Shasta Interagency Narcotics Task Force Reason for Inquiry: Shasta Interagency Narcotics Task Force California Penal

Recommendations 14

• R1
  The City Council should not derail well designed Infill and Planned Developments. Response: Concur, if they meet the General Plan and other development policies as determined by the public’s elected representatives who are selected to make these decisions. The Grand Jury’s finding on this matter (No. 6) has substantial factual errors. The City Council determined that the project was not consistent with the General Plan. The design of the project contained aspects that did not comply with the General Plan policy. GJ Reply to the Response: The Grand Jury finds the City Council’s response unacceptable. The Grand Jury determined that the project was consistent with the General Plan. Furthermore, if “…the project was not consistent with the General Plan,” as stated above, then it should not have been approved by the Planning Department in the first place.
• R2
  The Planning Department should attempt to expedite the permit approval process. The City’s Ombudsman report on recommended process changes should continue to be implemented. Response: Grand Jury Finding No. 9 states that “the City’s Ombudsman Report on Recommended Process Changes was presented to the City Council for consideration on October 25, 2004. …Some of these recommendations are being implemented by the City’s Development Services Department.” In fact, all of these measures are being implemented with the exception of the permit tracking system. The tracking system is extremely expensive, which is why it has taken longer than the other points mentioned in the Grand Jury’s findings. However, the City Council will be discussing this issue as the City looks at planning and engineering fee increases in the next few months. GJ Reply to the Response: The Grand Jury finds the response acceptable and looks forward to the implementation of the permit tracking system.
• R3
  Political influence should not override sound planning decisions. Response: Concur. Grand Jury Finding No. 8 states that, “strong political influence was exerted on the Planning Commission and City Council to disapprove this project.” This is obviously a statement of opinion. It would be equally valid to say that strong political pressure was exerted on the Planning Commission and City Council to approve the 2 project. Concerns for and against projects will very likely continue as the City entertains more infill projects. GJ Reply to the Response: The Grand Jury finds the response acceptable. However, it remains our “opinion” that the front-row presence of McConnell Foundation executives at the City Council meeting regarding opposition to this project represented undue “strong political influence” against the project’s approval. Report No. 2: Haste Makes Waste In a lengthy report, the 2004/2005 Grand Jury investigated the closure of the Shasta County Psychiatric Hospital Facility (PHF) and its impact on inpatient care of the acutely mentally ill. The overall operation of the Shasta County Mental Health Department (SCMH) was also investigated. The required response from the Shasta County Board of Supervisors (BOS) was sent to the presiding judge of the superior court on September 27, 2005. The Director of SCMH was also invited to respond to certain recommendations; the response was received on August 29, 2005.
• R4
  The Shasta County BOS should consider privatizing, in part or in total, the delivery of mental health services to the citizens of the county. With proper oversight, this would offer a more efficient overall operation. Assurances that all patients requiring treatment actually receive treatment would be necessary. The Grand Jury feels an extensive and well-planned transition program, with input from the general public and all providers of mental healthcare delivery, must precede any transfer from public to private operation. Response from the BOS: Currently 54 percent of the SCMH budget is devoted to contract services, and this has consistently increased over the past 2-3 fiscal years. As a result, SCMH is more than half “privatized.” With each contract for services entered into by the BOS, SCMH must assure that services are delivered in accordance with State Department of Mental Health requirements, which govern target population, service delivery, and the receipt of State and federal funds. SCMH provides mental health services to the residents of Shasta County in compliance with three State Department of Mental Health contracts. These contracts include very specific terms and conditions and are renewed annually with the approval of the BOS. (A one-page description of the contracts accompanied the response). The Grand Jury notes in its findings a number of perceptions regarding the role of SCMH in the delivery and authorization of inpatient mental health services that are not consistent with this contract and SCMH’s practice. The first and most important misperception is related to access to psychiatric hospitalization for all Medi-Cal eligible Shasta county residents. There are no pre-authorization requirements for emergency admissions to psychiatric inpatient hospitals for Shasta County Medi-Cal beneficiaries. SCMH provides post-admission review of written Treatment Authorization Requests submitted by hospitals as required by the State prior to payment by EDS (Electronic Data Systems). Since SCMH is no longer a provider of psychiatric hospital services, independent practitioners affiliated with the private treating facilities now make the determination of the patient’s admission and continued stay. GJ Reply to the Response: The Grand Jury disagrees with the response. The intent of the recommendation was to consider privatizing the entire mental health delivery system in Shasta County, including its administration. The privatization discussed by the BOS was, in part, necessitated by the closure of the PHF; patients who require hospitalization for acute mental illness now need to be hospitalized out-of- county (i.e., “privatized”). SCMH does serve as the managed care provider and pre-authorizer for Medi-Cal beneficiaries in Shasta County. This was confirmed by the SCMH Director (on two occasions), Deputy Director, and by multiple psychiatrists during the investigation; the Director of the NVMA concurred during a public forum held by the BOS in April 2005.
