Klamath County mental health clients, employees watch and wait for outcome

From the Klamath Herald and News, September 3, 2013

Dannielle Brown worked for the Klamath County mental health department for nine years. Now she is an employee of Klamath Youth Development Center, the nonprofit the county handed the department over to. She is the residential program supervisor of Phoenix Place, the only respite and residential care facility in the county.

Stan Gilbert, executive director of Klamath Youth Development Center, and Chris Eddy, licensed clinical social worker with Phoenix Place, the county’s only respite and residential mental health care facility, provide a tour of the facility.

Stan Gilbert, executive director of Klamath Youth Development Center, and Chris Eddy, licensed clinical social worker with Phoenix Place, the county’s only respite and residential mental health care facility, provide a tour of the facility.

During the transition from county to KYDC control, the county threatened to send Phoenix Place residents away because commissioners said they didn’t have enough staff to keep the facility open. More than a month before, the county sent out 30-day layoff notices. Though the notices had been receded, employees quit, retired or found work elsewhere.

Brown said during this tumultuous time, she wasn’t worried about herself.

“I can move on. I can find something else,” Brown said. “For the residents, especially the residents, they don’t have anything else.”

“They don’t have family members they can live with,” Brown said. “They don’t have friends they can live with. They don’t have the opportunities that we have to move forward with their lives. We are their lives. We are their homes, their family, their friends, their supports; we’re everything.

“For them to lose all of that, it would be like a giant earthquake hitting and you losing everything,” Brown continued. “I wasn’t worried about me. I knew I could figure it out. I was worried about the clients.”

Was everyone treated fairly?

It was in a letter on July 23 from the Klamath County commissioners to the Oregon Health Authority, asking the state to immediately take over the mental health program. The letter said appointments at the outpatient services office would be canceled and at Phoenix Place the county would “initiate patient transfers to other facilities.”

Financial impacts to county budget still to be determined

When the Klamath County commissioners chose to transfer mental health care to a nonprofit, it meant closing a large department within the county.

The Klamath County mental health department had 81 employees. As of last week, Klamath Youth Development Center had hired 27 employees.

Without a mental health department, commission chairman Dennis Linthicum said that department would no longer be around to pay its portion of the county’s overall administrative overhead.

“We’ll simply reallocate those costs,” Linthicum said. “Other internal organizations will bear the burden of those costs.”

Department funds

The balance of the Klamath County mental health department varied over the last few years.

In 2010 the balance was $788,406. In 2011 it jumped to $970,859 because “revenues exceeded expenses,” according to county financial documents.

In 2012 the number took a giant hop to $2.247 million.

In 2012 the county received about $1.5 million from Jefferson Behavioral Health, the company that used to manage mental health programs for five Southern Oregon counties. In 2012, four of the five counties changed to the coordinated care organization model for funding Medicaid and Oregon Health Plan patients and no longer needed Jefferson Behavioral Health. With only Klamath County remaining, it wasn’t enough to fund the company and it closed. The $1.5 million was a payout of what Jefferson Behavioral Health had in its reserves.

Klamath County Treasurer and chief financial officer Jason Link said the county will receive more funds from Jefferson Behavioral Health in 2013.

The mental health department also previously received funds from the Oregon Health Plan, commercial insurance, and the state of Oregon, Link said.

What remains of those funds is being used to tie up loose ends at the department — like finishing paying bills and fulfilling contracts with other mental health providers and programs, Link said. Some of those obligations will run through September and October.

As of last week, Link did not know if there would be any funds left over after all the bills are paid.

“We’re really just in the infancy stage,” he said. “Everything is still in flux.”

Some funds will go to the developmental disabilities, a sub-department of the mental health department that stayed under county control. Other funds may go toward alcohol and drug treatment programs in community corrections, Linthicum said.

Much of the state money the county once received will now go to KYDC as the state-designated mental health care provider for Klamath County.

Audit fees

Klamath County was audited by the Oregon Office of Payment Accuracy and Recovery, or OPAR, twice in recent history.

An audit of operations from January to December 2005 resulted in a $91,000 fine.

An audit of operations and billing from July 2007 to June 2008 resulted in a $325,000 fine.

The county worked out a deal with the state to make payments. The first was $25,000 on Nov. 1, 2012. The rest of the payments would be for $37,500 every quarter from January 2013 to October 2014.

At the time, the county said the payments would come from the mental health department. The county no longer has a mental health department.

The county still owes $187,500. Link said it will make one large payment, in total, to pay off the balance of the audit fines.

Department assets

The county also is deciding what to do with all the equipment the mental health department used.

Link said the department had 10 vehicles, which will be offered to other county departments. Likewise, furniture and office supplies will get “absorbed into other departments,” Link said.

