Why mental health services must be kept separate

Office of HCEnhancement quoteSince February, the Los Angeles County Board of Supervisors has been studying a proposal to create a mega health care agency that would oversee the Departments of Health, Mental Health, and Public Health, driven by the goal to provide an effective system of integrated health care. As laudable as this goal may be, the thought of such an agency was received with skepticism by advocacy organizations, service providers such as Hillsides and, most importantly, the beneficiaries of these essential services.

All parties involved in this discussion share the goal of providing integrated health care to the most vulnerable in our community. It is imperative, in light of any number of federal initiatives and indeed best practices, that primary health care and mental health services be utilized in conjunction rather than separate and unrelated because many physical disorders are rooted in mental health issues. However, the concern is that a new entity driven by medical practice would focus more on treatment services than on the recovery and resiliency models of care that are so effective in addressing mental health issues.

In addition, the bureaucratic and logistical issues of an all-encompassing agency could impede the delivery of care. Each one of these three departments is already composed of a byzantine operating system that make the simple task of certifying a facility for services an endurance test measured by reams of seemingly unrelated checklists. Hillsides, for example, has spent months waiting for facilities to be fully utilized pending certification. The specter of yet one more bureaucratic layer added to the regulations and requirements that already exist does not seem to serve the overall goal of providing a more effective or integrated system of healthcare services. The problem with these convoluted systems is that they result in impeding the delivery of much-needed services.

A coalition of advocates, service providers, and consumers propose an alternative to the creation of a new mega healthcare agency. Using the model developed to coordinate all aspects of the county’s child welfare system through the Office of Child Protection, the coalition proposes the creation of the Office of Healthcare Enhancement. This office would have the sole focus of overseeing the integration of healthcare services without the distraction of developing yet another operating bureaucracy. It would be better positioned to negotiate the various interests of the three agencies that it would supervise and ideally be a much more objective arbiter to assure quality care in an effective manner. For the time being, this proposal would leave intact these three departments, ensuring that their respective focus and emphasis on specific populations would not be jeopardized while at the same time examining ways to better provide an integrated system of healthcare services.

Hillsides, like many organizations that deliver essential services to vulnerable children and their families, is especially committed to ensuring that the needs of those we serve are not subsumed in any way to those of other populations needing care. The risk of children’s services being somehow diminished is not acceptable and children’s access to fully funded mental health services must be safeguarded.

This is an extraordinary opportunity for the Board of Supervisors to structure the county to be more effective in delivering much-needed services. Along with other members of the coalition, Hillsides fully endorses the creation of the Office of Healthcare Enhancement and encourages the Supervisors to give all due consideration for adopting this alternative proposal at their upcoming meeting on August 11th.

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