A Time for Direct Advocacy

The L.A. County Board of Supervisors needs to know of all opposition to the recent motion to investigate the creation of a health agency in Los Angeles that would be comprised of the Departments. of Mental Health, Public Health and Heath Services.

NAMI LACC is part of the steering committee on a coalition to oppose the merger and instead propose an Office of Healthcare Enhancement, which would help the agencies work together on areas of overlapping missions. Over 130 agencies have signed the proposal so far. NAMI LACC has shared a coalition report with the Board of Supervisors and needs personal letters to make its case even stronger. A sample supporting letter could say, for example:

Honorable Board of Supervisors
500 West Temple Street
856 Hall of Administration
Los Angeles, CA 90012

Re: Support for An Alternative to a Proposed Health Agency for Los Angeles County

Dear Supervisors:

I am extremely concerned about the prospect of a proposed Health Agency for Los Angeles County, and believe that there is a better way to promote integrated care for the clients served by the County Departments of Health, Mental Health, and Public Health, while at the same time ensuring the public health of all of the residents of Los Angeles County.

The proposed Health Agency model would have the heads of the Departments of Health, Mental Health, and Public Health reporting to the head of the Health Agency, rather than directly to the Board of Supervisors. If the Director of the Department of Health were to be named the Health Agency Director, as is implied in the Draft Report, the Departments of Mental Health and Public Health would soon be the only two County Departments not run by elected officials whose heads would not be reporting directly to the Board of Supervisors. This model is unacceptable.

Instead, I strongly believe that Public Health and Mental Health should continue to have the same autonomy, voice, and presence in the County as the other County Departments in being able to report directly to the Board. At the same time, I support a model that would be consistent with the Board’s recent unanimous decision to go back to its old CAO governance structure, which retains departmental collaboration and interdepartmental communication while reducing bureaucracy.

Importantly, I believe that the key to better integrated client care is based on a collaborative, problem solving approach among the three departments, which does not require the creation of a new Health Agency. In fact, I believe that if the Board directed the three departments and the CEO’s Interim Office of Health Care Integration to come back in six months with a Strategic Plan for Integrated Care, the talented and committed leadership of the departments and the CEO’s office would certainly be able to successfully do so.

The Draft Report itself acknowledges the fact that there are currently outstanding models of integrated care that exist today. I believe that instead of focusing the County’s efforts on the creation of a new Health Agency, clients would be better served by the implementation of such a Strategic Plan, which would identify ways to best replicate these successful models while overcoming any current barriers.

With regard to public health, the County Department of Public Health has, since its independence, become a nationwide leader in the public health arena, producing outstanding outcomes in protecting the public health of the County’s more than 10 million residents. I believe that its growing scope of critically important responsibilities — with our County residents facing growing public health threats in the aftermath of 9/11, and with growing environmental threats and threats of new infectious diseases such as SARS and the pandemic flu — requires maximum visibility and attention outside the shadow of a new Health Agency.

Similarly, throughout the past several decades, the County Department of Mental Health has built an expansive model of community-based recovery oriented services that is the envy of other counties in this State, has organized a stakeholder process that is unmatched, and has found ways to maintain the key elements of its system amidst rising expectations from all age groups, all while making a big dent in reducing disparities and integrating cultural compentency into its culture and services. Like public health, mental health deserves to continue to stay outside the shadow of a new Health Agency.

Accordingly, I respectfully request that the Board of Supervisors support a collaborative, problem solving approach to better integrated client care which does not require the creation of a new Health Agency, while at the same time allowing for the continued autonomy of each of the three departments and ensuring that mental health and public health continue as equity partners which report directly to the Board.

Thank you very much for your consideration.

Very truly yours,

Personalized (The letter is written for you–just add the date and your name), it could be sent by email to: ExecutiveOffice@bos.lacounty.gov, with a cc to:Mailbox@Healthcarecoalition.net. If inclined, you could modify and/or add your personal story.

Studying a Correlation Between Depressive Symptoms and Stroke Risk

From Psychiatric News Alert: Persistent symptoms of depression in adults ages 50 and older may double their risk for stroke, according to a recent study published in the Journal of the American Heart Association.

A possible connection between depressive symptoms and stroke risk

A possible connection between depressive symptoms and stroke risk

Researchers from Harvard T.H. Chan School of Public Health analyzed medical records of more than 16,000 older adults who participated in the Health and Retirement Study, which included interviews about depressive symptoms, history of stroke, and stroke risks factors.

Nearly 2,000 strokes were reported, and individuals displaying high levels of depressive symptoms during two consecutive interviews were more than twice as likely to experience a stroke during the subsequent two years. Even people who had depressive symptoms at the first interview but not the second showed a 66% higher stroke risk.

Said lead author Paola Gilsanz, Sc.D, a postdoctoral research fellow at Harvard, in a press release:

“This is the first study evaluating how changes in depressive symptoms predict changes in stroke risk. If replicated, these findings suggest that clinicians should seek to identify and treat depressive symptoms as close to onset as possible, before harmful effects on stroke risk start to accumulate.”

To read more about the relationship between depression and stroke, see the Psychiatric News article “Collaborative Care for Depression Can Reduce Risk for Heart Attacks, Strokes.”