Funding to Avert Mental Health Cuts, Officials Say

Millions of dollars in withheld mental health funding will again flow to Ventura County’s health clinics, averting the need to make deep cuts in patient services, officials said Thursday.

An initial $956,250 payment from the state Department of Mental Health will be transferred to the county within a week under an agreement reached between county and state officials. Additional payments, totaling about $3.3 million, will be distributed throughout the fiscal year--provided the county continues to meet state-imposed performance goals.

The state will continue to withhold about $1 million pending further negotiations. But county officials welcomed the pact, saying it averts layoffs and the closure of mental health clinics.

“The good news is the money is flowing,” said Supervisor John K. Flynn, a key player in brokering the deal. “We are going to be able to stay in business and continue our work.”

The state has refused to send any portion of a $5.3-million annual grant since July, shortly after a state audit found the county was not providing some services promised as a condition of receiving the grant.

Although the county has now corrected many of those deficiencies, the state will continue withholding $1 million for services it says are not being delivered. For instance, the county receives about $500,000 to send mental health employees to other counties to lead training sessions on how to operate a “Systems of Care” program, a team-based approach to treating people with mental illness.

But Ventura County currently is not providing that service, according to state Mental Health Director Stephen Mayberg in a letter to county Behavioral Health Director David Gudeman. Distribution of other withheld funds will be made pending further review and analysis of the county’s programs, Mayberg said.

“While we are pleased with your progress . . . we see these as first steps in a long process,” Mayberg wrote. “There is much work that needs to be done to revitalize your systems of care.”

State Sen. Cathie Wright (R-Simi Valley), who called for the audit out of concern Ventura County was allowing its mental health system to erode, said the county is not out of the woods yet. The subsequent payments will not be sent if the state finds the county is slackening in its resolve to fix problems, Wright said.

“They aren’t off the hook yet,” Wright said. “This shows the state is bending over backward to help them. But they have to follow a Systems of Care program to the letter of their contract.”

Under Systems of Care, which was pioneered in Ventura County, severely mentally ill patients are treated and if possible eased back into society. A team of psychiatrists, psychologists, nurses and social workers meet regularly to discuss the best way to help a patient live outside a hospital setting.

It has been broadly accepted across the state as a less costly alternative to placing mentally ill people in hospitals and institutions. But the program has come under fierce attack by local advocates who say it ignores the reality that many with severe mental illness are unable to care for themselves.

State auditors found the county’s program ran into trouble after the mental health administration was reshuffled, resulting in leaders unfamiliar with the program. The role of psychiatrists in addressing medical issues had also eroded over the years and unnecessary hospitalizations soared, the audit found.

As part of its agreement, the county will hire an independent consultant who will guide mental health employees as they continue to correct problems. The consultant, who has not yet been hired, will report to the county’s chief executive and Board of Supervisors and make progress reports to the state.

One issue the consultant will address is whether the county should convert its 21 mental health clinics from hospital-based providers to stand-alone entities. Reimbursements from the federal Medicare program would be lower if the clinics billed independent of the hospital, but it would give the county greater flexibility to implement the team-style approach to providing services, officials said.

Flynn and other county officials have for months lobbied for resumed funding. The state’s audit came on the heels of other federal reviews of the county’s mental health system sparked by an ill-fated decision last year to merge the county’s mental health and social service agencies.

One federal review that uncovered years of inappropriate billings in the mental health department will cost the county $15.3 million.

At issue is preserving a system that provides care to about 3,100 indigent mentally ill patients each year. The loss in funding also threatened layoffs for mental health employees.

For now, a bullet has been dodged, Flynn said.

“The clients will continue to be served,” he said. “And we as a county will make the commitment to providing a better system for the mentally ill.”