• R5
  The Grand Jury recommends the SCMH Director improve lines of communication to ensure that SCMH policies affecting the medical community and other public agencies are uniform and consistent. We encourage SCMH to continue to improve access to its crisis intervention teams to reduce emergency room transfer delays. Moreover, to improve the continuity of patient care, we suggest that SCMH expedite the transfer of medical information (history, diagnosis and prescriptions) along with patients requiring out-of-county care. Conversely, SCMH should demand that discharge summaries accompany its patients returning from out-of-county facilities. Additionally, 6 the Grand Jury discourages the indiscriminate delegation of 5150 authority by the SCMH Director. Response from the SCMH Director: SCMH concurs with the recommendation regarding communication with the medical community and out of county facilities. SCMH will promote collaborative efforts with the NVMA to provide education and training for area physicians regarding the treatment of psychiatric illness. As stated in Response No. 3, another solution to the local emergency department congestion and transfer time delays is the implementation of a coordinated case management system that will provide wraparound medical and behavioral healthcare, and psychosocial supports to a population identified as frequent utilizers of the Mental Health emergency response system. SCMH, in collaboration with North State counties, looks forward to the opening of the North Valley Behavioral Health and Sequoia Psychiatric Center PHF in Yuba City, both of which will exclusively treat our patients. This will greatly enhance the continuity of care and communication of critical patient care issues on admission and discharge for Shasta County patients. GJ Reply to the Response: The Grand Jury generally agrees with the response, however, the indiscriminate delegation of 5150 authority was not addressed.
• R6
  SCMH should establish written cost-sharing policies with the County Jail, Juvenile Hall, Probation department and other agencies for inpatient care and transportation of their mentally impaired inmates or clients. SCMH should improve its service to county agencies affected by the PHF closure, e.g. attend to inmates at the Main Jail and Juvenile Hall. Response from the SCMH Director: The Shasta County Sheriff’s Department and Probation Department maintain a contract with Prison Health Services for the provision of health and mental health services in the jail and juvenile hall. This contract is comprehensive in scope and specifies the responsibility of the provider in the provision of all planned and urgent medical services, including psychiatry. The contract includes the responsibility of the provider for reimbursement of hospital services for inmates and wards in custody, but excludes the contact provider from responsibility for reimbursement for psychiatric hospitalization. As a result, there is a serious gap in coverage for jail inmates in custody and juvenile wards in custody. SCMH works cooperatively with jail and juvenile hall staff to address this gap on a case-by-case basis, following written protocols that were developed collaboratively between the Sheriff’s Department, Probation Department, and Mental Health. SCMH also provides the services of a psychologist in juvenile hall and SHIFT (Shasta Housing Intervention For Transition) Program services in the jail to assist Prison Health Services and the courts with inmate/ward mental health issues. GJ Reply to the Response: The above response is inadequate. It does not address transportation protocols and/or cost sharing between SCMH and incarceration facilities since the closure of the PHF. The problem of court ordered on-site psychiatric evaluations is also not addressed. Jail representatives were unable to produce written protocols for inmate evaluation and treatment.
