Well, this may be just a bit of thread drift, but not so far off topic as to be completely out of line here.

In earlier posts I had talked about the privitization of Public Mental Health in my State, and also that I was struggling in the private sector to figure out to what extent I could speak forthrightly without jepardizing my job.

My direct boss, the Clinic Director of the clinic where I am the Outpatient Services Manager, called me tonight in tears to give me a heads up that a Division Director will be coming in the morning to tell me I am out of a job for the first time in my adult life. She had surgery on Friday and is on medical leave. At the insistent urging of the Division Director, she will be in the office tommorrow, full of Vicadin, to carry out her official duties. She called me at great risk to her own position if I am unable to conceal that I have been forewarned of the message that will be delivered to me tomorrow. I will be forever grateful for the chance to psychologically prepare, and will do my best to behave in a manner that does not result in her loss of employment as well as mine.

This is primarily a business decision resulting from an announcement the State made last Thursday that they are reducing the reimbursemt rate for community support services by 1/3, retroactive to claims paid (not services rendered) on or after April 30. I understand and accept that. The reimbursement rate for Outpatient and psychiatric services has never covered the cost of providing the service. Community Support was the money maker and kept us afloat. When I read the State memorandum, I knew it meant trouble. And I knew from the start of mental health reform that the new system, as designed, would not be financially viable. The question was always-How long?

The current company took us over at our predivestiture salaries.    Though not large, they were higher than this company typically paid. Regarding annual leave benefits, they started us earning based on our tenure in the public system. This company had been a private, children's therapeutic foster care and residential treatment provider prior to taking us over. They had some professional level staff, but these types of services are not provided by licensed professional staff. They were fairly large, with offices in 5 States, but quite specialized. They served children. Children have Medicaid. Medicaid was their primary payor source. (Private insurance does not cover therapeutic foster care or residential treatment such as group homes.) In the last 18 months, including the take over of our 4 clinics, they have grown 150%. They did not understand the financial risk they were taking on to provide therapy, psychiatry and community support to uninsured and underinsured adults. 80% of the adults we serve do not have Medicaid, medicare or insurance. Those of us who had worked in the public system knew the reformed system was not fiscally designed to be viable with low income adults, that adults are the largest popluation we serve, and that there was no way private companies were going to be able to break even, much less show a profit. The State went with it anyway on March 22 of 2006.

I am going to speak very personally now. In part this is out of my own need to write as tool to sort this out, but also because I think my situation is not unique, and that there is value to others in my sharing it. I am well aware that in doing so, I can not assume that either Dickey or AWG, or others like them, will respect what I am doing, or what I risk in doing so. I hope they surprise me. If not, well, I'll deal with it.

I do not make good money, several thousand dollars less than the median income for the region in which I live, but at the time of divesture I was the third highest paid clinician in the 4 public clinics operated by the Area Mental Health Program I worked for. Tenure played a role in that, but I also had received a number of merit raises that pushed my salary out in front. I say that not to toot my own horn, but by way of explanation. In the 1st 5 months after the private company took us over, I received another merit raise and then a promotion. The end result is I am the highest paid employee in the clinic.

At the time of divesture, in June, 2006, I was providing psychotherapy full-time. Our long-time clinic director took early retirement and left. He, too, saw the approaching train wreck, was in a position to leave, and did. So did many others. From June until October, we were without any on-site manager at all. I had been, and continued to be, the team leader for both of our adult treatment teams and was also providing clinical supervision to a majority of the Licensed Clilnical Social Workers among the outpatient therapists. I had previous administrative experience from my pre-graduate school years with the Dept. of Human Services in another state. By default, and by neccessity to the operations of the clinic, I fell into the role of de facto manager. The salary that was being offered for the program director's position was not competitive and for the longest time therew were no applicants. I wasn't interested. Direct practice is where my heart is. After 5 months, with no Program Director in sight, the Division management promoted me to Outpatient Supervisor. At this point I was still carrying a full therapy caseload, offically took on the Outpatient Supervisor's job, and was still functioning as the de facto clinic director. I do not assert that I was able to wear all those hats well. Working 50 to 55 hours a week, I was able to keep them on my head-at least most of time.

