Dysfunctional Family

Dysfunctional Family 070710
With patience, time, frequent visits, urine testing and proper supervision, the Board and Dr. Carol Roberts can live safely under the same roof.

The Board of Supervisors meeting in Downieville on Tuesday was an all day migraine.  The agita came from the long, long closed session the board held, but it also arose from strain between the Board and the HHS department.  
Health and Human Services is a very important feature of life in Sierra County, though many people don’t realize it.  Not only does it save lives (literally), it restores lives.  
It also funnels a lot of federal cash through the county.  The sweet nectar of federal cash is the drug causing the contention in our little family; that and the fact that money sent to help is really focused on regularization and social control.  Still, helping at the cost of behavior is also what parents do.  Besides, no drug lends its effects for free, they are all, from psyche meds to crack to Chardonnay, also tiny prisons; all the more true for federal nectar.
The HHS department, which in our county is housed in a few offices, would be at least three separate empires in other counties.   Even in Sierra County, the budget, and the department, have grown hugely over the last few years.
This is due in part to a trend in social services funding.  For a variety of reasons, some humane, some not, the government in the last two decades decided to spend big on social services and mental health.
But, it is also due to the efforts of director of HHS, Dr. Carol Roberts.
Dr. Roberts is the county’s first modern HHS director, and a true believer.  She has a fervor for helping and a faith in her paradigm that gives a country boy the heebie-jeebies.  Her skill is with social services funding, ah sweet nectar.  
Because the United States still has the vestiges of a free press, no one can stop us from assigning Dr. Roberts the role of “mom” in the family.  This isn’t being sexist; the role of a stern but patient helper fits very well as the role of “mom” in our culture; it’s just a convenient coincidence Dr. Roberts is a woman.
That leaves Board Chair Dave Goicoechea to be papa, a role he’s very good at, being jovial and stern as required.  As Dr. Roberts is very good at her job, Chair Goicoechea is good at his.  A life-long bureaucrat, the Chair understands that he doesn’t understand all he knows about social services funding.  He sternly insisted that the Board would take no action on HHS requests (in fairness, Supervisor Whitley was absent, and the board seemed to recognize it was important to wait for a full board) until everyone understood what was really going on.  At one point he assured Dr. Roberts that the Board was not going to make any decisions until they’d gotten more information.
The Board Members would be aunts and uncles, the wise heads of the family who will give their judgement when all is done.  Lee Adams is the stern uncle, dubious about the waste and worried about the impact.  The figures of aunts and uncles are important, because one of the unintended consequences of the new social control is that government is nana, and real aunts and uncles aren’t qualified and can’t be trusted to intercede in families.  Our analogy will empower them to help in this family dilemma, instead of going for social workers (attorneys, in this case).
Finally, mean spirited, gossiping neighbors, that’s the Mountain Messenger and the Sierra County Prospect, who popularized being dubious of social services.*
That’s the family, money’s the drug.
As a note, these conflicts and consequences can and will happen in every county in California eventually; in our little county, we can solve this for what is it: a community problem.
It isn’t very common for supervisors in any county to get involved in human services.  The funding for such programs, ah, sweet nectar, is all the reward most boards need, as long as the department thrives and there are no lay-offs.  If something goes wrong, the board has the CEO handle it, or goes into closed session and fires someone just in case.
We can’t afford that in our county.  First off, it isn’t easy to find one person who’s willing to do three or four jobs.  As we’ve mentioned before, Dr. Roberts has to function efficiently as Director of Mental Health, Director of Public Health, and Director of Social Services.  She must fulfill these duties as successfully as three people in many other counties.  
Secondly, it is very de-stabilizing for an organization to change directors.  Believe it or not, even though they seem to just sit a lot or go to meetings or occasionally sign a letter, directors actually do important things, and one of them is to set the tone for the agency in terms of service expectations and administrative requirements.  Do we really want to junk mom and get a step-mom?
Barring any legal problems, the Board would be unwise to let go of such an efficient fiscal administrator, particularly one who runs 57 funding sources without a large fiscal staff (it isn’t uncommon for a social services or mental health services agency to have ten or more analysts, even in smaller counties).  Again, the granting agencies don’t say, “you’re from a small county so you don’t have to have so much documentation;” the requirements from our county are the same as requirements from counties with larger staff.
