The proposals for mental health and opioid care have been requested, and advocates are watching

By ANNEMARIE SCHUETZ
Posted 6/16/21

MONTICELLO, NY — “Folks really want the best thing for this county,” said Sullivan County Health and Family Services Commissioner John Liddle. But the media climate is such that we “get compelled to find ways to argue with each other.”

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The proposals for mental health and opioid care have been requested, and advocates are watching

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MONTICELLO, NY — “Folks really want the best thing for this county,” said Sullivan County Health and Family Services Commissioner John Liddle. But the media climate is such that we “get compelled to find ways to argue with each other.”

As the requests for proposals go out, looking to privatize some or all of the community services department, we aren’t reliving the stormy months of the care center debate.

No long lines of speakers. In fact, the audience was small at the health and family services committee meeting.

Everyone, from legislators to commenters at last Thursday’s meetings, was careful to acknowledge the problems the county faces. Officials were careful in their word choice. They reiterated that the vulnerable and the staff who care for them won’t be forgotten.

“We provide a service for our constituents,” said Joe Perrello. “It’s not about making money... But we need to serve our people and get them some good help.”

What’s happening “will never replace the people of this county who are dealing with” the problem, said Luis Alvarez. There’s a big difference between the staff who know the situation and know the people and families involved, and someone coming in from outside. “It’s not the same.”

“I don’t think we’re looking to replace what we’re already doing,” said department head Melissa Stickle. “We need help. We need additional services.”

Sisyphean task

Her staff is coping with caseloads of 100 people each, she said. “And numbers are increasing.”

That’s what mental health and substance abuse look like in the county.

“I have five social workers,” Stickle said. She talked about how they triage cases now, and the three-week waitlist for those who can be safely added to it. (The suicidal and those in crisis are cared for immediately.)

“This is not to replace [staff], it is in addition to [who they have]... We have to figure out how to get services to people.”

They’re expanding telehealth and working with agencies like BOCES to use buses with WiFi to get mental health and substance abuse care to people where broadband is spotty.

Watchful waiting

Everyone acknowledges the problem, but that’s not to say that the public isn’t concerned.

“I’ve worked in private mental health care,” said Cat Scott. “We rejected people constantly.” She understood supplementing services, she said, but after what happened with the care center, “I don’t trust you guys.”

“The rules say this must go before the committee and it never did,” said Ken Walter during public comment at the earlier parks and sustainability committee meeting. “This is getting to be a bad habit on your part.”

He ran the numbers and worked out that the department currently costs the taxpayer $13.38 for every $100,000 in property value.

It’s clear that people aren’t aware of what’s contained in the request for proposals (RFP), Lou Setren said during the parks committee meeting. It would allow one or more private companies to take over almost the entire department. Mental health care isn’t a business, he said. It “goes to the question of what is a government supposed to provide for a society.” 

In the parks meeting, Walter listed the root causes of a substance abuse problem: Lack of education, lack of economic opportunity and difficulty in seeing the light at the end of the tunnel, or a way to improve one’s life. “Getting people out of addiction,” he said, “is really tough.”

What is the county looking for?

The 30-page RFP notes that community services is seeking assistance “to aid in providing mental health, chemical dependency and care coordination services” and invites vendors to assist with “one or all” of the services described.

Certain services, like court-related evaluations, have to stay under county control. But proposals are being sought for direct care, including psychiatric care for veterans, substance abuse treatment, other adult mental health care (including dementia) and school-based programs to identify and treat kids with mental health problems.

Federal and state aid can provide revenue, making mental health care something for the private sector to at least consider. In mental health care for youth, not only can treatment mostly pay for itself, the RFP notes, but it also “prevents the need for utilization of high cost, inpatient psychiatric hospitalizations for youth and costly travel expenses for parents/caregivers.”

Care coordination also generates enough revenue to mostly pay for itself.

The RFP outlines what a successful bidder would be expected to do. On the wish list: after-hours care, crisis and emergency care, care to inmates, decentralized care, working with Family Court and the judicial system and expanding school-based care. Working with BOCES, Head Start and schools was also mentioned.

Substance abuse care would go to someone with an established track record, would minimize disruption to Sullivan clients and “be willing to serve all clients regardless of ability to pay including Medicaid and indigent populations.” 

The RFP also mentions serving residents from any county as a condition for receiving state aid.

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