We have an awesome, dedicated staff, professional and clerical, and everyone else was working very hard also, trying to maintain a level of functioning that allowed us to serve our community, but systems- wise, we were a mess. We lost our data system when divestiture occurred. The new company had one in the pipeline, but 5 minutes before daybreak, realized it was woefully inadequate, pulled it and started from scratch. There should be a data system in place within the next 3 weeks. I won't be there to see it, but I understand from support staff who have started training on it that it is a good one.

Just before Christmas, we finally got a Clinic Director, she is fresh out of a doctoral program and had no prior management experience. Nada. At first it was awful. Slowly, we have started to get on track. She made some very serious blunders early on, but is a quick study. I work with her closely and think she is on the way to being a good manager. She unintentionally but seriously alienated staff, me included, when she first came in. But she is very direct, open and straightfoward and we have forged a good working relationship. Other staff, who have had less direct contact with her, have been slow to come around, but it is happening. She'll get there.

When she saw the number of hours I was working, (no comp allowed with this company) she told me to start transitioning out of direct therapy. I am now down to about 5 billable hours a week, and rarely work more than 45 or 46 hours a week.

So, here I am, relatively highly paid, and not seeing clients to bill out the hours. When I leave there tomorrow, the clinic expenses will decrease by the amount of my salary plus benefits, plus whatever other taxes and insurance a position costs a company. There will again be a supervisory/mangement vacuum that will have long term consequences, but the bottom line will improve in the near future.

The company operates a dozen or more clinics in my region. Heads are going to roll in those other clinics also. No one will be given notice. No one will receive severance pay or packages. In January, the company changed from annual and sick leave to paid time off. Under company policy, you are not entitled to be paid for paid time off at resignation or termination. We had the option, In January, of being paid for accumulated vacation, or we could roll it over into paid time off. I rolled 4 weeks over. I will not be paid for it because it is now paid time off. I willnot even be able to call my clients and tell them there will be change in therapists. This is a huge ethics violation. I can not prevent it.

Neither I or my boss know who gets riffed in other clinics tomorrow. Neither do the other outpatient supervisors I have called tonight. (And I did not tell them I was being riffed tomorrow.) But their impression is that in other clinics, tenure will play some role in determining who goes. There may be some demotions. No one really knows. It is very hushhush. A team of Division management will spread out to all the clinics tomorrow morning so that everyone cut gets the word at the same time and can be gotten out of the offices before they have a chance to talk to other staff. My boss was not given a choice re: who goes. There are two new clinicians that I hired in the last 6 months. They need their jobs also, but if tenure were considered, they would go and I would be demoted back to clinican (the work I really want to do.) I am not wishing them gone. If it were presented to me that two go and you stay. or two stay and you go, I can not truthfully say what my decision would be. I guess I'm glad I do not have to make it.

What my boss does know is this. Her boss said that the Division considers me to be too outspoken, not a team player. She asked him about this. He could not identify one example of unprofessional or inappropriate speech or conduct. I had simply dared to disagree. I had dared to challenge the party line. He acknowledged my personnel records are impeccable, that all my evaluations, going back 15 years, and including the one that has been done since divestiture, are very good to excellent. He tried to get her to say I have verged on insubordinate with her. She declined.

What this is about is, they would like to keep me from drawing unemployment.

I hope I don't have to. I'll be out beating the pavement as soon as I get my office packed up tommorrow. It is not going to be easy to find a job in my field. I'm 55 years old. Mental health reform, in reducing services, has also reduced the job market. the program I used to work for is still around. They are now a 'Local Mangement Entity.' I've heard they may have openings in care management. That would be a good interim solution, but I think within the next 6 months, they will also have a round of lay-offs. I have a close friend who could probably put me to work as a cook. It wouldn't pay much, but it would bring something in until something better turns up. Assuming something better does turn up.

No notice, no severance, and if they have their way (they won't) no unemployment to tied me over.

If you read the papers, you know my story is not unique. If it were, it wouldn't be worth telling.

Oh. Did I tell you the company's mission statement? I'm goin to paraphrase, cuz I wouldn't want this post to turn up if the phrase were googled. It is to the effect of take really good care of both the clients and the people who serve the clients.


Well, it is almost 4:00 a.m. Going in tommorrow on 2 hours sleep is not the best idea I have ever had. Oh well. I doubt I'd have slept before now anyway.

Good night, and may the dawning day shine on a new path, for me, and for America.

Janie