Still, something has to be done, on a couple of fronts.
First, the family has to curb its addiction to federal dollars.  Mom is heavily addicted; she needs the flow of dollars because she is required to by the state.  The county is mandated to provide services; if the county can’t or won’t the state might step in.  Ha ha ha ha!  The state!  
In truth, no one really knows what would happen if the county said “we won’t provide mental health or child welfare services within the state model.  These are local problems, we’ll deal with them in county.”
Very likely, lawyers would meet.  Who knows after that.
In any case, if the Board wants to tell the state to go to hell, that’s their prerogative; Dr. Roberts doesn’t have the luxury.
The leader in curbing the addiction to nectar is Uncle Lee.
Here’s a rough paraphrase of Uncle Lee this last Tuesday.
Lee: “There’s mental health care within 30 miles of every population center in the county.”
Response: “It isn’t easy for people to seek help outside the community.”
Lee: “When I was a kid we’d go to my Dad and say, ‘we’re hungry’ and he’d say ‘eat a peanut butter sandwich’ and we’d say ‘meh’ and he’d say ‘then you aren’t really hungry.”
In short, if you can’t drive to Nevada City or Portola for help, you aren’t really drug addicted, you aren’t really nuts, and you aren’t really an abused spouse.  
Those who know and love Lee Adams know he wasn’t actually saying that, but I’ll hazard that’s what Mom Roberts heard, and that is the key to the really difficult dynamic in the family: a crisis of culture.  The very people least likely to drive to Nevada City or Portola are the really drug addicted, really psychotic people, who often can’t even drive.  Lee knows that as well as anyone, but his point is still good.
Dr. Roberts is so good at what she does, and so believes in the miracles of her calling, if you tickle under her chin she will deliver a lecture on the needs of homeless people or the evils of marijuana.  She strongly believes in the power of modern mental health and substance abuse science to diagnose and treat those in need among us.
And, why shouldn’t she?  She’s seen first hand what those services can do to salvage a person, restore their sense of personal value, and help them live happy lives.  Having seen a few people completely saved, it’s hard to spend much time thinking about the people who weren’t saved, or who might actually have been made worse by social service intervention.
Lee Adams, on the other hand, has his own experience with the real world, one much more broad than peanut butter sandwiches.  Lee, as sheriff, turned back hundreds of thousands of dollars in nectar.  Because Lee is not addicted to nectar, he understands the relationship between using it and being poor.  The national debt is in the trillions
($-13,157,937,895,456; you should go here. ) and social service spending is a big part of it.  If everyone who was addicted to federal nectar would give it up, we could go a little tiny ways toward solving the national debt.
Further, Mr. Adams, lacking the clear vision nectar addiction gives others, has a stubborn rational streak.  Does a county of 3000 people need all these services?  How bug nuts are we all anyway, is there something wrong with the water?
He also shows an awareness of what statistics tell us: too much medicine will kill you.  Too many doctors, too many mental health workers, too many social workers, eventually the care is more toxic than the illness.
That awareness is almost absent from Dr. Robert’s view.
To be clear, she is not a prude, nor a temperance worker.  While not admitting to social drinking, she has made statements allowing for adults to responsibly drink wine and beer, and even tequila.  Neither is she ignorant of the problems of iatrogenic effects.
However, much of social service and mental health training is based on the assumption that we all have an optimum at which we can operate, and that optimum can be found through temperance, education, and application.  It’s what we all believe, everyone is created equal, we’re all OK to begin with, and then stuff goes wrong, and technology can fix it.
Sometimes, maybe even often, it can.  But, as Lee Adams apparently suspects, in as many as a third of cases, being involved doesn’t help, and might even make things worse.
A good practitioner knows the difference, but most don’t.
If we get enough staff, enough counselors, enough helpers, will we all be OK?  There is a staff person for every 75 county residents.  Should we submit enough grants to hire half of us to watch the other half (I’m watching you)?
Clearly, there is a limit to what the government can do to help.  Where is it?
I’ll propose that Dr. Roberts probably isn’t oriented towards that as an outcome.  
On the other hand, the Board isn’t currently informed enough to find the balance, either, and they acknowledge that.
Dave Goicoechea said the board hadn’t kept on top of spending in HHS.  He stated “unlimited funds doesn’t mean unlimited staffing.”
