Public, mental health departments to merge

On Dec. 17, the Tompkins County Legislature authorized the implementation of a plan to merge the county’s departments of public health and mental health into one department, with full merger of the departments to take effect in July of 2021, according to a recent press release.

The decision was made after six months of an intensive task force study and a month of review by legislators. The final vote was 11-3, with legislators Dan Klein, Leslyn McBean-Clairborne and Henry Granison voting no. The fully merged structure would replace the shared leadership model, which has been in effect for the past four years.

The task force identified several areas that will need to be addressed over the next 18 months, including a united vision and mission statement, a refined chain of command, refined models of communication and a harmonized chart of accounts.

Legislator Shawna Black said the integration was originally proposed by former Administrator Joe Mariani almost three years ago with the idea that the move would keep up with current healthcare trends throughout the nation that are placing more emphasis on holistic care.

“We should be offering different services that provide for the person, more or less a one-shop stop … so that people don’t have to go all over town to get the services that they need,” Black said.

For a few years, the two departments worked under a hybrid model, Black explained.

“We’ve been able to integrate the fiscal as well as the compliance aspect, but we really haven’t done much in terms of combining or integrating public health and mental health because there has been a point of no return, and once you integrate those models, it would’ve been very hard to separate,” she said.

The task force was not responsible for drawing up a specific plan or considering what costs and manpower might go into the merger, so it is unknown exactly what residents should expect. Still, Black provided a description of what the integration might look like.

“Behind the scenes, we can actually integrate administrative staff such as the financial function and the compliance function,” she said. “From an outward-facing stance, there are many different benefits of integration, which would include offering services at two locations, and then the departments actually working better to provide better service, more referrals and better linkage to the services we provide.”

Black said the Legislature plans to hire an outside consulting agency that will guide the conversation toward a more concrete plan over the next 18 months.

Prior to the vote, many health employees, residents and politicians alike raised questions and concerns, a common concern being that mental health would get overshadowed by public health through integration.

Granison, who voted against the merger, said he was still concerned about this prospect at the time of the vote.

“I had some concerns that they’d make [mental health] be maybe a second-class citizen in the merger; they weren’t going to be equal,” he said.

The task force, he said, did look at other counties with a merged health model, but in those counties, mental health was kept at the sidelines, which he doesn’t want to see with this merger. He said he hopes, in the next steps, proper attention will put to this issue to ensure the same doesn’t happen in Tompkins County.

As part of the discussion before the approval vote, Legislator Mike Sigler raised the question of how to balance what he sees as the largely individualized approach of the Mental Health Department with the frequent public health focus on larger wide-ranging issues. He said that his concerns were satisfied, and he approved of the merger because mental health could benefit from a wide-range viewpoint like with public health.

“If we can start addressing some of these mental health issues earlier, then maybe we don’t get to the point where we have somebody who maybe has barricaded themselves in their home or has gone down a path of more extensive drug use than they were, and then it’s even harder to bring them back,” Sigler said.

Black said the task force paid special attention to ensuring mental health would not be overshadowed, and the integration would likely allow mental health services to be offered at the current Green Street mental health clinic location or on Brown Road at the current public health department.

Others were concerned about the lack of a clear integration plan. A staff and employee survey from the two departments prior to the decision showed that 40% approved of the merger, 40% were unsure or didn’t know what the merger would look like, and 20% voted no. Black said many comments expressed uncertainty about the structure of a possible merger.

Klein said 40% approval was insufficient to justify a merger. He said he hopes the next group will address some of his and other’s concerns when drafting a plan.

“My concerns could be summarized as having a lack of concrete information on which to base such a big decision,” Klein said. “I want to know things like, how will it affect a resident’s experience as they make contact with the department? How will it affect the employees’ experience?”

Christina Moylan, president of the county’s Board of Health, said she sees the merger as a largely beneficial move for county residents, providing the county and individuals who work in the mental and public health departments opportunities to better coordinate and collaborate for the care of residents. In addition, the current education resources on the public education side could be brought over to assist mental health.

“Currently, there’s more resources available on the public health side, and I think that bringing some of that expertise to the mental health side would be really important to the community to help Tompkins County residents better understand the range of services that are available to them,” she said.

Chair of the Legislature Martha Robertson said she’s optimistic about the merger moving forward.

“I would hope that we have a seamless transition where you’ve got leadership is balanced in the two departments, … a new approach on the whole person, the whole client and the whole community that integrates services to individuals as well as systemic services,” she said.

Black said that communication with public and mental health employees and members of the community will be key to making the merger smooth and successful.

“There are always concerns with a big change like this,” she said. “The most important the key factor for us is really being transparent about the process and communicating with staff as well as our constituents in the community and having really candid conversations about what we want to have happen.”

The Task Force Report on the Public Health/Mental Health leadership structure is posted on the county website, at http://tompkinscountyny.gov/health/taskforcereport.