• R7
  The BOS and SCMH should closely monitor the costs (including all transportation costs) of out-of-county inpatient care. The Grand Jury offers the following options for reestablishing inpatient psychiatric services for which the County still holds State licensure: iReopen the 15-bed PHF at the previous site on Breslauer Way by deleting its Medicare designation and adopting strict admission criteria for adult inpatients. This would reduce the average daily cost of care by 50 percent (to $2 million per year) and also minimize patient safety issues. Medicare inpatients requiring hospitalization would be cared for at other facilities. iOpen a 15-bed basic PHF on Breslauer way as a combined adult/child inpatient facility by designating 10 beds for adults and five for children. iOpen a 15-bed basic PHF on Breslauer as the only north state child inpatient facility. Costs would be more manageable and there is a very low risk of associated physical co- morbidity in this age group. The BOS should obtain sufficient information to determine whether or not to renew the SCMH $1.3 million yearly contract for the Elpida Crisis Residential Center. Any option to reopen a PHF would necessitate either closing or relocating this center. The Grand jury recommends closure. In that event, inpatient psychiatric services could be funded using current SCMH revenues generated by increasing efficiency, reducing out-of-county inpatient care, substituting primary care practitioners for some psychiatrists and eliminating costly Medicare staffing. Moreover, additional funding may become available beginning in 2005/2006 through the Mental Health Services Act. The Grand Jury believes that County residents could, and should, have local access to both inpatient and outpatient mental health services. Inpatient child psychiatric services have been identified as woefully inadequate for decades and the Grand Jury invites Shasta County to take the initiative and establish a child/adolescent inpatient facility. A north state regional, multi-county proposal for Mental Health Services Act funds (perhaps orchestrated by the SCMH Director) could establish a geographically centered, acute care facility for children with mental impairment. Benefits of such a facility to the overall mental health of children include earlier recognition and treatment of impairment and an improved continuity of care. Enhanced case management, better social rehabilitative services, access to intensive family psychotherapy and recruitment of more child psychiatrists could result from a successful program. This is an opportune time for Shasta County to address the psychiatric needs of north state children. Response from the BOS: SCMH has submitted the planned budget to the Shasta County Administrative Office including projected expenditures and revenues for fiscal year 2005/2006. In this budget, the SCMH department does not recommend that it operate a staff a psychiatric health facility during fiscal year 2005/2006. The BOS concurs that an involuntary mental health acute care inpatient unit is needed in Shasta County but realizes that patient safety is of the utmost importance. In an effort to meet the medical needs of all patients, the delivery of mental health treatment services (involuntary or voluntary) should be integrated with emergency and primary health care. The County PHF was not licensed to provide emergency medical or primary health care services, therefore, reopening the facility is not viable. SCMH, in collaboration with the Shasta County Administrative Office and the North Valley Medical Association (NVMA), has facilitated contacts between interested providers of inpatient behavioral health services and the administrators of the local general hospitals. The goal of this collaboration is to integrate acute care psychiatry into mainstream primary health care so that those suffering from mental illness have the opportunity to receive treatment for all of their medical needs in an environment where they are not stigmatized or isolated form medical care. The BOS agrees that a regional approach to specialty psychiatric care is viable for target populations. An example of the potential in this area is the soon to open North Valley Behavioral and Sequoia Psychiatric Center PHF. SCMH has taken a strong leadership role in this 4-year effort and the SCMH Director sits on the steering committee that has been responsible for the planning and implementation of these facilities. Specifically regarding the viability of a regional facility for children, SCMH has promoted three regional options. The first option was the establishment of a regional locked community treatment facility, which was not supported at a regional level. The second option was the dedication of one of the new regional psychiatric facilities to children, which was also not regionally supported. The third option is the establishment of a regional interagency crisis assessment center for children. This option may be considered as a priority focus under the Mental Health Services Act. GJ Reply to the Response: The Grand Jury disagrees with the response. Adequate revenue exists for the reestablishment of a local, scaled-down (i.e., non-Medicare) PHF. Strict admission criteria would greatly reduce patient safety issues. The BOS talks of integrated care, but the SCMH Director’s responses to recommendations 2, 3 and 5 above, do little to promote integration with primary health care. The BOS response claims the County PHF is not licensed for emergency medical or primary health care and therefore, reopening it is not a viable option. The Grand Jury notes that while none of the State PHFs are licensed for emergency medical or primary health care services, they continue to provide acute psychiatric inpatient care. The Grand Jury further notes that the North Valley Behavioral and Sequoia Psychiatric Center, to which Shasta County sends inpatients for treatment, is not a full-service hospital providing integrated health care. Moreover, the BOS response does not address the recommended closure of the Elpida Crisis Center. The Grand Jury suggests that the BOS need only look as far as Butte County to consider a functioning non-Medicare designated PHF. The Butte County PHF exists because of support by both the general public and the Butte County Mental Health Director. The integration with mainstream medical care for their patients with co-morbidities is easily obtained because of a positive relationship with the medical community of that County.