The Klamath Behavioral Health and Wellness building on Vandenberg Road is still being cleared out. It was just re-opened in January after extensive damage from a 2011 fire.

Linthicum and Link said the building may be used as a new home for Klamath County Public Health, but a formal decision on what will happen to the building has not been made.

The next day representatives from the Oregon Health Authority came to Klamath County and signed a contract with Stan Gilbert, executive director of Klamath Youth Development Center, the nonprofit that took over the mental health department.

Treatment of employees

The Herald and News
asked commissioners if they believed the employees were treated fairly during this time.

“As fairly as could be expected under the circumstances,” said commissioner Tom Mallams. “I would have liked better coordination. I give credit to employees, they stuck it out when they didn’t know what was going to happen.”

“Yeah, I think they were,” said commissioner Jim Bellet. “We followed the contract of our union, gave them 30-days’ notice. … so we gave them notice. We followed all the procedures we felt were in our contract with those people.”

Commission chairman Dennis Linthicum said the loss of employees was due to a lag between when the county said it was getting rid of the mental health department, and when the state signed a new contract with KYDC.

“We knew we were in trouble with regard to continuing to pretend that things were not going to change,” Linthicum said. “We were under the assumption that all those individuals who worked for the county would get picked up by other service providers, the mental health service providers of the area. Indeed that is what happened. Our assumptions were validated. Those people did get picked up.”

Treatment of clients

The Herald and News also asked if the commissioners believed clients were treated fairly during the transition.

“Yes, I think so,” Mallams said. “Under the circumstances, because of the mental problems clients have, it was going to be traumatic even if it was an absolutely seamless transition.”

“I think so, yeah,” Bellet said. “We tried to treat everybody fairly.”

Brown said with the news about the threatened closure, Phoenix Place residents were affected.

“We’ve been really good at protecting the residents from a lot of what has happened,” she said. “But when that article came out in the newspaper, we get the newspaper every day, the residents saw it. There was a lot of anxiety of maybe having to move. A lot of our folks have been here a long time. So this is home. It may not be what we would consider home, but it’s home to them.”

One resident has lived at Phoenix Place for eight years. The newest arrived three weeks ago.

During the transition there were times when Brown and other staff did not have answers for the residents’ questions.

Mallams related to that situation, the insecurity of the future.

“The only answer we have is we don’t know,” Mallams said. “That’s not the answer they want to hear.”

During this time the long-term residents at Phoenix Place were agitated. They sometimes bickered like siblings, Brown said.

Phoenix also saw an increase in clients coming for crisis care: those who come for a few days and are often brought in by family or police. Respite care also increased: those who come for a few days of their own free will because their mental illness, or the demands of life, are too difficult. They need time to cool off and reset themselves.

In all, Phoenix Place has nine residential beds, six respite beds and three crisis hold beds.

Caring for clients

In the midst of all the uncertainty, Brown chose not only to stay, but to take the reins directing Phoenix Place. Up until a few weeks ago, she had worked various positions in the county mental health department both at Phoenix Place and at the Klamath Behavioral Health and Wellness outpatient building.

“All I could tell them is, ‘We’re working on it and we’re going to do the best we can. We won’t leave you guys out on the street,’ ” Brown said of the residents at Phoenix Place. “And I felt comfortable saying we would not leave you out on the street. If I had to take them home with me, I would not leave them out on the street.”

And Brown meant it.

People with mental illness are often stereotyped, considered the bad guys. Brown said in working with them, she knows they don’t fit that stereotype. They aren’t the monsters people think they are.

“These are the people,” Brown said. “When you take them out in the community, everybody’s afraid of them. ‘Oh, my gosh that person’s going to kill me because they have a mental illness.’”

That isn’t the case. Most often, they are people who need help.

“They really don’t have the capacity to function in the community without the supports we can provide them,” Brown said. “We need to be able to provide those supports. They are the ones who are going to be at a loss, for it. Not us.”

So when a program is in danger of shutting down, or even threatened to be shut down, it is the clients and the residents who suffer. They are the ones most vulnerable, and the ones who need the service the county once provided.

A brighter future

Brown was hired by KYDC in mid-July. After KYDC officially took over on Aug. 1, the transition has been running full force and with it, a measure of stability has returned to facilities like Phoenix Place.

Now all adult care happens there, both outpatient and respite and residential care. So far, Stan Gilbert, executive director of Phoenix Place, said 693 clients — mostly outpatient — have transferred to KYDC.

“There is a light at the end of the tunnel at this point,” Brown said. “We had all been up in the air for so long that having someone step in and be willing to take the proverbial bullet was helpful.”