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Mental Health Grievance Process: Foxes Guarding the Henhouse

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There are people in our community who are clearly in need of mental health services. In San Francisco we are fortunate in that we have a number of public health clinics where people can obtain treatment and assistance with their distress. Many homeless and poor people find these services-which include case management, therapy, medications, residential treatment-accessible and useful. There are times however when consumers (people who are utilizing mental health services) are dissatisfied with the treatment they are receiving from the city’s mental health system.

However, when consumers need to make a complaint, there is no formal representation or advocacy for them in the current set-up. They may file an informal complaint with the agency staff where they are receiving (or not receiving) services to try to resolve the issue. In this situation consumers may find that they are unsupported in voicing the complaint to their program. If the informal process doesn’t work, consumers have the option to file a formal complaint or grievance with the Community Behavioral Health System (CBHS), a part of the Department of Public Health (DPH). This way, their complaint can be formally resolved at the departmental level. However, in this system there is also no formal representation or advocacy for the consumer.

It has been brought to the attention of the CHEER (Community Health Equity and Economic Rights) workgroup of the Coalition on Homelessness that this decision making process is biased because advocacy for the consumer is lacking. DPH is in charge of the grievance process. DPH funds and oversees programs, and creates policy that determines how services will be delivered. When someone files a mental health grievance with DPH they are entitled to a hearing with a decision maker who is appointed by or employed by DPH. This appointee is the person who decides on the grievance. Since a grievance against a particular program is also a grievance against DPH, the current system allows DPH to process complaints against itself. It’s like letting the fox guard the hen house!

A number of community members have suggested to the Coalition that they would like a more impartial and balanced decision making body to rule on mental health grievances. Some people who have filed grievances (one person was even a member of the mental health board) have felt that their concerns were not taken seriously and that they did not have their issues addressed or resolved appropriately.

Since the cornerstone of the Coalition on Homelessness is outreach, the CHEER workgroup is in the process of obtaining authorization to conduct an anonymous outreach survey among mental health consumers who have filed grievances with the Department of Public Health. We need to find out what the experiences of those who have filed grievances have been like. It is important that we hear from people who are both pleased and displeased with the results of their individual cases.

The Compliance and Performance Office (1380 Howard Street, 4th floor, San Francisco 94103, 255-3661) is responsible for implementing the mental health grievance process. Recently the Compliance and Performance Office sent an email to a number of community health clinics directing them not to allow CHEER volunteers to poll their consumers at public health clinics funded by DPH. The goal of the grievance process survey is to document, represent and address the experiences of consumers. We hope that outreach and inclusion of consumer voices is also a priority of the Compliance and Performance Office.

If you are a former or current mental health client and you have ever filed a grievance with the City Department of Public Health we need to hear from you! Pleas contact James or Leanne with the CHEER workgroup at the Coalition on Homelessness (415) 346-3740.


Author: Street Sheet Editor

The STREET SHEET is the oldest continuously published street news paper in the United States. Organizationally, it is the public education and outreach tool of the Coalition on Homelessness. Every month, the STREET SHEET reaches 32,000 readers through over 200 homeless or low-income vendors. Our vendors are charged nothing for the papers they receive, and keep all money they earn through STREET SHEET distribution.

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