Calif. Reorganizes MH to Create New State Hospital Department
Mental Health Weekly January 3, 2012
Citing goals to improve treatment, safety and fiscal management,
California officials this month announced plans to transition its
Department of Mental Health into a new Department of State Hospitals to
focus solely on the state’s mental health hospital and psychiatric
programs.
The state’s Medi-Cal and community mental health functions will be
transferred to other state departments.
The move to create a new department started last spring, said Kathy
Gaither, acting deputy director for the Department of Mental Health when
Gov. Jerry Brown proposed that the mental health functions of Medi-Cal,
the state’s Medicaid program, be transferred from the Department of
Mental Health to the Department of Health Care Services (DHCS), said
Gaither. Brown signed the legislation last summer.
The state is expecting the full implementation of the mental health
realignment in FY 2012/2013 which begins July 1, 2012. State officials
say the plan calls for streamlining administrative policies, procedures
and reporting by staff to increase the focus onproviding care while
maintaining full compliance with federal standards.
“We worked with hospital executives and clinical teams [who] recognized
some effective ways to not compromise safety and not compromise
treatment,” Gaither told MHW.
Gaitther added, “We were faced with a $120 million deficit in 2010- 2011
and were on track for an even higher deficit this fiscal year.” Issues
identified included improving mental health outcomes, increasing
employee and patient safety, increasing fiscal accountability and
transparency,
she said.
Officials say key priorities are to improve patient care, reduce the
number of incidences of violence against workers and improve the
response time to incidences. Officials also want to improve tracking and
reporting of funds to ensure fiscal accountability, they said.
The state meanwhile will maintain some oversight of mental health
services, which are currently managed by the state’s 58 counties. For
some time
community mental health programs have been run by state counties, but
state rules complicated rules for the counties, said Gaither. “The
governor
wanted flexibility for the counties,” she said. “We’re not giving
counties more to do,” she said. “We’re creating a department to make
certain to provide more focus on an area we need to improve,” she said.
When asked whether this was a cost-saving move, Gaither responded that
it’s more than just fiscal.
“It’s about employee and patient safety and maintaining and improving
patient outcomes,” she said. State officials met with consumers, county
representatives and providers from July to October, she said. They
addressed what they wanted to see in terms of community mental health
programs going forward, she said. “My impression was that consumers were
really concerned about retaining their voice,” she said.
Rusty Selix, executive director of the California Mental Health
Association, said it is important that the state has an outcomes-based
system of accountability. The state audits and manages the community
mental health system for the counties. Providers spend considerable
funding documenting services, Selix told MHW.
As the state plans to transfer mental health related Medi-Cal services
to the state Department of Health Care services, Selix said he hopes
that mental health and Medi-Cal services are treated “as partners, and
not as a subsidiary.”
Mental health providers and advocates say they would also like to see
prevention and early intervention services in the primary care system,
including better use of EPSDT (Early and Periodic Screening, Diagnostic
and Treatment) services, according to a stakeholder report.
Administrative changes
The state administrative change that is occurring is due to a
combination of factors. All community mental health responsibility has
now been realigned to counties, along with dedicated revenue sources
that go directly to them and not through the state budget, said Patricia
Ryan, executive director of the California Mental Health Directors
Association (CMHDA).
“State hospitals are the only part of the system that remain the fiscal
and program responsibility of the state,” Ryan told MHW. The state will
continue to have regulatory, compliance and oversight responsibilities
regarding the community mental health system, since counties are
carrying out their community mental health (including Medi-Cal)
responsibilities on behalf of the state, by contract, said Ryan.
Additionally, moving the Medi-Cal specialty mental health oversight,
regulatory and compliance responsibilities from the Department of Mental
Health to the Department of Health Care Services is in many ways a
recognition that the field of mental health is moving toward integrated
care for the whole person, said Ryan.
Ryan added, “While we don’t yet know where the governor will propose to
move the remaining state level oversight, regulatory and compliance
responsibilities to take the place of the old Department of Mental
Heath, CMHDA believes it makes logical sense to transfer those functions
to the Department of Health Care Services as well, as long it includes a
high level of attention in the new state department.”
Again, as we move toward an integrated health care system, it seems to
make sense to change state administrative functions in an effort to be
more efficient and effective in addressing the whole health needs of
individuals in our communities, she said.