are.”

Mental Health Teams Area: Staff / Active Cases West Ventura: 10/196 East Oxnard: 10/173 East Ventura: 10/167 Mid-Ventura: 10/163 Simi Valley: 10/160 South Oxnard: 10/157 North Oxnard: 9/153 West Oxnard: 10/149 Santa Paula: 10/120 Conejo Valley: 9/113 Source: Ventura County Mental Health Department