• R8
  Other inpatient psychiatric services could include: iThe reopening of inpatient services for Medicare patients at a local rehabilitation facility. iA truly collaborative effort between SCMH and the local medical community too begin laying the groundwork for an inpatient psychiatric unit in one of the local full-service hospitals. Response from the BOS: The Shasta County BOS concurs with the recommendation that a local inpatient facility should be pursued. This facility should have the capacity to treat patients flexibly, which is best done in a licensed general hospital. SCMH, in conjunction with the Shasta County Administrative Office, has facilitated contracts with three corporations that are providers of behavioral health services that would like to develop a local inpatient facility. At a recent presentation, one provider made it clear that the provision of behavioral health services in a licensed general hospital with more than 100 beds is financially viable and of economic benefit to the hospital. NVMA representatives have made it contact with this provider and will facilitate meetings in an effort to promote the proposal, gain support from local hospitals, and encourage community involvement in this potential opportunity. GJ Reply to the Response: The Grand Jury accepts the response and awaits the outcome of this potential effort. The SCMH department is working with the NVMA to facilitate contacts between interested psychiatric providers and local hospitals. The Grand Jury applauds this portion of the response, but as noted in our report, the establishment of a psychiatric unit in a local full-service hospital is a three-year process.
• R10
  The Grand Jury suggests that the BOS pay a site visit to the County-contracted Elpida Crisis Residential Center and closely evaluate the benefits of the contract’s automatic renewal after fiscal year 2004/2005. Should Elpida remain open, the Grand Jury also recommends adoption of a formal lease between the County and Elpida’s private sponsor and establishment of an Elpida Policies and Procedures Manual. Response from the BOS: Representatives from the BOS, County Administrative Office, and Mental Health Advisory Board participated in a tour of the Elpida Crisis Residential Center on September 7, 2005, as recommended by the Grand jury. The Elpida crisis residential Center maintains a policy and procedures manual that addresses the areas required by State regulation. GJ Reply to the Response: The Grand Jury finds the response inadequate. Only two Supervisors participated in the Elpida tour and no evaluation of the benefit of extending the contract was made. The response did not address a lease between the County and Elpida’s private sponsor. The Grand Jury is still awaiting receipt of the Policy and Procedures Manual from Elpida.
• R11
  The Grand Jury recommends the County BOS and SCMH consider both financial and staffing support of a proposed County Detoxification Center. This center would afford opportunity for an improved collaboration between SCMH and both the local medical community and city governments. Establishment of a detoxification center would reduce the congestion in local hospital emergency rooms. Mental Health Services Act (Proposition 63) funding could be an additional source of financial support. Response from the BOS: The BOS, SCMH, and the Shasta County Alcohol and Drug Programs (SCADP) are in complete support of expanding the social model detoxification program in Shasta County. This is consistent with the “Community Action Plan” developed by representatives of Mercy Medical Center, Shasta Regional Medical Center, Shasta Community Health Center, the Good News Rescue Mission, SCMH, and the SCADP. A memorandum of understanding (MOU) has been developed by SCADP and circulated to the participants and other recommended collaborative partners. To date, only the City of Shasta Lake and the Shasta County Administrative Office have responded with support. The role of the Mental Health Services Act (Proposition 63) funding in this service expansion will be determined once the State Department of Mental Health guidelines for application for funding have been finalized and distributed. Additionally, the input received from stakeholders at more than 30 State required focus groups, conducted by SCMH, must be considered when prioritizing areas of need for mental health services expansion. This process targeted for completion in October to allow for a timely submission to the State Department of Mental Health. GJ Reply to the Response: The Grand Jury is satisfied with the response. We are also discouraged that only two collaborators have committed financially to a project that received unanimous support from all interviewees.
