May 18, 2015

Presented by: Bruce Wheatley, President/CEO, Inner City Industry and Co-chair DMH Cultural Competency Committee (CCC).

As co-chair of the department of mental health cultural competency committee, today I am representing disadvantaged citizens throughout LA County whom otherwise are absent from this discussion. When endorsed as co-chair of the CCC, I was explicit in expressing “I supported community first”.  As an African American male who has resided 200% below the FPL for nearly a decade, I am the underrepresented, underserved and when possible the inappropriately served. I have carefully witnessed this stakeholder process with disappointment while system administrators and contract providers position for control, autonomy and authority over the emergent system of care. There has been no mention or focus on ensuring the needs of my constituents who reside in vulnerable communities are addressed.

I speak to the most viable opportunity present.  To lead the transformation of health and human services in America by strengthen the socioeconomic safety-net of services that no longer exist in LA County.  Health disparities are at its greatest fifteen years into the 21st century and our system of care clearly does not work for the people intended to serve given recent population report data. LA County is as populated as forty-three states, what happens here influences the county.  We must exhibit or Angelino pride and represent this country with courage in the face of many challenges while highlighting our responsiveness to work together to serve diverse populations and communities.  My understanding of large scale transformation spans over fifteen years, since discovering African American students in K-12 education being inappropriate diagnosed with mental illnesses who otherwise had behavior issues.  As co-chair of the CCC, I whole-heartedly support integration among the departments of mental health, public health and health services into a single unit agency.

While I understand much about each systems culture, structure and revenue streams, I make no claim of being a practitioner or administrator.  My expertise is as a systems architect which encompasses understanding system and community dynamics as they currently exists.  While the CCC and provider networks take a different position than I, there concerns are warranted, well-received and understood. Many of their identified risk and challenges can be mitigated through coordinated communication amongst influential system administrators, contract provider and community leadership.  There are multiple theories and practices applicable to restructuring core support and work processes to fully integrate the three departments.  The intent is to ensure mental health parity by law and to achieve positive population health outcomes which one system cannot accomplish alone.

I acknowledge Schumpeterian theory which suggest the creative destruction toward innovative reconstruction as a core principal for health integration.  Keep in mind, every agency will not receive all that they champion for residents included however, we must reach common ground ensuring a fair exchange while maintaining laser like focus on ensuring increased population health outcomes.

Such a proposed shift in thinking requires an upstream approach to social change guided by social marketing ideology.  Our country’s infrastructure has reset and so must our system of care. My recommendations are based on the latest research data contributing empirical and anecdotal observation over fifteen years. Therefore, it would be wise for the board of supervisors to:

  • Research Large System Transformation to understand the dynamics associated with integrating multiple systems. Before the public comment period ends, I will present a position paper framing several dynamics essential to large scale transformation.  Considering this process as whole-system transformation suggest changing one part of a system requires changing the whole system.  Piecemeal processes fail to have significant lasting impact toward social change and causes greater damage to the external environment.
  • Utilize research data from the State funded and produced California Reducing Disparities Project reports. This community profile report will aid in developing a culturally responsive system of care based on relevant community input. Case in point, the African American report essentially says’ if you don’t change the system, nothing else changes.  The Department of Mental Health 2008 population report clearly identified South Los Angeles and African Americans as a disadvantaged community and population. From my experience in dealing with the mental health, education and health care systems neither lend any consideration to African Americans as a focus population. If you deny begging where disparity is at its greatest there will always be a disparity gap. Therefore Black lives must matter here as much as beyond these four walls.
  • Investigate to incorporate local community placed-based initiatives. Many of these projects represent the voice of community-based organizations and key stakeholders who have developed practical ideology and processes to meet localized needs. Projects that have the ability to scale should be considered as viable change mechanisms to sustain health integration outcomes.
  • Convene each county department cultural competency committee, unit’s and processes to initiate dialogue to reach consensus supporting community integration and delivering services. As primary and essential to reducing racial/ethnic disparity cultural competency must be embedded and considered in all aspect of decision making and delivery of services to strengthen the quality of care.  This internal system process will prepare agency leadership to appropriately engage the external social structure.

This is a long-term project produced in multiple phases over several years. Begging with reaching common ground among all parties, developing policy, implementing recommendations, evaluating processes to scaling services and making continuous improvements.  Without an effective strategy for community integration, agency and contract provider recommendations gain no legitimacy among its external social structure and increase the risk of a social revolt.  Health integration presents an opportunity for learning and discovering a new process to motivate staff to work more efficiently and effectively allowing residence to be active participants in meeting their personal health needs.

I thank you for considering these recommendations and reviewing the forthcoming position paper to glean understanding how to transition LA County’s health system into a fully functionally integrated system of care.


Bruce M. Wheatley