A proposal to consolidate the county’s public health, mental health and health services departments drew fire from mental health advocates and others on Tuesday.
Supervisor Michael Antonovich proposed the consolidation as a way to “enhance patient care and access” and “streamline bureaucratic processes.”
Dozens of mental health advocates argued that consolidating services would ultimately short-change mentally ill patients.
“Large health systems have not typically provided enough focus on mental health,’ said Brittney Weissman, executive director of the Los Angeles County Council of the National Alliance on Mental Illness.
When mental health services were previously grouped with general medical care, “mental health became a stepchild,” she said.
Many who said they live with mental illness praised the Department of Mental Health for helping them dramatically change their lives.
Some opposed the plan outright, while others urged the board to get feedback from stakeholders, invoking the slogan “Nothing about us without us.”
“We all agree about having stakeholders in the process,” Antonovich said.
Dr. Jonathan Fielding, who headd the Department of Public Health for 16 years, warned that if his old department became a division of the Department of Health Services, it would “jeopardize the health of Angelenos” as “public health has a fundamentally different mission than DHS.”
Still, Fielding said it was “well worth considering” an umbrella agency over all three departments to promote coordination and collaboration.
The Department of Public Health is responsible for managing outbreaks of communicable diseases; runs programs to promote health goals such as childhood vaccination; and inspects restaurants and nursing homes. It is designed to serve all 10 million county residents, Fielding told the board, rather than the roughly 10 percent of residents that make use of county clinics and hospitals run by DHS.
The union representing county healthcare workers signaled its potential support, calling consolidation a “bold idea.”
“Done right,” the change could cut through bureaucratic red tape and improve patient care, said Bob Schoonover, president of Service Employees International Union Local 721.
Supervisors Hilda Solis, Mark Ridley-Thomas and Sheila Kuehl each expressed support for breaking down walls between departments.
Schoonover voiced his confidence in Dr. Mitchell Katz, who runs DHS and could be chosen to lead an umbrella agency. No permanent replacement has yet been hired for Fielding, who retired last year.
Dr. Marvin Southard, who has run the Department of Mental Health since 1998, said he would work to make sure that Los Angeles County remained a “national leader in providing for hope, wellness and recovery” in whatever organizational structure the board put in place.
Katz told the board he envisioned “three independent departments working together,” each with its own budget. He said no jobs should be lost as a result of the new structure.
In an interview with City News Service, Katz offered more details.
The three departments would work “as equals … each helping each other to do a better job,” Katz said.
Staffers would be more likely to collaborate to solve problems if they were part of a single agency with a common set of priorities, he said.
“We don’t have to shake everything up,” said the DHS director, but he pointed to substance abuse as a problem that typically requires attention from all three departments.
One “compelling” statistic, Katz said, is that those suffering from serious mental illness have a life expectancy roughly 20 years shorter than non- sufferers. This is true even though they typically die not from suicide, but medical causes, he said.
Supervisor Don Knabe stressed that the proposal amounted to a “look- see,” saying he had fielded many calls about the issue by telling constituents to “take a deep breath.”
The board directed a working group to report back in 60 days with a potential structure for consolidation, a timeline for implementation and drawbacks to integration. The group was asked to gather input from various stakeholders.
At Ridley-Thomas’ urging, the group will consider merging the Sheriff’s Department’s medical services bureau, as well.
