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Marin civil grand jury cites flaws in mental health agency's budgeting process

Marin Independent Journal (CA) - 5/25/2015

May 24--A new Marin County Civil Grand Jury report recommends the county of Marin adjust its budgeting process so that it can better evaluate mental health program costs and benefits.

The grand jury also faults the county for failing to use the bulk of a $2.1 million state grant it received in 2009 for mental health housing. And the grand jury says the county needs to redouble its efforts to find a new site for the Helen Vine Detox Center, which is losing its lease in February 2016.

There were some 3,700 mental health patients in Marin in fiscal year 2012-13, according to Mental Health and Substance Use Services, a division of Marin County'sDepartment of Health and Human Services that oversees mental health services. These patients suffered from conditions such as severe schizophrenia, bipolar disorder and major depression.

The grand jury commended the division for using grant money to implement two new intervention programs, "one to de-escalate mental health crisis and another to prevent people from losing housing."

The county's recommended budget for fiscal year 2014-15 included $47.1 million to provide a safety net of mental health and substance use services. Revenues from state and federal sources were expected to contribute $36.2 million and the county's general fund was expected to contribute $10.9 million prior to the end of the fiscal year.

But the grand jury wrote that during the course of its investigation of Marin's mental health system, it became apparent that the "budget process is flawed."

The grand jury says it repeatedly requested budget information from the mental health division about its programs, but a budget for each program could not be provided. The grand jury says instead it was told, "'Marin County department budgets are developed based on cost centers and organized based on state required templates, which are not program specific.'"

The grand jury states, "The county can and should use the same state data to develop its own budgeting system that tracks individual program costs."

This same grand jury made a similar recommendation in its April report on homeless support services available in Marin.

Suzanne Tavano, the county's director of Mental Health and Substance Use Services, said, "The county is already underway with the Administrative Technologies of Marin (ATOM) project and the production of financial reports that are formatted differently."

The ATOM project is a new software system under design to handle all of the county's budgeting, accounting, purchasing and payroll needs.

Charlie Haase, Marin's chief technology officer, said, "The new system certainly has the capability to track things in ways that we can't track them today. We're setting it up with those things in mind."

Haase estimates it will be at least two years, however, before the new system will be available for use by the mental health division.

More housing needed

The grand jury says that while a key responsibility of the mental health division is to provide housing for mentally ill adults, there is a "significant lack of appropriate housing for mentally ill adults in Marin."

Marin General Hospital's 17-bed inpatient mental health facility is the only locked psychiatric hospital in the county. The grand jury notes that when no suitable beds are available in Marin, the county must contract to house patients in other counties, "imposing a burdensome and painful distance between patients and their families."

The grand jury said that locked long-term residential housing and post-crisis housing is also needed. It says the county should have used a $2.1 million grant it received from the state in 2009 to purchase mental health housing during the recession when real estate prices were depressed.

Tavano said, however, that the state required that counties only use that money to supplement new construction projects initiated by developers.

"The county did not have a choice," Tavano said. Buying existing properties was not an option.

The county was able to use about $700,000 of the grant to help underwrite the creation of five units at the former Fireside Inn in Mill Valley. The remaining $1.4 million remains unspent. In January, however, the county finally secured approval from the state to use the money to purchase existing housing, and Tavano said the mental health division is weighing its options.

Sandra Fawn, chairwoman of the county's mental health advisory board, said, "The county does provide over 400 rooms for mentally ill people."

Fawn said the county housed her mother, who suffered from schizophrenia, at St. Michael's Extended Care in San Rafael for seven years.

"The people there took great care of her," Fawn said.

Regarding finding a new home for the 26-bed Helen Vine Detox Center, the county's only public detox facility, Tavano said, "We are in full agreement that the detox center needs to continue. We are working very diligently on finding a location that will be acceptable to all. It's not a back-burner item at all."


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