Ecker, health unit clash New agency's autonomy at issue

August 29, 1993|By Jackie Powder | Jackie Powder,Staff Writer

After two years of study, the county's mental health advisory board has a plan for creating an independent agency to improve services for the mentally ill.

But County Executive Charles I. Ecker wants the core service agency to be a part of the county Health Department, instead of a private, nonprofit agency as the advisory board recommended.

"Why he would not take the recommendation of the people who studied the issue in depth, I don't know," said Marguerite Bridge, president of the Maryland Alliance for the Mentally Ill and a member of the board's core service agency task force.

Faced with opposition from mental health care advocates, Mr. Ecker has delayed a decision on the proposal, but he says forming the agency as a part of the Health Department would be cost-effective and efficient.

"There's a strong feeling in the mental health community that the health department would not be able to provide these services, and I say it will, and I'm committed to do it," Mr. Ecker said.

Advocates for the mentally ill insist that making the new agency a part of the health department would amount to a conflict of interest by placing the department in the position of evaluating its own mental health services.

They also contend that a private agency would be more flexible in creating services and pursuing private funding for services, free from the constraints of a governmental bureaucracy.

Howard advisory board members have looked closely at some of the 11 core service agencies that operate in Maryland serving 15 counties. One of the agencies serves five Eastern Shore counties.

The concept was approved by the General Assembly in 1991 as a way to improve the coordination of community mental health services and include mentally ill patients and their families in policy-making decisions. Core service agencies are not required, but the state would like to have agencies in all counties by 1995, said Jim Stockdill, deputy director of the state Mental Hygiene Administration.

"In the past, community-based programs have not been effectively linked," Mrs. Bridge said. "People had to go here for housing, and there for job training and someplace else for recreation. This would be a system of coordinated services."

In the last two years, core service agencies have worked to re-allocate $10 million from state mental hospitals to community-based programs serving the mentally ill, Mr. Stockdill said.

Agencies allocate money

Under state guidelines, core service agencies are responsible for allocating all state and county money for mental health programs in each jurisdiction. This year, for instance, a core service agency would be charged with overseeing combined state and county spending of about $3.1 million in Howard.

If the core service agency were set up as a nonprofit agency, it would determine how much money goes to the county health department, with county health officials losing some administrative functions and the ability to decide spending for mental health services. However, the department would continue its role as a mental health provider.

"Many people recognize that the health department can and does provide excellent direct day to day services. That's not the issue," said Andrea Ingram, a task force member and the executive director of Grassroots, a nonprofit Columbia group providing services for the homeless.

"A private nonprofit can do the things a core service agency is supposed to do a lot better than a government agency because of the bureaucracy," she said.

But Mr. Ecker and Dr. Joyce Boyd, the county's health officer, say the health department could serve as the core service agency and set up safeguards to avoid conflict of interest.

Dr. Boyd said the core service agency's board of directors, which must include patients and their families, would oversee program monitoring and be involved in funding decisions.

"I personally feel it's appropriate for public money to be distributed by a public agency rather than a private nonprofit," Dr. Boyd said.

While Mrs. Bridge charges that the health department supports an in-house core service agency because it is reluctant to give up control over funding, Dr. Boyd said the health department's record shows otherwise.

"For years, we have been requesting money not only for our clinic but for other nonprofit organizations," including Grassroots and Vantage Place, Dr. Boyd said. "I think we have shown an interest in providing the most comprehensive health services available."

With the additional state money that comes with the creation of a core service agency, Dr. Boyd said the department would be able to hire more staff and provide needed services, such as a 24-hour crisis team that could intervene in the home in the event of a mental health emergency. State health officials say that Howard County would receive approximately $150,000 to start a core service agency. Agencies also may apply for state money to establish specific programs.

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