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The Legislature's Health and Human Services Committee has received a report from the Task Force that, for the past six months, has conducted a comprehensive examination of the current shared-leadership structure of the County's Public Health and Mental Health Departments, an interim arrangement in place since 2016.

The Task Force (composed of three members each of the County Board of Health and the Community Mental Health Services Board; and the Chair of the Health and Human Services Committee, with support from County Administration) is unanimous in calling for full merger of the two departments, recommending that "the Tompkins County Mental Health Department and Public Health Department begin the process to become one integrated/merged department, creating a system of collaborative services under a single umbrella."

A proposed resolution, first reviewed by the Health and Human Services Committee at its November 14 meeting, would authorize County Administrator Jason Molino "to implement a plan identifying the responsibilities of departmental leadership for the departments of Public Health and Mental Health to be provided in a merged model, beginning full operations as one merged department no later than July 1, 2021."

Mirroring findings of the Task Force, the resolution also notes that "one department will best meet the needs of the clients, staff, and community as public health and mental health will function not just as opportunistic collaborating partners but will be working side-by-side to support progress toward achieving one single vision, and that as a single department, staff members will operate under a shared vision to support clients in achieving better health-related outcomes, be it mental or physical, both at the individual and community level."

Since 2016, the County's Mental Health and Public Health Departments have operated under a shared leadership model, with department head Frank Kruppa serving as both Public Health Director and Commissioner of Mental Health. The Task Force evaluated three options, considering the advantages and disadvantages of each: continuing that shared leadership model; separation of leadership and operations of the Mental Health and Public Health Departments; and a full merger of leadership and operations of the two departments. As part of its research, the group looked at how some other counties have implemented merged public health-mental health systems.

The Task Force finds that continuing the current shared leadership arrangement would be unwise, noting that the current structure, with no common vision and mission, or integration of services "leaves both Departments stuck in a state of paralysis and uncertainty" and that "significant untapped advantages" could be achieved with more sharing and integration of operations and services. The group also does not recommend returning to the prior model of stand-alone Mental Health and Public Health Departments, finding such an arrangement inconsistent with current health practice emphasizing greater services integration and a holistic care approach. "This seems like a backward step that could potentially duplicate positions, unravel efficiencies achieved to date, and leave the County ill-positioned in the public health/mental health marketplace of the future," the Task Force report notes.

Among the opportunities identified as part of an integrated/merged model:

• A shared vision of mental and public health for Tompkins County residents, resulting in consumers being able to be more broadly served;
• Reduced organizational silos related to public health and mental health;
• Options to co-locate services at multiple locations, within and outside the City of Ithaca;
• Integrated planning services that could lead to improved coordination across units currently housed in separate departments.

As next steps, the Task Force urges that an internal integration team, made up of staff from both departments, be formed without delay to provide input and address the elements needed to move forward with implementation—among them, identifying the name of the new merged organization; developing a shared vision, mission, and values; developing a new organizational structure; and discussing with authorities any regulatory accommodations that may be required for a new merged structure.

"The Task Force concluded that it would be a disservice to the residents of Tompkins County to continue to treat health in the silos of physical and mental health," the report states. "The synergies created by the two departments becoming one, which will serve all clients as whole persons, are vital in supporting our community. The Task Force states unequivocally its support for the value of both mental health and physical health services. Pursuit of an integrated/merged model should not diminish the focus or relative worth of one service over the other. They are both integral to the health and wellness of Tompkins County residents and should be treated as such."

In preliminary discussion of the report, Legislators thanked the Task Force for its intensive work over many months and most reacted positively to its findings. Legislator Dan Klein said that he could not yet envision what a merged department would look like, especially from a client and service perspective. It was stressed that in a merger neither department will consume the other; Legislator Anna Kelles said she considers it important that neither department would be diminished as part of a merged organizational structure.

The committee refrained from acting on the proposed resolution at this time and will renew discussion of the issue at its next meeting December 6, preparing for potential consideration by the full Legislature December 17.

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