That won’t be easy.  Department of Social Services funding it very arcane.  Some funds begin at the state level and are controlled by the state.  Many funds begin at the federal level and trickle down through the state; if there is a mistake in billing the state and county hold the bag.  Much funding is dependent on other funding; worse, many positions are dependent on more than one funding source.  It’s a lot to understand.
There are those who point out that sending back a few hundred thousand doesn’t touch the national debt.  We should hire as many local people as we can; if we send the money back someone else will just squander it, instead of us.
But what about the factor of too much treatment?  Sierra County has an unusually high rate of jurisdiction over families, much higher than the state, when in such a small county with such a large HHS budget, there should be almost no kids picked up.  The social workers in the department are all generalists, working CWS and adult protective services as well as occasional crisis counseling; the highest levels of social workers are not necessarily supported by the funding.  There are indications that the department might need more staffing, not less, depending on which world view you hold.
Every one of us in this county knows, or is related to, or is, someone who has used or maybe should use, services from mental health, substance abuse, or other services from HHS.  There are services 30 miles away from every center in the county, but are we saying we’re willing to work to keep banks but want to send our mentally ill to other communities?
Papa Goicoechea, thanks to Uncle Lee Adams, dropped the hammer on a “HHS workshop” in Loyalton on August 31. The meeting is Dr. Robert’s opportunity to bring the Board up to speed on what she does, where the money comes from, what is required by the state, what is required by practice, what they can change and what they can’t, what the number of people being served is and how it all comes together.  It will be a chance for her to bring in some people who’ve benefited, and to show the Board how hard the job is, how important, how frustrating.
And, it might give Dr. Roberts a chance to become familiar with the idea of community standards, familial traditions and Jesus.
I don’t bring the name of the Lord up in vain.  There are those among us, maybe even most of us, who don’t give a R’s A what they think back at the state.  Sometimes people need help, but the help they get from the government is more than they needed, and less than they needed, all at once.  We each have our own destiny; the state can’t and shouldn’t “save” every one of us.  It isn’t often that a college educated, probably middle class person can understand the demons someone less eloquent, less “enlightened” experiences, or the imperfect but still suitable cures people use.  We don’t want to doom kids to needless misery, but there should be a limit at which point a family is good enough just because that’s the family Fate or God or Chance gave the kid to.  There are many instances when county staff empower family to bring home a member that was temporarily lost to drugs or other demons, but plenty more where families are afraid to step forward, because they don’t want cops and social workers and the freakin’ state in their lives.  
Some things don’t appear in “evidence based practice:” real theorists know that, only mid level technicians and state consultants have total faith in “science”.  
At some point, there should be a place where as a community we recognize that people need to work some problems out themselves; Lee’s peanut butter sandwich.  Some kids have great parents, some kids don’t; some of us will be sharp to 80, some of us won’t; some of us will have hard emotional times and survive, and some of us won’t.  The government can’t change that; Dr. Roberts, for all her training and passion and intent, can’t change it.  The county needs to empower HHS not to serve, sometimes.

The entire discussion is made more important because society as we know it is clearly coming to an end, at least for awhile.  Funding which today seems “air tight” such as Mental Health Services Act funding and funding for the Teen Center might well disappear.  Many of the 40 jobs we’re worried about might take care of themselves, and those families will find themselves on hard times.  
The Board might find themselves wrestling about where to spend the little money they have.  We might all be eating peanut butter.

There is no one in the community who isn’t touched by this issue.  It shouldn’t be a divisive issue; our elected officials and the professionals who serve them will meet, and like a family, they will discuss finances, the wellbeing and needs of members, and in the end Sierra County will have better Health and Human Services.
It will also be leading the way for counties to retake, from the feds and the state, responsibility for the wellbeing of community members.

Be there!  August 31, 2010; Loyalton Social Hall (it is hoped); 9:00 AM.

Your mean-spirited, gossipy neighbors, the Messenger and the Prospect, will be there!

*Don Russell is insisting we all come to grips with the culture war by reading this book: Deer Hunting with Jesus 
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