Andrew, one of the most ardent and successful supporters of the ‘PACT’ concept is Ex. Dir. of L.A. County’s Mental Health Assoc. Dick Van Horn. He was and continues to be the chief lobbyist to people like Steinberg, in selling this model of treatment. The fact that AB 34, and 2034, with all the visits to the MHA’s Village program, visits by Tipper Gore, Sharon Davis and other VIP’s, Chesboro, etc. his Vision is to sell this concept like McDonalds, and franchise it.

One of the interesting but oblique references in the Little Hoover Report was that this system of delivery, or model, being new, has not shown any definitive difference in outcome versus either [the] medical model (HMO-County M.H. delivered services) or even the kind of non-traditional providers like Lamp, who have single source contracts but are continuum of care. Which [is what] had to qualify you for the RFP for these programs.

The point is that the state is moving in the direction of the ‘PACT’ — either voluntary or involuntary capitated services. That’s x amount of dollars for all the services. The MICCORG project I sit on is one, San Francisco has the duplicate. [In] Los Angeles, my board just got the RFP for another project, MICCORG-2, to have 200 dually dx. women in the jail, axis I dx., one felony, start treatment post release, and [not] have children.

At the same time, the hope by many is to sell this coercive treatment to the state CDC, in lieu of the 1.8 billion dollar forensic nightmare and revolving door they have.

What troubles me is that the state will see these kinds of pilots as “successful.” [And] they will, as we already have “cherry-picked the enrollees” to insure they have good ‘outcomes’ to continue leveraged funding.

The problem on the voluntary side is if the state likes the model, and they appear to, it gives more credibility to the programs like the Village ISA in Long-Beach, and they will start to reproduce.The model is very dangerous, and quite frankly, disempowering.

Van Horn is a good PR man, and has excellent connections. The problem is not what is the best model, as opposed to how the model works. The values, philosophy, respect, and amount of accountability and dignity that can be incorporated into these models is what we fight for.

This is an up-hill battle for reform. The system has to be much more flexible, and it isn’t. The values and philosophy and vision need to be [transmitted] to consumers, to first educate them to what else might be available on the idea table, and encourage them to get involved in the decisionmaking process. My thoughts and feelings about the Council and M.H. Commission are negative, because I see them also as an act of futility — the advice goes nowhere. They take us through a legally mandated process, and that’s about it.

The consumers, ourselves, [we] have to be responsible to educate the masses [and] the politicos. By creating the little cells like the Accountability Caucus, in order to rally the troops and facilitate change.

Andrew, am I in another world? Need a reality check from time to time.

Gerald