State Audit on Mental Health Care Criticized

“Unfounded and inflammatory” is how Ventura County officials describe some of the findings in a recent state audit that concluded services for the mentally ill here have badly deteriorated.

In a 26-page rebuttal to the audit, county mental health officials challenged several points of the survey, which warned the county would lose $5.4 million in annual funding unless problems were corrected.

“Unfortunately, we were unable to clarify some of the data in the audit before it was released,” Behavioral Health Director Dr. David Gudeman said Thursday.

For instance, the county does not prefer the involuntary hospitalization of mentally ill people, as stated in the audit, according to the rebuttal released Thursday.

In their audit, state officials said that clients must be placed in the “least restrictive environment” in order to continue receiving extra funding each year.

The county receives the additional funding because its mental health system is considered to be a state model that operates innovative programs. Citing the system’s deterioration, the state has threatened to withhold the funding.

The “priority” on hospitalization is proof of the system’s collapse, state auditors said in their report. “Mental health funds were utilized to support what appears to be unnecessary involuntary hospitalizations.”

But in his rebuttal, Gudeman said this statement is “unfounded and inflammatory.”

“We are committed to treating people in the least restrictive setting,” Gudeman said in an interview Thursday. “But at this point, we don’t have a subacute facility to place clients who are ready to leave the hospital.”

The county at times keeps patients in the psychiatric ward at Ventura County Medical Center longer than necessary while officials seek appropriate housing for them.

With a shortage of housing for the mentally ill, it is often difficult to immediately place a client, officials said.

To make matters worse, they said, the county has no rehabilitation facility for the mentally ill. Patients discharged from the hospital are usually placed in such a subacute facility before moving on to another living situation.

In their rebuttal, county officials said they plan to build a 30-bed rehabilitation facility.

The county also disagreed with the state’s contention that local officials failed to track patients who were released from the hospital.

“The county does monitor several outcomes including employment, living arrangements and admission of clients into the Intensive Patient Unit,” the county’s rebuttal stated. “The county has also established a Performance Outcome Committee . . . to ensure the collection of data to track children and adult outcomes.”

But the county agreed with auditors that the role of psychiatrists has eroded in recent years.

Psychiatrists began taking a back seat to social workers about the time the county merged its mental health and social services departments in April of last year.

Under that system, teams made up of psychiatrists, psychologists and social workers had equal say to how treatment of the mentally ill was delivered.

After federal officials determined the reorganization violated Medicaid and Medi-Cal billing rules, the county dismantled the superagency in December.

The failure of the superagency touched off a series of federal and state audits, including the state Department of Mental Health probe. State Sen. Cathie Wright (R-Simi Valley) called for that audit in March.

After the superagency was dismantled, psychiatrists began taking a leadership role in treating the mentally ill.

“We would like to work with the Department of Mental Health in strengthening the critical role of the psychiatrist,” officials wrote in the rebuttal, which was presented to state officials Wednesday.

Stephen Mayberg, director of the state Department of Mental Health, met with county officials in Ventura on Wednesday to discuss the audit’s findings.

“I was pleased with the tenor and the nature of the meeting,” Mayberg said Thursday from his office in Sacramento. “The county agreed that the audit was a good starting place to move from.”

Mayberg said county officials seemed committed to improving the system. Officials have until July 1 to develop a plan showing how it would fix the problems, he said.

If the county moves forward with a correction plan, it would not lose the funding, Mayberg said.

“There are no guarantees that is going to happen,” Mayberg said. “But the energy and commitment level of the people in the room appeared to me that they were the right people to make it happen. . . . We’ll do our darndest to make this happen. I’d like to see the system vibrant again.”

Supervisor Judy Mikels, who also attended the meeting, said she was confident the county will keep its funding, usually distributed in September.

“Dr. Mayberg assured us that the money was still earmarked for Ventura County,” Mikels said. “Once we’re in compliance we will be able to receive the [money]. He said he was certain we could bring the county up to speed.”

Supervisor John Flynn, who also attended the meeting with Mayberg, said state officials will work with the county to fix the local mental health system.

Flynn said one way the county plans to disperse a climate of fear and intimidation between top management and other employees in the Behavioral Health Department is to have Mayberg visit the department and talk to workers.

“We have got to stop the animosities between professionals,” Flynn said. “We need to get their spirits uplifted.”