• R12
  The Grand Jury recommends that County and City Government guarantee public safety at all times by ensuring law enforcement personnel attend to 11 5150-designated patients while they are treated in, and until they are transferred from, local “unlocked” emergency rooms. Response from the BOS: The process for transfer of law enforcement 5150 detentions is governed by an interagency agreement developed by local law enforcement agencies in collaboration with representatives of SCMH, Shasta regional Medical Center, Mercy Medical Center, and Mayers Memorial Hospital District. Less than half of the calls to the emergency departments are the result of this process. More than half of the calls for SCMH crisis response are for patients who have presented to the emergency departments without law enforcement involvement. Thus, law enforcement personnel are not present in these cases while the emergency department examines the patient to determine if an emergency medical condition exists consistent with the federal requirements under the Emergency Medical Treatment and Labor Act. In these cases, SCMH determines the legal status of the patient if the emergency department physician decides that transfer or discharge to a specialty psychiatric facility is necessary. Response from the City of Redding: The Grand Jury recommendation requires further analysis. The Police Chief cannot guarantee that law enforcement personnel attend to 5150-designated patients while they are “treated in, and until they are transferred from, local unlocked emergency rooms.” It would mean that police officers would need to be diverted from our neighborhoods and businesses to attend to individuals who should be at a detoxification center or at a mental health facility for as much as 24 to 30 hours. Currently, police officers remain at the hospital with a 5150-designated patient until the patient is stabilized and no longer believed to present a threat to themselves or anyone else. Since the closure of the County PHF, police time necessary to handle these calls has already increased 66%. Remaining at the hospital to await transportation would further tax resources by doubling the average amount of time spent by police with each patient. We agree with the hospitals that the solution is not more police officers, but rather more and better health care. Specifically, patients need to be evaluated much quicker as to the cause of their illness (drugs, alcohol, or mental health) and the patients need to be transferred, where appropriate to a detoxification center or a mental health facility. Having patients come to a hospital emergency room, waiting much too long for evaluation, and having a police officer sit in an emergency room and spend time with that patient for hours and hours is a poor use of the public’s limited resources and is not a solution to the premature closure of the County’s Mental Health Facility. Response from the City of Anderson (received August 18, 2005): Just like the Grand Jury, the City of Anderson, as well as our Chief of Police, are very concerned about public safety. As such, we cannot guarantee that Anderson Police Department (APD) officers can attend to 5150-designated patients “until they are transferred from local ‘unlocked’ emergency rooms.” To meet this recommendation, police officers would need top be diverted from our neighborhoods and businesses to attend to individuals who 12 should be at a detoxification center or at a mental health facility for a minimum of several hours and/or as much as twenty-four to thirty hours. Diverting officers from their patrol duties would not guarantee public safety, but instead would decrease public safety in our own neighborhoods by reducing the number of officers available for law enforcement. Typically, ADP deploys two to three officers on each twelve-hour shift. These officers’s primary responsibility is the safety and security of the Community of Anderson. Currently, when an arrest is made, or a 5150-designated patient is taken into civil arrest custody, the shift coverage is reduced to two officers, and too often to just one officer, remaining in the City. Obviously this represents not only an “officer safety” issue but a “community safety” issue as well. Currently, an ADP officer will remain at the hospital with a 5150-designated patient until the patient is stabilized and no longer believed to present a threat to himself or herself or anyone else. Since the premature closure of the Shasta County Mental Psychiatric Facility, without adequate planning, the amount of time a police officer must spend at the hospitals handling 5150-designated patient calls has already increased. Remaining at the hospital to await transfer, as recommended by the Grand Jury, would further tax APD’s resources, typically doubling the average amount of time spent by the officer with each 5150-designated patient. The Anderson City Council appreciates the opportunity to respond to Grand Jury Recommendation Number 12 and hopes that our response is helpful. Response from the City of Shasta Lake (received July 28, 2005): The City of Shasta Lake agrees with the recommendation. Law enforcement services for the City of Shasta Lake are provided by the Shasta County Sheriff’s Department. The Sheriff has provided these services since the City’s incorporation in 1993. It is currently the policy of the Shasta County Sheriff’s department to provide law enforcement personnel to attend 5150-designated persons while they are treated in, and until they are transferred from local unlocked emergency rooms. GJ Reply to the Responses: The Grand Jury accepts the responses from the representatives of law enforcement in the County. We acknowledge the extra time and cost of attending to 5150-designated patients. We remain concerned that persons, who by definition are a risk to themselves or others, even when stabilized, are left unattended in area emergency rooms. A potential for harm within the hospital setting, or after a 5150 designee decides to leave against medical advice, remains a public safety issue.
