SALT LAKE CITY — The Salt Lake County Council authorized Tuesday an independent, comprehensive review of the county's mental health system.
While the audit will cover the entire system, some council members lit into Valley Mental Health for its handling of an announcement that it would no longer serve as many as 2,200 patients due to a reduction in funding it receives from the county. The organization announced to the news media it would be making cuts and that affected consumers would be contacted by mail.
"This was Valley Mental Health throwing us under the bus, under a freight train," said Councilman Randy Horiuchi.
Lori Bays, the county's director of human services, told the council that the county's mental health system is "robust" because the County Council vastly exceeds the 20 percent Medicaid match the state requires. The county's $56.5 million system would be a $39.8 million system if the county simply met the state requirement, she said.
Councilman David Wilde said Salt Lake County is a leader in the state, if not the country, for its commitment to mental health funding.
"I’m pissed off how VMH handled this, to read this in the newspaper and accuse us of being irresponsible," Wilde said.
Horiuchi said the issue "probably came about because of a tremendous lack of communication" between the county and Valley Mental Health.
Horiuchi said he believes the county representatives should serve on Valley Mental Health's board of directors. When VMH was the sole provider and manager of the county's mental health resources, there were three county representatives on its board.
Bruce Cummings, chairman of VMH's board of directors, said he "did not personally object to that (county representation on the board). It's obviously going to be up to the whole board."
For the past two years, OptumHealth has managed the county's mental health resources. It is not a provider of mental health services but it contracts with some 200 different providers, including VMH, a private, not-for-profit organization.
Switching to a fee-for-service model as an OptumHealth contractor has been challenging, said Valley Mental Health President and CEO Gary Larcenaire.
VMH adapting to an entirely different business model, and there were difficulties matching its IT system to OptumHealth's.
"Your management decisions depend on that. The IT challenges have been hard. It made an already difficult process more complicated," Larcenaire said.
Ginger Phillips, a peer advocate for people with mental illnesses, urged the county to work quickly to select an evaluator and conduct the reviews because "this county is in crisis."
Between media reports and letters that have been sent to patients who will no longer be served by VMH, many mental health clients have experienced great stress over the news.
"Just the letters going out caused so much anxiety," she said.
Brian Neilson, who said he has undergone treatment for schizophrenia at Valley Mental Health, credited the patience and persistence of VMH professionals for his progress in managing his mental illness. "Stable treatment takes a lot of trust in your doctors and your therapists," he said.
Neilson, 48, said he has schizophrenia and for years had mistrusted clinicians to the point that he would only seek mental health services from VMH on a walk-in basis. Neilson said he had spent 28 years on the street and "I've been in prison" for many years. But VMH professionals continued to reach out to him.
"I’ve had a pretty rough life. Through Valley, I am where I am now," he said.
Neilson said changes to the county's mental health system had stressed VMH's ability to provide services, despite the best efforts of practitioners. "Valley can't afford to bend any more. They broke."
Julie Hardle, manager of recovery and resiliency for OptumHealth, said she, too, has been a consumer of mental health services. She is in recovery, having once been diagnosed with a serious, persistent mental illness and hospitalized seven times.
"I do have a lot experience with crisis, what crisis means, as well as the anxiety of change and how that affects a person," Hardle said.
But Hardle said the transition of moving from VMH providers to other providers has been difficult for some patients. "There are many other experiences people are having where they feel supported and they're making the transition," she said.
As VMH has reduced services, OptumHealth has attempted to place them with other mental health providers or help them appeal VMH's decision to longer serve them.
Bays said some 730 letters have been mailed to VMH clients. "Fifty-eight appeals have been made and one-third of those have been granted," she said.
Larcenaire said VMH "has stopped sending letters until we are assured that the current clients are successfully transitioned."
VMH undergoes some 20 reviews each year as required by state, federal and local mental health authorities, Lercenaire said. It will cooperate with the system evaluation approved by the county on Tuesday. OptumHealth has likewise promised to comply with auditors.
Council Chairman Steve DeBry said the council looks forward to a comprehensive review of the county's funding of mental health services and an evaluation of services.
"We all want answers. We all want to know what's going on and why," he said.