April Baer: No one ever said the job was easy. Michael Thomas, chairs the board of governors of the Cuyahoga County Community Mental Health Board.
Michael Thomas: We're under enormous financial pressures, at the same time, more & more people than ever are looking to access service.
AB: Here at the Positive Education Program, some of the county's most troubled kids are sent to an Early Intervention Center for help with behavior problems. Many of its rooms look just like nursery school, but the games and songs are all tightly focused on improving children' emotional skills.
In another room, a mother plays with two little boys while a staff member observes. Later on, the staffer will ask the mother what helped encourage the bots to play cooperatively; then she'll offer some feedback. The Center's Stacey Bush explains the idea is to offer help for both children AND parents, who actually become part of the staff.
Stacey Bush: When you come here, you get a resource, consultant, which is sort of a case worker/school psychologist person. They help you wade through the paper work - there's lots of paperwork! - help you set up goals. You get the classroom staff, and you get someone like myself, who's been through the program.
AB: Most eventually go on to mentor other families. Stacey says she was in desperate need of help when she came here for help with her son's explosive behavior.
SB: When I came here, I was very isolated, I didn't have supports. I was like a prisoner because I couldn't go out with him, my friends wouldn't come over. I couldn't do any of those things. What I got here was knowledge and skills. While the problems Ben has may never go away, I can handle them.
AB: The program's Executive Director Frank Fesser says, as much as the Early Intervention program has accomplished for people like Stacey, its future in jeopardy if the mental health funding system goes on exactly as it has.
Frank Fesser: The dollars are not there, Medicaid rates have remained flat for 7 years while the cost of living and cost of providing services continues to go up. The state is in a budget crisis and that impacts the board of course tremendously. I think the danger is that we'll be running out of money to provide some of the necessary services.
AB: Cuyahoga's mental health system has several funding disadvantages working against it. First, expenditures will have to be cut in coming months as the state and county governments try to balance their budgets. Second, a quirk in federal and state rules requires the board to spend what money it has on Medicaid patients first. The thousands of people who can't qualify for Medicaid, or who aren't signed up, can't be turned away, but in taking care of them, the agencies rack up millions of dollars in uncompensated costs. Finally, Board Chairman Michael Thomas says it's a tough job distributing money among these cash-strapped and frustrated agencies, and trying to get them to work toward common goals.
MT: It puts the director in the position of having to sort of herd cats. You have to bring all these agencies together, and to a very large degree, they are out there doing what they want.
AB: Thomas says, the board's next executive director will have to be a unique individual. Several people from within the system have been considered for the job, including Joe Gauntner, an experienced county administrator, Steve Friedman, the head of a local service agency. But it's no secret that the Board wants to offer the job to Bill Denihan. Denihan's had a long career in public service; he won respect as Cleveland's safety director, and at the head of the county's department of children's services. Thomas says he strongly favors the idea of hiring someone who has the big picture in mind, and who can work within and without the system. But the board's top choice has one big hurdle in his way: opposition from the County Board of Commissioners.
Tim McCormack: There's a legal requirement that that person be a mental health professional in the sense of having a mental health background.
AB: Commissioner Tim McCormack says he is not ready to accept Bill Denihan, because he has never worked in a clinical setting. He is not pleased with the mismanagement at the mental health board under previous executive director. This time he says, he wants a real professional.
Denihan's backers suggest that anyone who's worked in the law enforcement and children's services should be more than ready for the job. Some even suggest McCormack's opposition has more to do with hard feelings than with policy. Denihan and McCormack were rivals in last year's mayoral campaign. Neither of them made it past the primary, but the race did create bitter feelings between Denihan, and his former boss at the County. McCormack scoffs at the suggestion that it is he who is letting personal concerns shape the hiring.
TM: This is a political process right now. The choice of this executive director is being driven by people who are intimately involved in the political system. It SHOULD be made by people who foremost have mental health services in focus.
AB: Commissioner McCormack says the state director for mental health services agrees that board's new chief must have a clinical background, but Director Michael Hogan is declining public comment, except to say he wants the issue resolved locally.
At this point, the Cuyahoga County Community Mental Health Board appears to be in a strategic retreat, standing by Bill Denihan, but also assembling a solid clinical team, to try to make his hire more appealing to detractors. If trusted professionals can be found to oversee the delivery of mental health services, the board hopes the state - and ultimately the county - can be won over. Board officials say they hope to have their hire made within the next few weeks. In Cleveland, I'm April Baer.