• R13
  The MHAB needs broader community representation. Private physician, local hospital and clinic, and law enforcement inclusion would strengthen the MHAB role as the community advocate for mental health issues. The Grand Jury encourages the BOS to improve the MHAB composition and strongly urges the MHAB to carefully review all major contracts entered into by SCMH. Response from the BOS: the BOS concurs with the Grand Jury’s recommendation regarding the expansion of community representation on the Mental Health Board. The Chairperson will work with the Mental Health Board Membership Committee to recruit a broader cross-section of community members. The MHAB will continue to review the State Department of Mental Health Performance Contract, which governs aspects of the operations of the SCMH Department before it is submitted to the BOS for approval. GJ Reply to the Response: The Grand Jury is satisfied with the response and again encourages MHAB input on all major contracts entered into by SCMH.
• R14
  Citizens of Shasta County can take advantage of a new source of state funding for expanded mental health services through the Mental Health Services Act. Similar to new library construction funding a few years ago, this Act awards state tax revenues to individual or joint county proposals for services based on the merits of the plans submitted. Shasta County citizens rallied impressively to support the library and the Grand Jury strongly recommends the BOS encourage a similar community effort. This is an excellent opportunity for increasing access to local services that are both desperately needed and chronically under funded. Mental health services should be prioritized through the public input sessions sponsored by SCMH. The BOS and MHAB should incorporate this community input into any proposal being submitted. Response from the BOS: The BOS concurs with the Grand Jury recommendations regarding the Mental Health Services Act. GJ Reply to the Response: The Grand Jury appreciates the response. The Grand Jury is concerned that a broad community effort to mobilize for real change in local mental health service delivery is not a priority. The BOS consistently ignores community needs for access to local inpatient care by allowing SCMH to export inpatients to out-of-county facilities. While purporting to support the active integration of mental illness into mainstream medicine, BOS policies and SCMH decisions continue to impede this integration. If the BOS, SCMH and area providers cannot unite to address this problem, it is unlikely that cohesive community support will follow.
• R15
  The BOS should not rely entirely on staff recommendations when considering future funding and direction of mental health policy in Shasta County. Assigning large, long-term, mo-bid contracts for untried services (Elpida) and closing the super PHF against the recommendations of the MHAB and a citizen’s Community Committee do not represent the best interests of County residents. Since the prior BOS (with the exception of one member) felt economic considerations superceded community recommendations to maintain an inpatient facility, the Grand jury encourages the current BOS (with two new members) to reexamine the issue. From the data presented in this 14 report, the Grand Jury recommends the BOS reconsider the economic factors that led to the decision to close the PHF. We fully appreciate the patient safety issues of the inpatient facility as it was configured prior to its closure. However, our investigation indicates that reopening a basic PHF (non-Medicare) with strict admission criteria is an economically viable and safe alternative to having no local locked inpatient facility at all. Establishing appropriate and affordable local inpatient hospital services would improve patient access ands care and alleviate the problems generated by the closure of the PHF. In conclusion, the Shasta county Grand jury asks the BOS to examine all the facts and govern for its constituents, and not for what benefits SCMH. Response from the BOS: The BOS does not rely solely on the recommendations of staff when considering funding or policy changes. The Board follows an extensive process of review to include a departmental staff report, County Administrative Office review and concurrence, County Counsel review, and Risk Management review. In addition, the Board receives and considers constituent feedback, including Advisory Board input, and public input regarding all Shasta County issues. The BOS voted 4-1 to close the PHF after considering all of the information and several factors including patient safety due to the lack of emergency medical care and the subsequent exposure to litigation. Continued operation of the PHF would require significant funding reductions in other areas of the Mental Health Department. Mental Health Outpatient services would have to be eliminated to ensure the ongoing financial viability of the inpatient unit. Discontinuing outpatient treatment programs would impact a larger population than the closure of the PHF. The loss of outpatient treatment services would impact approximately 87 percent of the total SCMH patient population receiving preventative services, case management, therapy, life management skills, medical management skills, counseling, and other specialty services that minimize or eliminate the need for emergency mental health treatment. Without outpatient treatment the need for emergency mental health treatment services would increase exponentially and exceed the capacity of the PHF. The legal, social, and