Bonnie Caplan has an atypical view of bureaucracy.
Bonnie Caplan: I like going to a lot of meetings! Frequently you learn something, that's the goal.
As the newly elected chair of the Cuyahoga County Community Mental Health Board, she'll have plenty of time to enjoy them.
Caplan's also a Cleveland Heights city councilwoman and a former psychiatric therapist. Her chairmanship comes at a time when expectations are high. Her numerous new board members are looking for guidance on mental health's Byzantine funding. She'll have to rally support for the upcoming Health and Human Services levy and convince local and state leaders that mental health system has changed - and is ready for a much bigger slice of the pie.
As if all that weren't enough, there's a question that hangs at the back of her mind. Caplan wonders: What can the board be expected to accomplish, in a system that's under so much pressure to dedicate money and resources to Medicaid cases?
Bonnie Caplan: The fewer dollars there are that are left for non-Medicaid services, then the challenge is what services DO we pay for with the non Medicaid dollars, and WHO gets cut out of receiving the service?
The board hasn't made much progress in recent years, primarily because of internal problems. Its meetings were legendary for their length and spectacular squabbles. Most of the executive directors that have served the board over the past twenty years have been fired. One former chief filed suit for racial discrimination. The most recent to leave was Ella Thomas. Her tenure began well. Thomas worked hard, and took steps to police providers that had a record of neglecting clients. But ultimately she was fired, in a dispute over a retirement system refund. For nine bitter months, the terms of her exit were negotiated. When Thomas and the board finally parted ways, the system was more than ready for new blood.
Bill Denihan: I've been in a lot of different positions in my career, and I don't think any one of those other constituencies were dealt with as this constituency is being dealt with today.
Bill Denihan is former Cleveland safety director, with a reputation for credibility and effectiveness. He won high marks at the county's department of Children and Family Services, where he reduced caseloads and boosted adoption rates. Recently he was called on by Bishop Anthony Pilla to lead a commission reviewing the sensitive subject of sex abuse policies within the Catholic Diocese.
Since his hiring in June, Denihan's impressed the board with his dedication to cost cutting. He fired twenty-one administrative staffers, and consolidated offices, so spare rooms could be leased out to bring in new revenue.
Denihan won cautious respect from a number of mental health providers for the 40 visits he paid to them, just after he was hired. But as capable a political technician as Denihan is, his work has only begun.
Bill Denihan: Last year at this time, we had to take a 10% cut out of county funding, which is about $1.6 million. Within five months we were hit with another cut on the non-Medicaid side of $4 million, and thirty days after that we're hit with another $824,000 cut from the state of Ohio.
The board's cash flow problems have slowed intake down to a trickle. Some of the county's 34 mental health providers are no longer admitting new clients, because they've run out of money. It's not clear how many people are being turned away; each agency keeps its own records. Denihan wants more information about intake, but doesn't want to antagonize the providers. It's just one example of how his hope to improve relations with the agencies may sometimes conflict with his goals as board chief. But Denihan insists he will not try to impose mandates from the top down.
Bill Denihan: I think the common ground is the lack of appropriate funding. Everyone has the same core base issue, and I think bringing them together on that basis, and the basis that we're here, to provide direct services for our consumers, fundamentally is going to get us there.
Local administrators like Bill Denihan and Bonnie Caplan are constantly dogged by the lack of parity in mental health funding. Because few private insurers recognize mental illness as a health concern - on par with heart disease or diabetes - the public system ends up paying for most every patient, by default. At the same time, they're all too aware of how many more people never get help. Preliminary statistics compiled by the Federation for Community Planning indicate that the county system is reaching less than 10% of those believed to have a diagnosable mental illness, and less than 15% of people with severe diagnoses.
While the pressures are intense, Caplan and Denihan also get frequent reminders of what successes are possible every time they attend a board meeting. Joan Leeb is a veteran schoolteacher whose life was interrupted by schizo-affective disorder when she was 37.
Joan Leeb: The first time I went to the hospital, I was hallucinating very badly... I didn't realize I was hallucinating... a voice told me to try to kill myself. The second time my mom and dad had me probated. And the police picked me up and forced me to go.
Leeb ultimately went through three hospitalizations, years of struggle, and several bouts of homelessness. After bottoming out, she entered treatment with Jewish Family Services, and started mending fences.
Joan Leeb: Well there's no more friction. I'm present mentally with my family, I'm aware of what's going on, my time management skills have improved greatly, I volunteer for several campaigns, attend recovery meetings. I'm taking computer classes and I'm on the board of governors for the mental health board."
While she's not yet completely independent, medication and therapy have helped Leeb regain a degree of functionality that many would not have thought possible. If leaders can pull the system out of its downward spiral, every county resident with mental illness might someday have the same chance as Joan Leeb. For ideastream, I'm April Baer in Cleveland.