Wednesday, July 12, 2006

ADAS - Mental Health Board Merger

There's been some coverage of this merger in the news over the past several days, but the real story about this started much earlier.

Originally, when the state mandated that Alcohol and Drug Addiction Services be created, counties were given the option of forming a new board or of incorporating those services into their existing Mental Health Boards. Eight counties chose separate boards, the primary reason being the concern that adas-type services would be 'lost' in the delivery of services to mental health clients. Lucas was one of those counties.

In 2001, the Mental Health Board, in doing their proper role of evaluating their performance (especially in light of levy requests) conducted a study, the results of which were easily available on their website until today. To see the whole report, click here.

That report focused on the Mental Health Board, but included a review of how agencies work together and it stated (on page 12), "TAC believes that many of the benefits of coordination and collaboration can be achieved without combining the LCMHB with the ADAS board."

In 2003, state law was amended to allow, between July and December, a window of opportunity for the 8 counties with separate boards to consider a merger of those boards. Both the ADAS and Mental Health boards said they were not interested in a merger. Commissioner Tina Skeldon Wozniak, on Dec. 16th, introduced a resolution to have the boards merge. Comments from ADAS and MHB members were against such a merger and the BCC, listening to and respecting the recommendation of the boards, voted against the resolution to merge (2-1 Thurber & Barlos against, Wozniak for).

But then the makeup of the BCC changed and in 2005, the ADAS and MH boards were asked to do a study on a merger. The report of their study was completed in February, 2006, and the state law, at the request of the boards in Lucas County, was again amended to allow another opportunity for merger. Like in 2003, the window for merger was between July 1 and December 31st. (To see more of the maneuverings on this, see my post of May 7th, "Of Special Meetings and Grubs....)

While there is significant benefit to studying such an issue, the report our boards produced as a result of this study was certainly lacking - or perhaps my expectations were too high.

If I were asked to study an issue, I'd produce a report which identified the issue or concern; produced documentation on the extent of the concern; detail options - and their pros and cons - to address the concern; report on the decision as to the best option; and then make a recommendation which would include 'next steps' in the process. In this instance, if the recommendation was to merge, I'd also include sections in the report on the impact of the decision on funding sources, wages/benefits (if the agencies had different scales), organizational structure and any layoffs, costs of office renovations, etc...

These items were lacking in the document presented to the BCC. In fact, the rationale for the merger was only two pages with bullet points, and many of the pages in the study were only a paragraph or two on a page, making the entire report about 15 pages (including an organizational chart and a page on the amendment language).

Because this was a merger of two public agencies, I believed that many of the questions I had should be asked and answered during the public hearing - which I did on July 6th. However, as is typical, legitimate questions such as "what's changed since 2001 and 2003 which you were opposed to this path," and "are you prepared for questions about this just being a way for ADAS to get levy monies since their individual levy was rejected several times by the voters," received criticisms of an "ambush" and an "attack." In bringing up the levy - critical funding for the Mental Health Board and a bullet point under their rationale for merger - I was accused of bringing up a "wedge" issue and trying to "disguise the purpose of the merger."

Unfortunately, critical thinking and analysis are often criticized because they bring up issues others would rather not have made public.

However, during the merger hearing, two critical points were made - it's just that they weren't included in the report. They were:

1) In addressing the coordination of services for dual-diagnosed or "cross-over" clients, there needs to be one entity responsible and accountable for the services and the outcome. That is best accomplished by merging the two boards.

2) A single board can accomplish more on behalf of their clients than the two boards can accomplish individually.

I have asked that the merged board create a document - bullet points, if possible - to list the many things that can be accomplished under point #2.

The study did identify some salary savings by eliminating duplicate positions, but since the disparity in wages between the ADAS staff and MHB staff was not addressed, it's still uncertain how much money may be saved. And the costs of office renovation, changes in letterhead, etc... were not detailed - but neither were any savings that providers of services may see as a result of dealing with only one agency instead of two.

In the end, this was a done deal as soon as Commissioner Wozniak had another vote on the BCC - and everyone knew it. The issue then became - if we're going to have to do this, how do we do it right? Which may explain why the documentation in support of the merger is so lacking...

Despite my concerns, I voted to support the merger. In the final analysis, I decided that the unanimous support of the Commissioners was more important to the people who depend on these services than any objection I could raise, given the fact that the merger was going to happen regardless. I hope that I've made the right decision, but since the new Mental Health and Recovery Services Agency will have a levy on the ballot next year, only time will tell.

6 comments:

Kate said...

Maggie - many thanks for the look into the process and your decision making journey.

I attended the commissioners meeting when the issue was discussed. I felt that the report, which was apparently only two pages, could not be sufficient to discuss the logistics of a merger of this size.

The issues to be contended with are large - geographical location, merging of offices, staffs and salaries.

I did not hear any discussion of how to make a change over (actually I heard no mechanics of HOW a change over would even occur) seamless and transparent to the clients. I did not hear how this would affect the number of providers that the clients now have and if it would decrease choice.

Alot of unanswered questions - I would have hoped the report would have spelled out how they came to the decision, what the decision means to the community, the dangers of the decision (reasons against a merger) and what the plan is to counter those issues.

But as you say, if the decision was already made by two of the commissioners - what would be gained by fighting at this point? Maybe it is best, if it is indeed unavoidable and work together to make the best of it.

Just my two cents worth. But it has made me wonder why they even have a third commissioner if two make all the decisions regardless of how the third feels?

Lisa Renee said...

I agree that details should be clear and planned for before a merger is done. It's the same basic principle for Commissioner's when considering a vote as it would be for individual citizens. If you don't have the information, how can you make an informed vote?

Maggie Thurber said...

Kate and Lisa - great points and thanks for making them.

I continue to be alarmed that many decisions are made and then information is gathered to support the decision - rather than gathering information and making an informed decision.

I believe the next example of this will be the downtown arena.

Do said...

Maggie,

This was not a issue that should have been taken lightly. And I appreciate that you raised questions in an effort to make a informed and intelligent decision.

The change in your vote is totally understandable. I know it was a difficult choice for you.

The benefits of this merger have not yet been substantiated with complete data. All that has been presented is a flowery picture of what might be, not what will be.

I hope that the folks that these organizations serve will not fall as pawns in a political game. To serve these people is necessary and admirable. To play them in game fashion would be inexcusable.

Sometimes the beaurocracy (sic) loses sight of the PURPOSE of the organization and sees only dollar signs. I will pray that this is not one of those cases.

You have much support - and we all know it's not an easy job being a Commissioner. :)

Kate said...

This had better be on the up and up. I can say that I believe that a communities worth is in how it treats it's most fragile citizens. Those who are mentally and physically challenged are to me, those worth protecting fiercely :-)

Turns out to be a profit venture for someone? I think it would be very bad for those people. Political suicide.

Hooda Thunkit said...

Maggie,
"I continue to be alarmed that many decisions are made and then information is gathered to support the decision - rather than gathering information and making an informed decision."

But, that's just normal politics in Lucas Co. (normal for Lucas Co., that is).

You can't let good information get in the way of uninformed snap decisions, now can we?

It's just another 1-act play in the theater of the absurd, that is local politics...

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