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LA takes first step toward rolling mental health, other health agencies into one

Hundreds of people line up to join the Board of Supervisors meeting, where L.A. County leaders will discuss a controversial proposal to combine three health departments into one.
Hundreds of people line up to join the Board of Supervisors meeting, where L.A. County leaders will discuss a controversial proposal to combine three health departments into one.

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Los Angeles County supervisors took a first step Tuesday toward merging the departments of Public Health, Mental Health and Health Services into one county health agency, angering hundreds of mental health advocates, who attended the public meeting to oppose the move.

“Mental health in this county, and the thousands of people that it serves, deserves its own department of Mental Health,” said Bruce Saltzer, executive director of the Association of Community Human Service Agencies.

He said mental health services would get "short shrift" if the department is dissolved into a bigger agency. He said the move "would convey the message that mental health care doesn’t deserve the same standing as physical health in this county."

The five county supervisors and the Director of Health Services Mitchell Katz attempted to calm attendees, telling them the new bureaucratic structure would still allow the departments to work independently, but it would also break down some of the silos that stand in the way of integrated care.

"The intent of all members of this board was not an implementation plan - this was a 'look-see' plan," said Supervisor Don Knabe. "Take a deep breath."

The proposal, authored by Supervisor Mike Antonovich, said consolidation of the three departments would help the county adapt to changing trends in health care delivery, policy and reimbursement, some of which involves the Affordable Care Act, which provides funding for both physical and mental wellness.

New county supervisor Sheila Kuehl said the need for the consolidation was obvious to her on the campaign trail last year.

"I think the word I heard most often during that time was the word silo," she said. "People kept feeling that there was such a separation in county departments."

Mental health advocates, including many people who offered emotional testimony about their mental health struggles, took issue with how the supervisors went about the unveiling of the proposal.

They said they went about this large bureaucratic change hastily, without seeking input from those most affected. Several people told the supervisors that they found the sudden news of a vote on such a large bureaucratic change "threatening."

“I experienced fear, I experienced stress, I experienced anxiety, and it is really sad that I would have to experience that on account of you,” Reba Stevens said during public comment. "This is about trust. I’m questioning my level of trust with you."

In response to the outrage, supervisors modified the proposal during the meeting, allowing for more public comment over the next 60 days while staff come up draw up a plan for implementation. 

The motion, approved by supervisors, will also now require county staff to consult with the departments of Mental Health and Public Health on the benefits and drawbacks of such a plan. They will report back to the board in 60 days.

This story has been updated.