February 5, 1999

The California Psychiatric Association (CPA) applauded a decision by the Health Care Financing Administration last December to reject a controversial merger of mental health care with welfare services in Ventura County.

The Ventura County Board of Supervisors responded swiftly to dissolve the merger it had approved in April (Psychiatric News, September 18, 1998). The board promised to remove the behavioral health services department from under the newly created Human Services Agency, which also oversees welfare, and place it back under the control of the Health Care Agency, which runs the local hospital, according to CPA attorney Daniel Willick in Los Angeles.

However, the county could lose up to $15 million in mental health services billed to Medicaid and Medicare between last April 1 and December 21, when the merger was in place, according to HCFA officials.

Willick told Psychiatric News, "In rejecting the restructuring, HCFA officials agreed with us that federal law requires the county's licensed hospital and independent medical staff to supervise the care of the Medicaid mentally ill. Removing that oversight responsibility from the hospital and medical staff and placing it under the human welfare agency was illegal."

In letters to government officials and meetings with state representatives in San Francisco, CPA had argued that the merger violated federal regulations.

"CPA also opposed the merger because it demedicalized the treatment of the mentally ill," said Willick.

Proponents of the merger, including three county supervisors, argued for a social model rather than the traditional medical model of treating the mentally ill. A doctor/social worker team approach would move the patient toward independent living instead of being placed on medication and institutionalized, according to an article in the December 23 Los Angeles Times.

Among the opponents was CPA member Ronald Thurston, M.D., a psychiatrist in private practice in Ventura County. He told Psychiatric News, "HCFA requirements ensure independent medical authority and decision making. To pretend that tucking the psychiatric services department away in a social welfare agency would cover the licensing and supervision issue was a distortion of medical care. The quality of medical treatment of the mentally ill would be greatly diminished."

Lou Matthews, president of the National Alliance on Mental Illness/Ventura County agreed. "As the organization representing family members, we were concerned that the merger with welfare services would further marginalize treatment of the mentally ill," she said in an interview. "Mental illnesses are medical problems, and doctors should have primary oversight of mentally ill patients. We also believed this was a power grab by the social services agency that had little to do with welfare of the mentally ill. We knew that it was having budget problems prior to the merger and that the agency's funds could be blended with funds for behavioral health services. Medicaid and Medicare have become a cash cow that does not translate into more programs for the severely mentally ill."-C.L.