Politics Obscures the Nature and Value of Systems of Care

As turmoil swirls around the delivery of mental health services in Ventura County, the term “Systems of Care” has been bandied about freely without anyone accurately explaining the program. Vague references to a “team approach” and a “psychosocial model” have only obscured the common-sense approach that Systems of Care provides.

It was, and is, not a mental health system as such but rather a comprehensive human services system for people with serious mental illness and their families. Some understanding of the system is necessary to evaluate the current controversy.

In 1984, Ventura County was the site for a state-funded pilot program that clearly demonstrated the benefits of a community-based, interagency, case management approach to the delivery of services to emotionally disturbed children. The program involved agencies concerned with mental health, alcohol and drug treatment, social services, education and probation and required negotiated cooperation agreements among them all.

The focus was on the needs of the child rather than on the sometimes conflicting requirements of government agencies. The program had clear goals and measurable outcomes that provided an accountability missing in most social services programs. It was a pioneering concept.

Adult Systems of Care grew out of the children’s program. The basic principles--a defined target population, clear and measurable goals, interagency collaboration, client-centered services and continuous evaluation--were the framework upon which the system for mentally ill adults was built. With the adults, the issues of homelessness, unemployment, independent living and interaction with the criminal justice system became an added focus.

The model developed in Ventura County, implemented and funded under a contract with the state, centered on the development of 10 teams, organized generally on a geographic basis. Each team was composed of a psychiatrist, a psychologist, two psychiatric social workers, two mental health associates, one nurse, two rehabilitation therapists and one community service worker.

Each client was assigned to a team that accepted responsibility for coordinating that client’s treatment and support services. The mental health administration was funded to provide additional staff to ensure fiscal accountability and to meet program requirements of the plan submitted to the state.

Beginning in 1989, the crisis team, which works with local law enforcement, was reestablished with Systems of Care funding from the state. Budget cuts had eliminated it in 1986. In addition, the number of psychiatrists working with adults was doubled, their salaries increased to promote retention, and the forensics mental health team added five staff members to work with judges to divert mentally ill defendants from jail to outpatient treatment programs.

Systems of Care funds also made possible the hiring of a full-time housing coordinator, which led to the development and construction of Las Posadas, a 28-bed residential program for the mentally ill.

Given this history, it was rather puzzling that recent articles lauding the county for plans to hire a housing consultant failed to mention that the housing coordinator required under the county’s Systems of Care contract with the state had been laid off in 1995 at the direction of the Health Care Agency. Funding for the crisis team was reported as if the team did not already exist or that requests to expand it had not been made in years past. The proposed hiring of more psychiatric nurses was also hailed as part of a new vision for county mental health while ignoring the fact that Systems of Care staffers have been laid off, transferred or pressured to leave over the last several years.

Four million dollars in state general fund money has been given to Ventura County annually since 1989 for the Adult Systems of Care program. Ventura County is one of only three counties receiving this additional money, which was awarded to carry out a specific plan the county contracted with the state to perform. The current state of affairs is a result of the slow dismantling of that plan, especially since 1995, and the movement of money--given for a specific purpose and program--into other, more generalized activities.

Readers who have followed Ventura County’s latest funding dispute--this time with the federal government over Medicare and Medi-Cal billing--will find nothing in the state’s Welfare and Institutions Code remotely related to billing for services. For county officials to suggest that Systems of Care is the cause of Ventura County’s problems over billing practices is disingenuous at best.

The Systems of Care approach to the treatment of seriously emotionally disturbed children has been successfully implemented in 38 counties in California and in many other states. The adult system, although it continues to be successful in Los Angeles and Stanislaus counties, has in Ventura County become embroiled in political in-fighting that has obscured its nature and value. Lack of oversight by the state has contributed to the problem. Although I have always been a strong advocate for local control, from this experience I must concede that when the state gives money to a county for a specific service, it must maintain close enough ties with the program to ensure its integrity.

I know that the principles of interagency coordination of services and the other core values of Systems of Care will survive the small storm generated by recent events in Ventura County. I am saddened, though, by the knowledge that the Ventura County Mental Health Department, once acclaimed as the standard setter for California, now stands as an example of how effective programs can deteriorate over time as county leadership and priorities change.

Elected officials have a responsibility to familiarize themselves with the programs run by county departments. Most Ventura County Supervisors presided over the dismantling of Systems of Care without knowing much about it and without understanding their contractual arrangement with the state.

As a taxpayer, I would like to know exactly how the $4 million received each year was spent. The state audit was forthright about shortcomings and hard-hitting regarding the level of knowledge and attitude of the current administration. It was, however, extremely gentle in reporting its investigation of misdirected funds.

Now that the county administration and the Health Care Agency seem intent on blaming Systems of Care for its problems with the federal government, I am convinced that such generosity was misplaced. I will watch with interest as the administration attempts to reconstruct the program and will pay close attention to the budget manipulations this requires. I hope fellow taxpayers in Ventura County will do the same.