New Orleans mental health agency diagnosed as unfit

From a much longer report in the Times Picayune. This is obviously just the tip of the iceberg.

For the past year, New Orleans leaders have pleaded for Gov. Blanco's help addressing a critical shortage of services for patients with chronic mental illness. With few places to go for care, these patients have crowded jails and jammed emergency rooms that have limited capacity to help them.

The state, it turns out, has made $74 million available in the past two years, but the money is under the control of an obscure public agency that has fumbled numerous chances to expand services since Hurricane Katrina and spends money with minimal oversight and accountability

Many fault the Metropolitan Human Services District, a state-financed agency governed by a board of directors appointed mostly by Mayor Ray Nagin. Health providers who work with the district say it is opaque, unresponsive and awash in internal problems that have crippled its ability to connect patients with services at a time when mental health across the region remains fragile.

In one example of such missed opportunities, Metropolitan has used only $430,000 of the $4 million in block grant money it received from the state to resurrect mental health services after Katrina -- even as Nagin was begging the governor to intercede in what he called a mental health crisis.

The only entity with the power to rein in the problems, its board of directors, sat half empty for almost a year. Nagin controls seven of the nine board appointments, but he failed for months to
appoint replacements for people who resigned their seats or were displaced by the storm and could not attend meetings. He finally filled all the board slots in late September.

With the board threadbare for so long, the executive director had almost unilateral control over contracting procedures. While most Metropolitan contracts have gone to nonprofits in the city, public records and interviews show a few were awarded to friends and business associates of executive director Jerome Gibbs.

What's more, patients have gone without services while Metropolitan remains mired in internal chaos. Scott Griffies, a psychiatrist who works at University Hospital, says he sees a large volume of patients in the emergency room who use drugs and alcohol to escape the stress of living in a stricken city. Meanwhile, numbers provided by the state show that Metropolitan is treating only a third as many patients with substance abuse problems as it was before the flood.

Metropolitan is supposed to provide services in the same fashion as United Way, by channeling money to nonprofit agencies with a track record of providing quality care. The agency also runs seven clinics in Orleans, Plaquemines and St. Bernard parishes. Data from the state shows the number of patients served at those clinics has dropped 46 percent since the storm.

When the state created Metropolitan four years ago, it ceded oversight of its operations to the board of directors. The state pumped $45 million into the agency last year and sent another $29 million its way this fiscal year, but the Department of Health and Hospitals does not have a detailed breakdown of how the agency spends the money.

A report released last year by the legislative auditor indicates that the agency has mismanaged some of that money. The auditor found that cash collected at the agency's clinics was not properly documented and that the hours listed on employee pay stubs did not always match the hours on their time sheets.