Deputy CEO Cherie Johnson reminded the board of the nuance of the agenda item, which was to eliminate the full time positions of public health director and behavioral health director, and create one position to oversee the two departments. Dr. Jenine Miller, who currently holds the position of director of Behavioral Health and Recovery Services, has been overseeing both departments since December.
“Public Health and Behavioral Health are not merging,” Johnson declared, specifying that “it’s an integration of the administrative services positions,” an effort to “help with the budget constraints.”
At the last Board of Supervisors meeting, Dr. Miller shared an overview of cost savings she has brought about as a result of what is scrupulously being called an integration, rather than a merger. She reported that administrative staff has been reduced by 13.5 full time equivalent positions, and that Medi-Cal is being billed more efficiently. At the June 4th meeting, Dr. Coren, who retired as public health officer last year, didn’t mince words.
“This is a very bad idea for a number of reasons,” he opined, elaborating that, “Public Health and Behavioral Health are completely different enterprises. It would be like asking a psychiatrist to direct a department of surgery. Behavioral Health takes a clinical therapeutic approach to disease that is mostly funded for services rendered. Public Health, on the other hand, is for prevention…Epidemiology is needed to tell the county what the vulnerabilities are…most of these being social determinants of health: Things that have not happened yet and could never be billed.”
The county is still without a public health officer, though Johnson reported last month that the county’s recruiting service has sent out thousands of messages in search of one. The application period closes next month.
Mendocino County is in bad shape when it comes to social determinants of health, according to a report from the California Center for Rural Policy at Cal Poly Humboldt. Rural northern California as a whole is ahead of the state average in “unintentional injuries, drug-induced deaths, motor vehicle accidents, liver disease, suicides, and firearm-related deaths,” much of it due to “mental health challenges and substance use-related issues.” In Mendocino County, tobacco use contributes to elevated rates of lung cancer, and heavy alcohol consumption is a factor in many of the other outcomes, including more than a third of fatal car crashes. The rate of homelessness per capita in Mendocino County is highest in the state, close to three and a half times that of the state average. Most of the region, including Mendocino, has a shortage of all kinds of health providers, including dentists.
But employees lined up at the podium to say the public health department has improved under Dr. Miller’s leadership.
Katherine Reel, a supervising Public Health nurse, said that as a current employee, she could attest to greater efficiency, soaring morale, “and more collaboration between departments than many of us have ever seen.”
Dr. Coren persisted, saying he believes the planned Health Services department, which would include both Public and Behavioral Health, should have someone who is versed in the principles of public health at the helm. “The danger is that we're going to lose the Public Health perspective,” he warned, adding that he believes the current lack of controversy is due to the departure of those who presented “recommendations that were much more consistent with the needs of Public Health, rather than just the defense of a leader and making the the administration and the budget smoother.” He also predicted that combining the leadership of the two departments would lead to the necessity of hiring a deputy director with an understanding of public health.
Beardsley, a trained epidemiologist, added that a lack of training in the methodology of public health is “a recipe for disaster.” She warned that bird flu, which has already jumped to other mammalian species, including humans, “could well become the next covid-19.”
Jennifer Lucky, who works with the CalFresh healthy living grant in public health, called in to say that she had been ambivalent about a career in the department before Dr. Miller stepped up, but she has observed positive change since December. “I feel that she’s really been pushing, creating that team,” she said. “We have people now getting out, learning, getting training so that we can better serve our community. So I am thankful.”
The board voted unanimously to eliminate the two director positions for Public and Behavioral Health, and to create one director position overseeing both. They also agreed with Dr. Coren’s suggestion to start a public health advisory board.
