Inside UDJ by Editor K.C. Meadows

The PHF was closed because the staff were not able to be retrained. Kristy Kelly tens of thousands of dollars trying to keep the PHF open, some went into remodeling the unit and the rest went into staff training. The PHF was not a good place for those with mental health issues. The Dr was (and still is) very off putting and the nurses were known to verbally and sometimes physically abuse patients. These are facts that are indisputable. The PHF was a very bad place and it became clear that nothing could be done to save it. One of the biggest problems is that the County does not pay high enough wages to bring in a good psychiatrist and well trained nurses.

Where I do no think we need another PHF operated by the County, I do think that there needs to be 24/7 psychiatic services available, somewhere where medication evlauates can be done without the high cost of hospitalizing people. The place that was going to be developed at the old Silver Burches was a great idea and would have saved the County hundreds of thousands of dollars each yeat.

So, what is the solution. First and foremost, there needs to be a complete shakeup of the administration at Mental Health. The people now in charge have been there for many years and have not been able to fix it's problems. It's time for some new, fresh blood who are willing to take on the CEO and the BOS and fight for consumer rights and that can also recognize what our community wants and needs.

There have been a number of surveys done pver the past decade and all of them came back with the same results. But sadly Mental Health has ignored those survey results. Both Kristy Kelly and Beth Robey did their best to make things better. The only real objections came for the BOS and CEO's office. Mental health treatment should never be left in the hands of politicians and business managers.

We need a new 24/7 unlocked facility where people can get med evaluations and even spend the night if need be.

We also need to have proper medical services, not just a psychiatrist. We need a comprehensive medical approached when dealing with people with mental health issues. You would not believe the number of people that have been 5150'd when all they needed was a thourow medical evaluation.

Things need to change and the only way to accomplish it is to replace the people at the top of Mental Health, including Dr. Rossof.

(and please forgive my spelling mistakes. I am rushing to write this as I am getting ready to leave for Berkeley.)

K.C. - It continues to surprise me that the personal tour of the PHF that I gave you during a time of temporary closure of the facility (due to lack of staffing) had so little impact on you. The information you report getting from me is inaccurate. I do not expect that my corrections to the record here will make any real impact on your opinions, but perhaps they will make sense to your readers. 1. A Psychiatric Health Facility (PHF) is a tightly regulated operation. Proper staffing is outlined in law and is not under local discretion. 2. Operating a PHF is a serious business because by definition it is one of the few places in California where, upon entry, the constitutional right to self-determination is typically suspended. Without committing a crime, people are locked in and may be placed in physical restraints against their will. I walked you inside a seclusion room and showed you the table with 5-point restraints. I pointed out the overhead camera that provided continuous observation of patients in this setting, and demonstrated that this room was additionally locked. It would be a travesty to have such a setting inadequately staffed and supervised - as well as illegal. 3. At the time our PHF was permanently closed there were only 16 PHFs in the entire state. Successful PHFs are located in areas that have educational resources close by to provide a supply of properly trained professional staff. They are not located in small, isolated communities where psychiatric rotations and a renewing pool of nursing staff are not available. The staffing crisis at the PHF coincided with the retirement of a cohort of long-time staffers, many of whom had worked at Mendocino State Hospital. They knew how such facilities are operated. This resource was time-limited as the State Hospital had been closed by Ronald Reagan when he was governor. Eventually all of these employees reached retirement age. 4. The only economic consideration at the time was that a day at the PHF cost the County $800, while beds at St. Helena (which was properly staffed and provided excellent care) ran about $650 per day. Like access to many specialty health care services in a rural area, there is a 1 1/2 hour ride to get there. People in Mendocino County frequently travel to Stanford to get high quality specialized care. There is no reason to expect that a small, rural community should be able to provide every health care service close at hand.

Because Beth Robey (who was then with the CAO's office) and I worked closely to explore all options to closure, and this information was carefully considered by the Board of Supervisors in making their decision, I have never questioned the wisdom of this closure. I did have an opportunity to discuss this a few years later with Bob Egnew, who was the Mental Health Director who created the PHF in the early 1980s. His immediate comment was: "You still had the PHF? The county couldn't possibly afford that PHF!" He explained that the PHF was created as a wing of the County Hospital, at a time when it was financially adventageous to operate it as a separate unit. He questioned that it could be financially viable with the closure of the County Hospital.

None of this speaks to the issues brought up by Mr. French in his response to your article. While I do not agree with all of his statements, there is no denying the powerful objections he has to portraying the PHF as a benificent local service to those with mental illness. While access to hospital care is still needed, the PHF was an "old school" model that sucked up resources that could be better used to help people stay healthy in the community. That was the argument I made to the Board of Supervisors at the time, and the basic approach has been statistically validated by research from programs funded under AB 2034. (The independent State Legislative Analyst's Office has reported on this.)

In recent years, Federal EMTALA regulations have given Emergency Rooms a much larger role in dealing with psychiatric emergencies - they are rightly seen as health emergencies without discrimination or stigma attached to their genesis. I believe it is time to look forward in this discussion, KC. There are positive directions mental health is going with the implementation of the Mental Health Services Act. Reporting on the strengthening of local services that are capably provided at the community level and any subsequent impact on the demand for inpatient services would be much more interesting reading than ongoing lamentations for the PHF.