Roberto Quiroz, the county's recently appointed mental health director, probably would have been a lot better off if his department had not received more than $20 million in new state funds this year.
Without that money--the first real bonus county mental health programs have received in years--the odds are good that Quiroz could have quietly established himself in his new job and mapped out his plans for the highly visible department.
But largely because of that money, Quiroz has been fighting a multifront battle over how best to spend it. He has been accused of being in the pocket of county Supervisor Michael Antonovich's health deputy, Marcia Nay. And he has had to struggle for months to establish credibility with community groups that ordinarily should be among his strongest allies.
At the core of the fight is how Quiroz sought in two separate actions to pump millions of dollars of new state money into Antonovich's pet project, Olive View Medical Center, at the expense of community-based, non-hospital programs backed by private mental health advocates. If that were not enough conflict, Quiroz also finds himself on the sticky fringes of a political squabble between his controversial predecessor, Dr. J. Richard Elpers, and Nay over Elpers' hiring nearly a year ago by the UCLA School of Medicine.
With a $210-million budget, the largest in the state for a local mental health program, Quiroz oversees a wide array of services ranging from emergency medical treatment of the mentally ill at county hospitals to neighborhood crisis intervention centers where people can get emergency counseling. The county's mentally ill population runs the socioeconomic spectrum and includes all age groups.
The fundamental battle lines surrounding Quiroz are formed by two groups. On one side are proponents of community-based, non-hospital treatment of the county's mentally ill. On the other are backers of an increase in emergency hospital beds to deal with, among other conditions, the rising number of homeless mentally ill.
Quiroz, whose background is in social work, has been with the county since 1979, when he left a mental health center directorship in Pueblo, Colo., to become the department's regional director in the San Fernando Valley. Early last year, Elpers promoted him to head of departmental planning, and when Elpers resigned to take the UCLA post, Quiroz was named acting director last Sept. 4.
Caught between two seemingly opposite approaches to mental health care, Quiroz, 47, has been on the defensive almost from the day last March when he was named permanent director. For months he has been waging a one-man public relations fight to persuade these competing constituencies of the merits of his plans for the Mental Health Department and insisting that he supports all of their goals.
"Our whole focus is not (just) emergency services," Quiroz said. "What we're trying to do is a balanced system of care. But a balanced system of care includes inpatient care and it includes community-based care and it includes self-help and a whole range of programs."
Despite these assurances, Quiroz's main credibility battle has been with private mental health providers, family groups and volunteer mental health organizations that have sharply criticized some of his actions.
They say Quiroz betrayed them when he scrapped a comprehensive plan to spend nearly $14 million in new state money on non-hospital programs in favor of a plan heavily weighted toward increasing the number of emergency county hospital beds. While some new emergency beds were justified, these advocates acknowledged in interviews, they complained that Quiroz shortchanged non-hospital community programs.
"We gave our priorities of what we felt was needed," said Donald Richardson, vice president of the National Alliance for the Mentally Ill, a parent support group. "Then Roberto set those on the shelf and came up with his own plan, which in many cases ignored the plans of (the community groups)." Richardson, also a member of the county's Mental Health Advisory Board, said the general reaction to Quiroz's move was one of shock.
Quiroz's spending plans also triggered immediate accusations from a host of private community organizations and contractors that Nay, Antonovich's health deputy, had pressured Quiroz to redirect money from the inner city to Antonovich's San Fernando Valley-area district. Nay said she favors an increase in emergency hospital beds to serve the homeless mentally ill, but adds that she also has been highly critical of what she views as a lack of mental health funds channeled to Antonovich's district under Elpers' administration.
Nay also lobbied hard for Quiroz's appointment to the $75,000 post.