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Cover Story

Mental Hell at Valley Mental Health Page 1

Cut backs eliminated programs; clients have yet to recover.

By Stephen Dark
Photo by Doug Boehm 
Posted // May 19,2010 -

Attorney Lynda Krause sat with her arms crossed in the reception area of Valley Mental Health's Midvale offices and watched her sister have a meltdown.

“I don’t want to die,” a crying Carol Prewitt said as she paced up and down in front of receptionists frantically trying to locate her therapist. “Take me to a hospital. My heart hurts. I feel sick.”

Earlier that day in late April 2010, 44-year-old Prewitt had called Krause’s husband, terrified she was dying of a heart attack. Prewitt—who is bipolar, has borderline personality disorder and a history of drug abuse—had spent the previous night smoking methamphetamine.

“Why don’t you call Debra Falvo?” Krause told the receptionist sarcastically. After months of mounting frustration with Valley Mental Health, Krause had dumped Prewitt on Valley’s doorstep. “This is her baby.”

Debra Falvo is chief executive officer of Valley Mental Health. The counties of Salt Lake, Tooele, and Summit as well as the State of Utah all subcontract with Valley for treatment of 22,000 mentally ill clients and substance abusers. Valley comprises 46 percent of Utah’s mental-health system and receives around $90 million in Medicaid funds from those contracts.

SistersSad.jpgKrause held Falvo responsible for Prewitt’s crisis. She also blamed Valley’s board, the state, Salt Lake County—all three of which have oversight responsibilities of Valley Mental Health—and her sister’s own choices for her ever-deteriorating situation. In October 2009, Falvo announced sweeping changes to Valley Mental Health, Utah’s largest treatment provider, because of a forecasted budget shortfall of between $8 million to $10 million. She announced the changes without warning the county—which she partly blamed for the upcoming shortfall—of the details of those cuts. She intended to lay off 125 of 740 full-time employees, downsize the number of licensed social workers, and close four programs in eight weeks. Clients used to years of individual therapy sessions were now faced with group sessions and short-term, part-day hospitalization if they were in crisis. There would be no transition program to help what Krause calls “the most fragile and sensitive members of our community,” through the profoundly traumatic changes happening in just a few months.

Pathways to Recovery, a day-treatment center for mentally ill adults, was among the programs slated for closure. Pathways helped Prewitt stabilize for the first time in 13 years, her sister says. Krause brought her sister to Utah in August after Prewitt had lived for 10 years in a Las Vegas apartment “so filthy and in such a dangerous neighborhood you would rather be on the street,” Krause says. A psychiatrist told Krause that Prewitt’s brain was severely damaged from more than a decade of inadequate treatment for mania and depression, compounded by self-medicating with street drugs. Krause had a stark choice. “She was like a puppy in the road. Leave her to die or bring her home.”

Prewitt attended Pathways for several months. Because its highly structured, morning-to-night classes run by therapists filled her days, she started to inch towards stabilization. “I woke up in the morning, and I couldn’t wait to get there,” Prewitt recalls. Two months later, when Falvo announced its fast-tracked closure in favor of a client-run drop-in center and therapy classes run by case managers, many of Pathways’ chronically mentally ill clients, like Prewitt, suddenly faced losing their support system. In the final weeks before Pathways closed, Prewitt became increasingly more anxiety ridden. In each panic attack, Prewitt says, “I feel like I’m going to die.” In January, she locked herself away with another Pathways client in Prewitt’s apartment and took prescription drugs.

“Carol is one of many,” says National Alliance on Mental Illness [NAMI] Utah Executive Director Sherri Wittwer. “Pathways meant something to a lot of people. That’s why there’s been such a sense of loss.” Since January, the number of mentally ill and their families seeking help from NAMI, a nonprofit with a $750,000 annual budget, “have definitely increased,” she says.

Six months after Falvo’s bombshell, the darkest irony at the heart of what Valley calls its “reconfiguration” is that part of its purpose was to introduce “person-centered” care. This involves putting the client in control of his or her treatment. The net effect for many, however, was quite the opposite. Along with staff firings and complaints by many Valley employees of feeling terrorized, the change alienated clients and provoked genuine fears among Valley clinicians that the most vulnerable in their charge would slip through the cracks and disappear because of the reduction in services.

What some Valley insiders describe as the “callous” way the closures were handled and the traumatic impact it had on staff and vulnerable clients raises questions about the lack of oversight that has dogged Valley Mental Health since 1986, when Salt Lake County and the state made it a stand-alone, private nonprofit.

Prewitt and Krause ended up in a counseling session with two Valley therapists, a case manager and a psychiatric nurse. “I’m sorry you’re in this situation,” Krause told her sister. “You made a bad choice, but really, honey, Valley set you up for failure.”

Patrick Fleming is Salt Lake County’s director of division of substance abuse. A private nonprofit, he says, means that in exchange for a community mission, a volunteer board and a philanthropic commitment, the corporation does not pay sales and property taxes. Valley currently owns $70 million in property assets. For some critics, it’s become so large and powerful they question whether it can be held accountable.

Valley is one of 19 treatment providers Fleming oversees that are contracted to care for county substance abusers. “Valley delivers some of the very best services you are going to find anywhere,” he says. But, he argues the nonprofit’s leadership has lost sight of its community mission. “Maybe the business game became too important.” Fleming sees “the wielding of a budget shortfall as a convenient excuse to change a delivery system.” Bottom line, Fleming concludes, “You don’t use scare tactics to force clients and staff” into accepting change, particularly when those tactics turn out to be based on inaccurate forecasts.

