Agency Merger Requires Study

Is mental illness a medical problem or a social problem?

Both, said the Ventura County Board of Supervisors when it voted last April to shift control of the county’s Behavioral Health Department from the Ventura County Medical Center to the Public Social Services Agency, thus creating a new superbureaucracy called the Human Services Agency.

As you wish, replied the federal agency that oversees such things, but if you expect Medicare or Medicaid to pay any of the bills, you had better keep your medical bureaucracy in charge of medicine.

Three times the county tried to get around that mandate, and three times the federal Health Care Financing Administration delivered the same verdict.

“The definition of insanity,” Albert Einstein once said, “is doing the same thing over and over again and expecting a different result.” In this case, the board finally got the message and voted last week to rescind the merger and draw up a different plan. The nine-month experiment could end up costing county taxpayers as much as $2 million in lost medical reimbursements.

In agreeing to what board Chairwoman Judy Mikels called a “re-reorganization,” several supervisors praised the vigorous discussion that has boiled since April and expressed eagerness to fully study all the ramifications of various approaches to caring for the mentally ill.

We agree wholeheartedly. As we have said before, we wish Supervisors Susan Lacey, Kathy Long and John Flynn had looked down before they sent the county running off this particular cliff, not after. But now that we are back on solid ground, it’s time to explore the questions that were glossed over last April--despite warnings from Chief Administrative Officer Lin Koester, a platoon of advocates for the mentally ill, and even a consultant’s report commissioned by the county.

Which brings us back to: Is mental illness a medical problem or a social problem?

In recent years we have learned more and more about the human brain and why it sometimes malfunctions. Some conditions that used to make it impossible for people to function in society, let alone live a normal life, are now easily managed with drugs or therapy or both. With this progress, our society has moved away from simply locking up everyone with a mental disorder.

“We have no choice but to mix the medical model with a social model,” Flynn told the board meeting. “Camarillo State Hospital was the medical model and the state closed it down. We couldn’t afford to follow that model, and in today’s world a combined medical-social model is the morally right thing to do.”

If that philosophical shift is at the core of the county’s desire to change the way it assists the mentally ill, then the county needs to find a way to quantify how much of the care it provides is indeed medical--and hence covered by Medicare and Medicaid. That might seem like a petty, paper-shuffler sort of detail but it’s a detail that could potentially cost Ventura County about $15 million a year in lost reimbursements. And that’s a pretty compelling reason to get federal approval before jumping.

Koester’s recommendation last spring, which a majority of the board chose to ignore, was to keep the agencies separate but foster closer partnerships between doctors and social workers to serve the mentally ill.

Even last week as she stuck by her guns and refused to vote with her four colleagues to undo the merger, Lacey held out for some hybrid approach that would keep the social-service bureaucracy in charge of medical care. She said the objective all along has been to avoid placing mentally ill people in the hospital and instead move toward helping them learn to live independently. We do see merit in that.

We see even more merit in Lacey’s comment to the board, “I think we need to discuss things thoroughly.”

Better late than never.