Grand Jury

MARIN COUNTY CIVIL GRAND JURY REPORT SUMMARY 7 MARIN COUNTY CIVIL GRAND JURY 2014-2015 • AUGUST 2015 Report issued May 19, 2015 When state mental hospitals across the nation began to shut down in the 1970s, providing care for the seriously mentally ill became the responsibility of individual counties. What should Marin County do for its mentally ill? e Grand Jury investigated Marin County's mental health programs, services and related costs, and found an array of services being off ered, but critical gaps exist and more can and must be done. Mental Health and Substance Use Services (MHSUS), a division of Marin County's Department of Health and Human Services (H&HS), is responsible for public mental health services in the County. e population MHSUS serves is primarily the County's Medi-Cal 1 enrollees and the uninsured. e Grand Jury found that the County provides a comprehensive range of mental health programs and services following the model set forth by the State of California through the Mental Health Services Act (MHSA), 2004. While MHSUS programs are well intended, the Grand Jury found it diffi cult to evaluate their costs, benefi ts, and eff ectiveness. e Grand Jury recommends that MHSUS develop a programmatic approach to budgeting that will track individual mental health program costs and benefi ts. Once the individual program costs are tracked and known, each program must be subject to a set of measurable outcome goals to ensure program eff ectiveness. Without this accountability, how can the County accurately represent to the community the costs and relative eff ectiveness of its individual mental health programs? A key responsibility of MHSUS is to provide housing for mentally ill adults based on the severity of their illnesses. However, there is a lack of such housing, which results in a gap and a bottleneck for patients and imposes a signifi cant fi nancial burden on the citizens of Marin County. e Grand Jury recommends the County add more vitally needed housing for the mentally ill, including using the $1.4M MHSA funds awarded over six years ago for this purpose. e potential closure of the Helen Vine Detox Center would represent a huge loss in reaching and providing assistance to individuals with mental health and/or alcohol and substance abuse issues. e Grand Jury therefore recommends that MHSUS fi nd a replacement location for the Center before its lease expires in 2016. FINDINGS F1. Despite Mental Health and Substance Use Services (MH- SUS) providing a comprehen- sive range of mental health programs and services, there are major gaps and bottlenecks in Marin County's mental health system. F2. Since MHSUS's outcome met- rics lack clear meaning and their program costs are not de- fi ned, neither the Grand Jury nor the public is able to assess the programs' eff ectiveness. F3. ere is insuffi cient housing for the mentally ill in Marin County, resulting in costly out of county and/or unnecessarily higher level placements. F4. MHSUS' failure to identify and purchase additional housing for the mentally ill during the recent recession, despite hav- ing $1.4 million in Cal/HFA grant funds available since 2009 for that specifi c purpose, is unfathomable. F5. e potential closing of the Helen Vine Detox Center, the only Marin County public de- tox center, represents a huge loss of service and treatment to individuals with mental health and/or alcohol and substance abuse issues. RECOMMENDATIONS R1. Marin County Board of Su- pervisors and Mental Health and Substance Use Services develop a programmatic approach to budgeting able to track individual mental health program costs and benefi ts along with using quantifi able data to analyze programs for eff ectiveness and effi ciency. R2. Marin County Board of Supervisors and Mental Health and Substance Use Services immediately add more crucial housing for the mentally ill, including us- ing the $1.4M MHSA funds awarded over six years ago for this purpose. R3. Marin County Board of Su- pervisors and Mental Health and Substance Use Services fi nd a replacement location for the Helen Vine Detox Center before the current lease expires in 2016. 1 Medi-Cal is California's Medicaid program, a public health insurance program for low-income people. MARIN'S MENTALLY ILL: What's Being Done?

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