Sonoma County Grand Jury • 2004-2005

Mental Health Services Division: on the Mend?

Published: June 18, 2005 8 pages
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Findings and Recommendations 15 findings

F1
Mental Health Services has had four division directors in the last fifteen years. While this may not appear to be significant turnover at the director position, when added to the complex task of leading a team in a changing environment, it could be an unanticipated catalyst in department turmoil.
Related Recommendations (1)
R5
Insufficient consideration has been given to the Director’s tenure affecting MHS Division turmoil. Mental Health Services should be examined by an oversight committee consisting of one or more representatives from the Board of Supervisors, the County Administrator, and the Director, Health Services to uncover the underlying reasons why MHS has lost four directors in the last fifteen years. Required Responses to Findings None . Required Responses to Recommendations Required responses per CA penal code 933c: • Board of Supervisors no later than September 28, 2005 • All others no later than August 29, 2005 Director of Mental Health Services – R1, R2, R3, R4, R5 Director of Health Services – R1, R5 Director of Human Resources – R2, R3 Board of Supervisors – R5 County Administrator – R5 1 Based on 2002-2004 Sonoma County Human Resources data. Average total county employment for this period was 4024 employees of which Health Services comprised 606 employees (15%) . Based on 2004 Sonoma County Human Resources data. Twenty-two union grievances filed for all county departments. The Health Services Department (563) employees filed seven of them (32%). For the extended period of 2001-04 the total number of county grievances filed was 53 and the Health Services Department filed 18 (34%). 3 2003-2004 Grand Jury Final Report: “Mental Health Management Ills”: Findings: F4d, F4e, Recommendations: R2 4 Based on 2002-2004 Sonoma County Human Resources data. Average turnover for all reasons in this period: Sheriff’s Department: 36 of 676 (5.3%); Human Services: 35 of 633 (5.5%); Health Services 48 0f 606 (7.9%) 8
F2
County departmental grievance data (2001, 2002, 2003, 2004) indicates the Health Services Department submitted 32% of all grievances filed while representing only 15% of all county employees.
No recommendations for this finding
F3
The Director of Health Services hired an independent consultant to perform an organizational assessment of the Mental Health Division. This assessment, performed over a two-year period, resulted in the formation of teams to establish priorities and recommend solutions identified during the assessment process. The MHS division formed a Staff Advisory Team to help facilitate the implementation of the recommendations. Follow-up survey results indicate approximately half of the MHS respondents felt senior management/staff relations had either “remained the same” or “deteriorated.”
Related Recommendations (1)
R1
a. The MHS Director should actively support and promote the formation of an Implementation Team consisting of cross-functional staff and management as soon as possible. b. Participation on the Implementation Team should be open to anyone in the division. Recognizing workload pressures of the division staff, schedules should be adjusted, where practical, to allow participation. c. The Implementation Team should be empowered to formulate the plans and timeline for implementing the changes documented by the consultant’s Recommendation Teams. d. The Implementation Team should report progress back to the Mental Health Services Director and the Director should communicate this progress to the rest of the division staff. e. The MHS director should commission an independent survey six months after the formation of the Implementation Team to assess both tangible and perceived progress with the results of the survey communicated to the entire staff. It is the belief of the 2004-2005 grand jury that changes need to be made within the division by those closest to the issues. We recommend that MHS management give priority and support to activities undertaken by the Implementation Teams. The basic groundwork has been established to identify and prioritize the issues facing Mental Health Services that generated staff complaints relating to staff safety, morale, and workload. Imbedded in the recommendations from the consultant’s study are comments relating to management style and workplace environment. The latest MHS follow-up survey indicates much work still remains to be done to establish an environment for sustainable improvement. 6
F4
A majority of the staff psychiatrists submitted a press release declaring a “no confidence” vote for the MHS Director. The doctors expressed little confidence in any departmental- initiated attempt to resolve the perceived problems in MHS through the application of a consultant study or the recommendations submitted by the newly formed employee
No recommendations for this finding
F5
Recent grand jury final reports from seven of thirty California counties had some mention of complaints related to Health Services, but none remotely close to the severity of the problems described within Sonoma County MHS.
No recommendations for this finding
F6
The Sonoma County Board of Supervisors, Sonoma County Administrator, Mental Health Board, and the Human Resources Division have provided little or no oversight or direct involvement to address these on-going issues within the Mental Health Department.
No recommendations for this finding
F7
County employee turnover data 4 shows only a small difference among the three county agencies that have more than 500 employees (Sheriff’s Dept., Human Services, Health Services). The Health Services Department’s average yearly turnover for this period was 7.9%. This is about one-third the rate reported for the private sector.
No recommendations for this finding
F8
The employee exit interview process has not been designed in a way that allows potentially valuable information to be collected and made available to the MHS Division for constructive feedback.
Related Recommendations (1)
R3
