Siskiyou County Behavioral Health Department works on a new plan

Richard DuPertuis
Director of Human Services Michael Noda asks FRC executive directors, "Where do we go from here?" For over three hours in the Behavioral Health building Wednesday, Noda struggled to find common ground with the FRCs that both complied with state requirements and continued mental health services to outlying regions of the county. Others at his table were, left to right, Arden Carr, Watha Dubonnet, Sheila Kuck and Kate O'Shea.

Family Resource Center executive directors lined the tables in Yreka’s Behavioral Health building Wednesday to voice concerns over their roles in a proposed realignment of mental health services in Siskiyou County. Their immediate concern was their belief that the MHSA executive committee had already decided to close centers in outlying regions of the county, which the committee assured them was not the case.

“Correct me if I'm wrong,” said Happy Camp FRC Director Karen Derry, “But this was the plan. Services will be pulled back to the I-5 corridor. For you to say there's no proposal – did I miss something?”

“To me it sounded like a plan was on the table,” echoed Jill Phillips, executive director of the Siskiyou County Services Council. Both women had attended a meeting May 11, where issue  was raised for the first time.

Director of Human Services Michael Noda replied, “We have to address the funding methodology and clinical oversight. The way to do that hasn't been decided… The purpose of this meeting is to get feedback and put together a plan. That's what the questionnaire was for.”

The questionnaire, which had been emailed out to the FRCs, did not achieve the desired results. Kerry Chris, executive director of the Butte Valley FRC, stood with a letter of response signed by eight directors. “While we are interested in participating in a true planning process to determine how to best serve our communities,” she read, “we don't think it appropriate at this time to provide response to the limited range of services suggested under the current proposed redesign option.”

Two members of the Behavioral Health board, a citizens' mental health oversight group, also expressed irritation with being excluded from initial planning. “If you had included us, we'd be on board,” said chair James Cavener.

Behavioral Health board member Marilyn Seward said the board is never included in planning with the executive committee. “We've been a rubber stamp board,” she said. “We're supposed to be involved in planning. Instead, we see a report on something that's already been done.”

“That is a critical component that this department has been negligent in,” Noda conceded.

Need more services

Noda sat in the center of a panel of executive committee members: Arden Carr, Licensed Clinical Supervisor for MHSA and Medical Services; Watha Dubonnet, Deputy Director of Behavioral Health Division; Legal Services Coordinator Sheila Kuck, who recorded minutes; and Deputy Human Services Director Kate O'Shea.

Speaking as a single voice, the panel members pleaded with the audience to understand their situation. They said that they have come to the end of the initial, five-year MHSA plan, and that their services for serious and persistent (S&P) mental health clients have fallen short, leaving them open for problems with the state.

“The state requires us to serve 51 percent S&P,” said O'Shea. “We don't.”

Added Carr, “Clinical coverage hasn't been adequate for two years.”

One way to do this, proposed the panel, is to regionalize adult day treatment to local FRCs. The case managers now working out of the Behavioral Health building would hold therapy groups in communities. O'Shea also shared a way to provide required services without FRCs.

“A federally-qualified health care clinic could provide required services with clinicians,” she said. “This would use a different funding stream, which would not affect county dollars.”

Warned Dubonnet, “I want to be effective and correct, or we're all going to be in trouble.” She said that under the current operating model they were not providing services required under MHSA regulations, stating, “We are at risk for audit.”

The FRCs spoke back in chorus. They said that they are meeting S&P needs, as they were trained to do by MHSA under the five-year plan. “The existing plan lays out S&P services,” said Chris. “Arden, you trained us yourself!”

“We're on an annual basis now,” replied Carr. “We need a new plan for this year, and provide more services than we have in the past.”

“Sounds to me like you need clinicians in FRCs,” said Cindy Foreman, director of the Dunsmuir and McCloud centers. She asked if they could hire clinicians to place in all the FRCs.

“I don't think we have funds to hire staff,” answered O'Shea.

“How are the proposed changes going to help in outlying areas?” asked Derry.

“There will be clinical oversight, much more than now,” replied Carr. “And much more continuity of care.”

Dubonnet added, “We've got to put someone out there who can manage the paperwork for an audit.” She also said that Behavioral Health clinicians are trained to deal with acute crisis, and asked everyone present if anyone had received such training.

The room went silent for half a minute.

Other comments

The FRCs received supporting comments from other stakeholders who wished to continue services to outlying regions of the county, including those from law enforcement. Allison Giannini, the Sheriff's Department’s Programs Coordinator, expressed her concerns for both the safety of law enforcement officers and mental health patients should outlying centers be forced to close.

“The FRCs help mental health patients stay on meds,” she said. She described how the FRCs daily contact with clients gave them somewhere to turn when crisis approached, and how that support, called “prevention and early intervention” often prevented panic attacks from escalating. “This saves the cost of having to respond to a 5150 situation,” she said.

“Are you going to have a law enforcement part to this?” asked Captain Jim Betts. “The FRCs are doing a great job. About 70 percent of our inmates have mental health problems.”

“I'm worried about what happens when they get out,” said Giannini.

The executive committee also heard from mental health clients. One of them, Brian McNaughton, said that he had been part of MHSA for over four years. He testified how he has seen benefits of the program up close.

“I've never seen such a social program do so much good for people at a relatively low cost,” McNaughton read from a letter. “The cost of altering or ending the award-winning MHSA program will be enormous for the community.”

Two Siskiyou County supervisors, Ed Valenzuela and Grace Bennett, sat in the back of the room and watched the proceedings silently.

Seeking common ground

Noda summarized three points on which all parties agreed. In addition to on-site clinicians, the FRC executive directors approved of MHSA continuing to fund drop-in centers. And, he said, they agreed that there needs to be more clinical oversight, meaning that MHSA will supervise their clinicians in the FRCs. “It's an audit issue,” reminded O'Shea.

Sighed Noda, “That leaves maybe program reallocation.”

“Why not decentralize?” suggested Phillips. “We provide local services, with less rent.” She said that local community members would not face the burden of transportation, and so would be more likely to reach out. She noted the savings would be about $1,200 compared to the Human Services MHSA Division's $13,000.

“We form relationships with people in the community,” she continued. “They've come to expect services from us. What happens when that all goes away? You can't stay open without being able to provide services. This proposal puts most FRCs at risk.”

Carr said to the rows of frowning faces, “We've heard your concerns. Give us an idea of how we can work with them.”

According to Carr, the initial five-year MHSA plan expires June 30. As of the date of this meeting, a little over 40 days remained to draft a new plan to provide needed mental health services in Siskiyou County, and to do so within the restraints of the budget.

Sheriff's Office Programs Coordinator Allison Giannini expresses her concern for the safety of law enforcement officers and mental health patients should outlying FRCs be forced to close. Captain Jim Betts said that the centers work well for prevention and early intervention for clients who might go into crisis without immediate, local support.