Valley’s $8 million deficit never came to pass. Falvo says some budget assumptions did not occur. After the cutbacks and with money from Valley Foundation, its fundraising arm, the treatment provider’s books are, for now, balanced. What the October-trumpeted changes did provoke, however, is more attention to Valley’s leadership. Fleming and county mental-health director Tim Whalen says that the county’s oversight of Valley has increased. “There will be no more tail wagging the dog,” Fleming says. “That’s over.”

Fleming’s boss, Salt Lake County Mayor Peter Corroon, describes Valley’s October announcements as “a communications breakdown” rather than an oversight issue. The county, he says, is responsible for setting policy for mental-health services. “A major budgetary and policy decision was made [by Valley] without significant consultation.” Valley, he says, provides services and does it well. “That’s why we haven’t made any changes.”

At the height of the closure controversy, Salt Lake Tribune columnist Peg McEntee profiled Falvo, who took over as Valley chief executive in 2005. The former nurse said she often visited clinics to “get my clients’ fix.” That claim rang hollow among some of Valley staffers who work on the frontlines of Utah’s mental-health care.

A Valley clinician, who spoke on condition of anonymity, asserted that the October-flagged changes “came from a small cadre of administrative people with limited clinical experience.” He contrasted that cadre to the advisers surrounding former President George W. Bush’s White House when “it decided to go into Iraq,” he said. “The top level executives, who are pretty insular, made sure they had people who agreed with their view and made some pretty serious mistakes.”

Prewitt and Krause ended up in a counseling session with two Valley therapists, a case manager and a psychiatric nurse. “I’m sorry you’re in this situation,” Krause told her sister. “You made a bad choice, but really, honey, Valley set you up for failure.” None of Valley’s staff said a word.

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Posted // April 10,2011 at 14:35

There should be further investigation into Debra Valvo, Richard Hatch, for misuse of funds and abuse sto patient care, in addition, the board members.


Posted // July 21,2010 at 13:25

Regardless of client complaints and state audits demonstrating poor access for the mentally ill, Salt Lake County has posted an RFP that continues to bundle mental health services, in favor of valley monopoly health. Valley continues to prosper, increasing salaries and exec positions despite its poor reputation and complete lack of staff trust. $100M flowing into vmh and it still takes 5 weeks for an appointment??


Posted // May 28,2010 at 05:50

When does it end. When do state and federally funded organization get held to account for the unethical practices they employ in dealing with the individuals they serve and the staff they employ. How many more complaints and concerns raised for clients, staff, family members and the public does there have to be in order for someone to say stop! Just because the the organization has been successful and around since the dawn of time doesn't mean that that the people in charge are not fallible. We have seen this over and over in organizations and businesses that have been allowed to grow to monolithic proportions. They become arrogant and subjugating. this is what happens when people stay silent. When they allow their own mistreatments to go without remedy. When they are silenced by their fears and their peers.

When we allow this type of treatment to go on, when we let people be treated with such disrespect what does that say about us as a community and as a society?


Posted // August 19,2010 at 19:42 - An OIG officer has been contacting community partners - so apparently some of these complaints have been heard. vmh youth programs will be at 50% capacity from numbers served last year. vmh outpatient units STILL cannot get new clients in for 3-4 weeks and DO NOT provide weekly therapy, leading to increased rates of institutionalization. vmh administrators continue to be highly paid, incompetent, and corrupt.


Posted // May 28,2010 at 15:24 - I guess time will tell.


Posted // May 28,2010 at 10:29 - The county administration's sentiments will be evident in the upcoming RFP. As this article suggests, it's time to end Valley's monopoly on mental health and offer more choices and better access for clients, as they now have in substance abuse treatment.


Posted // May 28,2010 at 02:28

I think it's an absolute shame and very sad the way the Valley Mental Health Administration namely Debra Falvo, has screwed up the mental health system royally and so badly that it's left an indelible scar on people who used to go there and are used to going there for treatment. Treatment, believe it or not, is a way of life for these people. It's all they have (at least some of them anyway), and it happens to be the only station to which they are accustomed. Apparently, Ms. Falvo and co didn't think about the long term or even short term in this case, effects that it would have and has inevitably had on many of it's clients and staff. Just because Fresh Start "seems" to be going okay, things aren't always what they seem. I know this first hand, because I attended Pathways to Recovery for several years. 17 to be exact. It used to be called A.D.T. (for Adult Day Treatment), but even though the name changed, the program was still the same. That is, until now of course when everything suddenly "changed over". A lot of clients have stopped going since everything changed, and it is definitely not the same place. I think it's a shame that some people feel like they have to do away with something that is helping people and changing their lives for the better. Unfortunately, some people just don't care because they're not in a position to care. They're apparently too busy and wrapped up in their own pathetic so called lives to care, so they end up passing the buck, and the clients and staff are the ones who end up bearing the brunt of everything that's wrong with the system and it's like a huge weight or burden is being placed on their shoulders which is much more than they can handle. But why am I not surprised? I know Carol Prewitt and I don't condone her drug use, but when someone feels like they don't have anyone to turn to, of course they're going to self medicate!!!!! Think about it. When someone has a choice, and then their choice is taken away from them and the rug has literally been pulled out from under their feet, what other choice do they have but to isolate and self medicate and feel alienated and closed off from the outside world especially when they don't have anywhere else to go for treatment? It doesn't make sense. Everyone has the right to go someplace where they feel safe and secure regardless of whatever their background is, and nobody should have to be left out in the cold to fend for themselves. Thank you Mr. Dark for your insightful, eye opening article. Problems like this should not be ignored.


Posted // May 27,2010 at 16:09

Just for the record Care Coordinators DO NOT make more than 46,000 a year not even close. I know because I am one so I don't know where someone got these numbers from.


Posted // May 28,2010 at 05:21 - Yeah whatever, guess if you are one (care coordinator) and not making that you're not in the club and therefore replaceable.


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