Outside mental health association recommends dissolving, replacing county’s volunteer board

12/10/2013 3:06 PM

12/10/2013 3:06 PM

A state association of mental health centers has issued a sharply critical assessment of the governing board of the Johnson County Mental Health Center.

The reports says the volunteer board “has created an unhealthy, unproductive atmosphere through a combination of perceived inaction and inappropriate actions” at the center that has contributed significantly to the center’s budget crisis.

The association also recommended the governing board be dissolved and replaced — a measure that the Johnson County Commission will discuss at its regular meeting Thursday. Meanwhile, Maureen Womack, former executive director of the center, has resigned. She had been on administrative leave since October.

The report gives an inside look into some of the problems that have put the mental health center on shaky financial footing as the year ends. It does not point fingers at a specific executive director, and some of the issues date to Womack’s predecessor.

The commission recently approved a bailout so the department can meet its payroll through the end of the year and the first months of 2014. The center is expected to be $1 million in the red this year.

Because of the shortfall, the commission appointed the county manager’s office to go over the books and operations with Chad VonAhnen, who became temporary director of the mental health center when Womack went on leave. VonAhnen is director of the county’s developmental supports department.

It was the county manager’s office that requested the report from the Association of Community Mental Health Centers of Kansas, a group dedicated to efficient and effective mental health care, according to its website. Johnson County’s mental health center sees the most severely mentally ill, many of whom are among the poorest in the county.

The 20-page report by a team of five health center professionals covered most aspects of mental health care at the center, from billing to staff morale to quality care for clients. From the team’s observations, a picture emerged of the Johnson County center as an agency in disarray and steadily losing money and personnel, with a staff at sea over unfocused or obtuse management decisions. And that confusion carried over to prospective patients, who were often referred away in an effort to cut costs, according to the report.

The mental health center is overseen by an eight-member board appointed by county commissioners that meets monthly and submits an annual budget to the county commission. Day-to-day managerial decisions had been made by Womack and before her, David Wiebe, who retired in 2012 after 26 years.

The association’s report faulted the governing board for poor oversight of the center. “It is our opinion that the current mental health governing board failed to act as assertively as necessary on their fiduciary responsibility to the (mental health center). Considering the information provided by staff, there is no evidence that the board appropriately addressed the financial situation with the executive director or held the executive director accountable for the financial performance of the organization,” the report said.

The association also said the governing board “demonstrated a lack of understanding of their role and responsibilities.”

Kevin Moriarty, chairman of the mental health board, said the report is “completely accurate and absolutely on target.”

He said he supported the county commission taking over the health governing board’s role “until some stability takes place.”

The mental health department has been struggling with a confluence of changes, including the managed care system, the loss of fee-producing employees and staff from early retirement and reduced revenue from the state, Moriarty said.

“The Center needs additional staff to help our most vulnerable citizens, and this cannot be done without the Commission’s approval,” Moriarty wrote in a statement. “The Commissioners will be in a better position to see the needs of the Center if they are experiencing everything first hand. I realize that other Board members may not agree with me on this point, but I do understand the Commission’s need to get a handle on the problem.”

The county commission on Thursday will discuss the possibility of dissolving the current board and replacing it with commissioners. Essentially, this will mean the commission will at times be able to act as the health governing board. The commission already operates this way to conduct business as the Public Building Commission and the Public Health Commission.

At the commission meeting last week, some commissioners said the wording of the report was unduly harsh on the volunteer appointees of the governing board. Commissioner John Toplikar objected to the strong wording on a staff briefing sheet that was identical to the report. “You really ripped these guys. This is scathing,” he said. “Keep in mind this is a volunteer board. These people volunteer their services. They’re doing the best they can.”

Commissioner Steve Klika agreed the tone was harsh. But, “ultimately this is our responsibility,” he said. “Ultimately we’re the ones that can fix the problem. So we might as well step to the plate here and get this thing moving. Prolonging the issue is just going to make matters worse.”

Much of the rest of the analysis centered on the need for the center to generate more income from paying clients and their insurance companies. Along with that was the need to engage and retain the clinicians and case workers who can bill for that income. Many of those billing employees have left in recent years.

The mental health center has lost about a quarter of its billing employees since 2009, with the majority during the past two years. Holding onto that staff, and perhaps replacing some of those who have left, was mentioned numerous times in the report.

The association called the center’s failure to fill vacant positions “extremely short-sighted.” Although the report did not identify specific reasons so many employees left, it did say that compensation wasn’t a factor.

The report generally praised the remaining staff for its willingness to help the center get back on track. But analysts also painted a picture of a staff anxious about the financial difficulties of the center and confused by changing performance expectations.

Part of that confusion came from a recent change in the types of patients that would be targeted by the center. During Wiebe’s tenure in 2010, the mental health center switched from outpatient and community-based services to focus mainly on the more severely mentally ill, apparently due to staff limitations, the report said.

But the staffers told the association auditors they were often uncertain about who the health center management had decided to serve. In some cases, clients who could pay for services were referred away from the mental health center because the agency chose to focus on people with more severe disorders, the report said.

The unfilled spots for billing employees, plus a loose approach to collecting money, also contributed to the financial crisis, according to the report. “In looking at policies and messaging to the public (including the website), the agency appears to be doing everything it can to deter or push away ‘paying customers,’” the report said. “It almost comes across that the Center is ashamed to accept money from individual citizens, even for high cost care.”

Community-based services for children also should be a target for growth, according to the report. The auditing team urged the mental health center to try and get the Shawnee Mission and De Soto school districts to allow services to be provided to children during school hours as a way of meeting the mental health needs of kids and also generating revenue that can support other programs. Currently the Olathe and Blue Valley school districts allow limited access during school hours.

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