On 26Mar2010, at 15:54, =========== wrote:

I've specifically been praying for $1M for TCORE. Is that about right?

Understand that I have no inside knowledge of the budget of TCORE, DBHS, or the RSTs. I'm going by things I've heard, so these numbers might be wildly wrong. On the other hand, after 13 years in this system...

Ponder this:

At our current level of staffing, that $1m would cover TCORE for about six months. Our current case load is about 700 patients (650 open, about 700 patients who have contacted TCORE in some way, and 1,200 patient for whom we ultimately have responsibility). Using the 700 figure, we're providing care for about $240 per patient per month (pppm). I'm given to understand that the overall average costs in the county adult system (and remembering that the figure includes TCORE but not the Sacramento County Mental Health Treatment Center) is $600-700 pppm. If that's true, TCORE is costing taxpayers about 1/3 of the cost of other programs. Notably, I am betting every monetary asset I have on the notion that I can provide a different but generally higher level of care for about $80 pppm including a small profit, but that's another story.

Currently, there are roughly 6,000 souls in our system for treating adults with mental illness. The TCORE model is proven and is generally scalable/duplicable (though we cannot clone [our incredible TCORE staff]). Converting the whole system to a TCORE model could potentially save almost $2.2m. Add in the $2.9m loan that Mary Ann Bennett incorrectly claimed has to be repaid this year and we have more than covered the entire revenue shortfall ($4.9m) that DBHS claims is forcing them to eliminate services.

I can say with absolute certainty that a TCORE-model reform was never seriously considered, since serious consideration would necessarily have involved talking with me about it. Egotistical, I know, but also factual as I have exclusive access to the IT infrastructure that is a small but critical part of TCORE's success.

I do want to talk w/you. Last Tuesday when we talked you were ready to do your Psych Envy and giving up on the county. What are your current thoughts?

My thoughts:

Scenario 1:

The current plan goes forward, including the laughable proposal for ongoing services that's currently circulating behind closed doors. The supervisors buy the DBHS proposal, and everything closes. Any service coordinator, manager, office worker, or doctor with any sense (I'd like to think that's most of us) has already found new employment. The programs are no longer able to provide services, and our friends and neighbors are left to suffer and die.

Scenario 2:

The current plan goes forward, including the laughable proposal for ongoing services that's currently circulating behind closed doors. The supervisors see through the charade, and either increase funding or otherwise order CSA to do the right thing and keep all the programs open. Alas, it's now June 21st -- the supervisors aren't even calendared to begin budget hearings until June 14th -- and funding for the affected programs has already been halted. Any service coordinator, manager, office worker, or doctor with any sense (I'd like to think that's most of us) has already found new employment. The programs are no longer able to provide services, and our friends and neighbors are left to suffer and die.

Scenario 3:

Monday, DBHS announces that they miraculously found the $2.9m that they mistakenly lost and along with some other "painful cuts" such as eliminating some cost-of-living raises that amount to 600% of the actual increase in the cost of living, they can save the RSTs, TCORE, and WRC for another year. Any service coordinator, manager, office worker, or doctor with any sense (I'd like to think that's most of us) has already seen the handwriting on the wall and is going to find new employment as soon as possible. The programs are no longer able to provide services, and our friends and neighbors are left to suffer and die.

Have I missed anything? All probable scenarios result in the same outcome: The programs are no longer able to provide services, and our friends and neighbors are left to suffer and die. The DBHS March 16th memo killed mental health services in Sacramento County, and killed a number of the people that DBHS are charged with caring for. The timing of the memo was, itself, callous, cynical, and dangerous.

I believe that a better system will rise from the ashes, but we are now charged with two tasks. First, we must minimize the suffering for as many people as possible during the transition. Next, we must assure that care for adults with mental illness is never again subjected to the incompetent management of local government.

Comments?

Peace...

--Ron

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Topic revision: r3 - 2010-04-03 - RonRisley
 
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