New Mental Health Chief Arrives Amid Turmoil

After spending much of his life enmeshed in the world of academic research, psychiatrist David Gudeman is now under a microscope himself.

Appointed last week by a divided Board of Supervisors, the new director of Ventura County’s troubled mental health department arrives at a time of crisis with no clear mandate. Gudeman, 39, who had been the interim director for three months, knows that his every move as head of the department of 650 employees will be scrutinized by his critics.

Among their complaints already: He is a mouthpiece for his boss, Health Care Agency Director Pierre Durand. Having worked only two years with the county’s mental health department, he lacks the administrative experience to lead it out of turmoil. The county should have conducted a broader search rather than delete the “interim” from his title so soon.

In an interview in his sparse office at the county medical center, where a metallic balloon declaring “Congrats!” floated behind him, Gudeman defended himself and promised to prove his critics wrong.

“I’m no puppet for Pierre Durand,” Gudeman said. “I think people say that because they’re quite concerned about the department. It’s an expression of anxiety.”

Durand has been a central figure in the controversy over mental-health services. A fiscally conservative manager, he put the department back on sound financial footing, but in the process alienated people who said he was cutting back services to the mentally ill. He is supported by county Supervisors Frank Schillo, Judy Mikels and John Flynn.

On the other side are Supervisors Kathy Long and Susan Lacey, who supported Gudeman’s predecessor, Stephen Kaplan. A social worker, Kaplan was forced to resign in the wake of a long feud with Durand and the county’s failed attempt to combine its mental health and social services departments.

Saying they wanted a more seasoned mental health chief, Long and Lacey voted against Gudeman’s appointment on Tuesday. They had pushed for a nationwide search.

When discussing whether he can effectively lead a department with a $50-million budget, Gudeman remained unflappable.

“I’m going to prove that I can,” he said. “I’m confident that I’m going to do a good job.”

Born and reared in Wichita, Kan., Gudeman is the youngest of three children. After high school, he traveled around the western states, working at a ski resort in Colorado and cutting hay and driving a tractor in Alaska before going to UCLA to become a psychiatrist.

Critics and advocates agree that Gudeman--whose salary increased from $121,077 to $127,131 with the permanent post--has his work cut out for him.

Under the old regime, the department strived to help mentally ill people live in society independently, with county support. That system offered teams composed of psychiatrists, psychologists and social workers who had equal say in how treatment was delivered.

Emphasizing the importance of medicine in serving the mentally ill, Gudeman’s new direction gives the leadership role to psychiatrists. The so-called bio-psycho-social model that he favors requires patients to first be stabilized with medication. After that, social workers can help them get jobs and places to live.

“I have a vision, and I don’t know if it’s different than Mr. Kaplan’s,” Gudeman said. “Medication development has intensified, and new medications are coming on line almost monthly. Systems have to be nimble in responding to these changes. So by changing the department, it doesn’t imply that the previous situation was unacceptable.”

Gudeman’s supporters also praise him for bringing attention to the need for housing for the severely mentally ill.

As interim director, he hired a new housing specialist, Lynn Aronson, to develop a long-term housing plan. He also drafted an ambitious $3-million housing proposal, which includes providing a 30-bed facility for the mentally ill.

The new direction has created anxiety among some social workers, who say morale has plummeted since Gudeman’s arrival. They fear an emphasis on medicine will erode the role of social workers. Worse, they fear some social workers might lose their jobs.

“We have no plans to do that,” Gudeman said. “Our social workers have the skill and experience that the department needs. If our funding remains the same, our goal is to have no cutbacks at all. . . . But we are in the midst of five audits.”

The Behavioral Health Department has been rocked by controversy since December, when supervisors dismantled the 10-month-old superagency after federal officials warned that the new structure violated Medicare and Medi-Cal billing rules.

The failure of the superagency has prompted at least five audits by federal and state agencies, which are reviewing the fiscal practices in the county’s mental health system. Officials say the audits may result in a loss of millions of dollars in Medicare and Medi-Cal funding.

Further, the state Department of Mental Health recently announced that it may strip the county of $5.4 million in annual funding unless it fixes what auditors consider to be a deterioration in services for people with mental illnesses.

“All this unusual amount of scrutiny can be welcome,” Gudeman said. “It’s really an opportunity to create a well-running system.”

Gudeman said he would work toward healing the rift between psychiatrists and social workers.

“A large part of it is opening up communication,” he said. “Building trust, that’s going to be a big part of it.”

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Profile of David Mark Gudeman

Age: 39

Residence: Thousand Oaks

Education: UCLA, bachelor’s degree in biology; Kansas University, master’s degree in anatomy; UCLA, doctor of medicine; UCLA, intern and resident in internal medicine at Olive View Hospital in Sylmar; California Institute of Technology, biology fellow; UCLA Neuropsychiatric Institute, resident in psychiatry; UCLA-NPI psychiatry, chief resident of substance abuse.

Experience: Physician investigator at the Veterans Administration Medical Center in Los Angeles; staff psychiatrist, chief acute-care psychiatrist and acting director at the Ventura County Behavioral Health Department.