fiscal impact on law enforcement, social support agencies, and the community in general would be significant. The Grand jury recommendation states that the Elpida contract was a large, long-term, no-bid contract for untried services. The initial term for the Elpida Crisis Residential contract commenced July 1, 2004, and ended on June 30, 2005. The contract was renewed for the same term length for fiscal year 2005-2006 on July 1, 2005. The Elpida Crisis Recovery Center is a subsidiary organization of Crestwood behavioral Health, Inc. Shasta County has had many contractual agreements with Crestwood for similar residential psychiatric services. The Elpida contract was approved by the Board in an amount not to exceed $1,124,200. This amount represents a cost savings for inpatient services that were provided at the PHF. GJ Reply to the Response: The Grand Jury disagrees with the response. With the exception of this final recommendation, all the responses received from the BOS 15 appear to have been provided solely by SCMH; they are taken almost verbatim from a set of responses received earlier from the SCMH Director. This is an indication of a continued over-reliance on staff recommendations. We feel compelled to point out that the Elpida Center is not licensed as a locked inpatient acute care facility (i.e., a PHF) and is not similar to other Shasta County- Crestwood psychiatric ventures. And although some patients are transferred from local emergency rooms directly to Elpida, it remains our contention that expenditures for this facility do little to address the need of County residents for acute inpatient treatment. The Grand Jury remains convinced that developing our own inpatient services is preferable to renting them. We contend that reopening a basic PHF is economically viable, as the yearly cost for a similar facility in Butte County is around $2 million. This represents less than 10 percent of the total SCMH budget, and less than the County is now spending for Elpida and out-of-county inpatient facilities. It is our belief that this will not impact the delivery of outpatient mental health services as described in the response. Conclusion: Prior to, and since the release of our report, public interest in the delivery of mental health services to County residents continues to make news. In April 2005, the BOS held a workshop on mental health issues and listened to patient and provider complaints. In May, the BOS, in conjunction with local hospitals and the Shasta Community Health Center, agreed to seek funding for an outside consultant to review the operations of SCMH. The Grand Jury commends the review and hopes its findings will lead to an improved delivery of care. In July, SCMH psychiatrists finally applied for privileges at one local hospital, but not at the other. A claimed “lack of collegiality” at the hospitals was offered as the reason SCMH physicians had not previously applied for privileges. An unfriendly response is not a reason to seek or deny privileges, nor has it prevented other specialists from attempting to do so. This slow pace of psychiatrist integration into general medicine, and a similar disinterest of the medical community to “buy-in” to the public delivery of mental health care provided by SCMH, remains a significant obstacle to further progress. For example, the declining interest in establishing a joint-partnership, community- sponsored, detoxification center underscores the level of mistrust between providers, SCMH and local government. The integration of mental illness into mainstream medicine cannot occur without willing and effective leadership from all sides. Over the summer months, anecdotal stories from citizens about their inability to access care at SCMH continued to be heard by the BOS. Claims by SCMH administrators that “payer source” is not a factor in the decision to treat patients have been contradicted by both community physicians and families. The Grand 16 Jury remains concerned that there will be no resolution of SCMH bureaucracy and, therefore, gaps in coverage will continue. On a positive note, SCMH will hold a Mental Health Services Act (Proposition 63) public hearing and release its community action plan for funding in October. The Grand Jury applauds the effort by SCMH in soliciting broad community involvement over the past year and looks forward to the presentation of the plan. A major goal of our report was to expand the community discussion about mental health. We believe this has been accomplished. However, discussion is only the first step. Productive action by local government is still lacking. Even with re-opening an inpatient facility, the poor communication between SCMH and the medical community, the ongoing problems with patient access, and an overly bureaucratic mental health department, continue to stymie progress. Report No. 3: Redding Land Purchases The Grand Jury reported on the increasing number of land purchases by the City of Redding, specifically the purchase of an 82-acre vacant parcel along Interstate 5. The parcel, ostensibly purchased as a buffer zone to the City’s southern boundary, is situated mostly in a flood plain and lies outside the city limits. The $1.5 million purchase was funded by a loan to the City’s general fund from the Redding Electric Utility (REU) reserve fund. The report also focused on the use of Redevelopment funding for the purchase of two other properties. The City of Redding responded to four recommendations by letter submitted to the presiding judge of the Superior Court by the Mayor of Redding on July 20, 2005.