a. The Human Resources Department, with assistance and support from Mental Health Services Division, needs to revise its process for collecting and analyzing employee exit interview comments. b. All employees who terminate should be encouraged to write a summary of their work experience. c. The exit interview process should be conducted in a consistent manner with a neutral person who can ask questions and record answers in an unbiased fashion. d. Exit interview comments should be considered valuable information and reviewed by each successive member of the management team including the MHS Division Director. The Human Resources Department should take a pro-active role by developing a revision to the exit interview process that allows potentially valuable information to be available not only to the MHS Division management but to all County departments. Currently, there is no consistent method for collecting and analyzing the comments made by employees during the separation process, resulting in the loss of valuable feedback to supervisory personnel. A process to compile, analyze and report the data on exit interview documents back to the departments will provide an additional source of information to help management improve the work environment and potentially reduce recruitment and training costs.
F9
The employee turnover data is currently lumped together and compiled by total number of separations only. By not sub-dividing this statistical information into major categories of employee attrition (i.e. retirement, both early and normal, termination for cause, death, voluntary resignations, etc), an additional source of information to help management understand and improve the work environment is lacking.
Related Recommendations (1)
R2
a. The Human Resources Department, with assistance and support from Health Services Department, needs to revise its process for collecting and analyzing employee turnover data. b. The process for documenting turnover data should delineate the various reasons for separation. c. This turnover data should be examined on a periodic basis and compared to other county departments. Analysis of this data, not available today, could provide another useful tool for insight into departmental behavior. The Human Resources Department needs to assume a more pro-active role in connection with reporting and analyzing employee separation statistics. Only the total number of all types of separations (i.e. voluntary and involuntary terminations) are currently compiled and reviewed. This statistical information would be far more valuable if it was sub-divided into major categories of employee attrition such as retirement, both early and normal, termination for cause, death, voluntary resignations etc.. Reasons for voluntary terminations should be compiled and reviewed. This type of statistical data can frequently go a long way in assisting managers to discover areas of weakness and concern that requires immediate attention.
F10
The number of employee grievances and complaints within MHS correlates with the remote location of employees, and the number of shift schedules. 4
No recommendations for this finding
F11
Some employees within MHS bypass traditional communication channels with management personnel and take their complaints directly to the press or the grand jury.
Related Recommendations (1)
R4
The management of MHS should make a concerted effort to encourage employees to discuss work place problems and concerns with management personnel first. Submitting complaints directly to the press, or utilizing the grand jury as a sounding board, is not the most effective way to resolve these issues.
F12
Recently implemented state and federal regulation and compliance rules have resulted in a major increase in documentation requirements. This increased paperwork demands time the staff could be spending with the patients and this is hard for the staff to accept.
No recommendations for this finding
F13
Current funding for mental health services in Sonoma County has not kept pace with the 10% per year increase in baseline service costs. Employee compensation and benefits comprise most of these costs.
No recommendations for this finding
F14
While there have been serious allegations of medical decisions made by MHS psychiatrists being overridden by managers, it is important to point out this investigation revealed no evidence of purely medical decisions being reversed.
No recommendations for this finding
F15
The Health Services Director has retired (12/04) and the Director of Mental Health Services has resigned (2/05) creating an opportunity to refresh the top-level management team. Conclusions There is no question that the Mental Health Services Division has seen turmoil in staff- management relationships for the last several years. Attempts within the division to identify and address these issues have, for one reason or another, been marginally successful as measured in the recent employee-survey results. The mentally ill are a vulnerable segment of the county’s population. They are highly dependent on the county for programs that not only minimize physical risk to themselves and others but also provide them with the tools and assistance needed to become productive and self- supporting members of the community. This valuable but difficult work can lead to personal stress in the workplace and can impact the efficiency of serving the clients. Emerging regulatory and compliance requirements along with a decrease in funding levels are also factors. Increasing abuse of both drugs and alcohol by clients compounds the complexity and stress of providing care and assistance. The talented and dedicated staff and management of the MHS Division have, with the assistance of an independent consultant, identified and prioritized the most needed areas for improvement. The active support and leadership from the department and division directors to address these issues should be considered one of their primary objectives. Significant progress can be made if the work already started is expanded into permanent success. Commendations The grand jury would like to thank all those who assisted in providing valuable information toward this report. During the course of this investigation the grand jury observed firsthand many talented, motivated, compassionate, and dedicated staff and MHS managers working diligently to make these programs effective.
No recommendations for this finding

Conclusions 1

Commendations 1

No Responses Found 2

Government entities assigned to respond to this report. No response documents have been linked in our database.

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