Public Trough II

People keep asking me why the Sacramento County Department of Health and Human Services, Division of Behavioral Health Services (to spare my fingers, hereinafter known as DBHS) is dismantling effective community programs in favor of a monolithic county bureaucracy. Lately, attention has also turned to the Sacramento County Mental Health Treatment Center, affectionately known as SCMHTC, or “schmick,” and why the county keeps paying for this dinosaur rather than replacing it with Medi-Cal funded Psychiatric Health Facilities (PHFs). Earlier today, I found myself answering the question in an email to a prominent mental health activist, and thought it would save a lot of time and trouble to just post it publicly. So here’s my take on why DBHS keeps insisting on spending more money to provide less service.

I’m sure you know that the Sacramento County Mental Health Treatment Center is — by far — the largest and most expensive county-owned mental hospital. Did I mention “by far”?


There is a plan to move outpatient services into this same inefficient and expensive system to “save money.”


(It isn’t 71-J — that issue was invented after the plan to close the RSTs was already under consideration.)

It’s as simple as this: Draw a black box. Label it DBHS. On the left, draw an arrow going into the box. Label it $172,000,000. On the right, draw an arrow going out to the community nonprofits. Those nonprofits provide about 100% of outpatient services. Label it $20,000,000. The $152,000,000 that disappears inside the black box represents DBHS’s astonishing 88% administrative overhead. It’s just that simple. It takes DBHS hundreds of pages of “it’s not that simple; you just don’t understand” flimflam to try to obscure that simple fact.

You can use completely different methods to calculate overhead, still using DBHS’ own numbers, and you come up with the same answer about The Public Trough.

In the past, that waste has been partially hidden by inflating the budget of the by-far-largest-and-most-expensive county owned mental hospital in the state. The smoke grew thinner and the mirrors more tarnished after last year’s 50% reduction in services (but not budget!) for the Sacramento County Mental Health Treatment Center.

Now what seemed nonsensical becomes clear: the more DBHS can move services in house, the more opportunities they have to call their waste “direct services.” The black box grows to cover the $20,000,000 arrow on the right, and they can claim anything they want as “cost of care,” just as they do now with the by-far-largest-and-most-expensive county owned mental hospital. Bob Hales and Jim Hunt can continue to collect their half-million dollar yearly compensation. Everyone’s happy! That’s why they’re against the community non-profits. That’s why they’re against The Effort (services at no cost to the county? Gasp! we’d lose everything). That’s why there’s foot-dragging on the PHF proposals.

Make sense now?

Ron  – 16 Jun 2010