This is a letter sent to three state agencies responsible for regulation and administration of California-contracted mental health providers. At best, SCHARP is a poverty-industry welfare-graft machine, sucking up public funds to no good effect. At worst, SCHARP is a mental-illness provider. I want to find out.
—Prince
I am a citizen with concerns about mental health provision in Los Angeles County.
I went seeking mental health services in January 2024, to cope with the loss of my job and a crisis in my family. I am fortunate to live in an area with several mental health clinics.
Southern California Mental Health & Rehabilitation Program (SCHARP) runs what appears to be a vibrant and welcoming clinic in my neighborhood:
SCHARP Behavioral Health
3860 Crenshaw Blvd #201
Los Angeles, CA 90008
so that is the one I visited.
Sadly, it is in violation of parts (1) and (4) of the California Code of Regulations, Title 9, §1810.435, “MHP Individual, Group and Organizational Provider Selection Criteria”:
In selecting individual or group providers with which to contract, the MHP shall require that each individual or group provider:
(1) Possess the necessary license or certification to practice psychotherapy independently. Each individual practicing as part of a group provider shall possess the necessary license or certification.
(2) Maintain a safe facility.
(3) Store and dispense medications in compliance with State and federal laws and regulations.
(4) Maintain client records in a manner that meets state and federal standards.
(5) Meet the MHP’s Quality Management Program standards.
(6) Meet any additional requirements established by the MHP as part of a credentialing or other evaluation process.
I will explain how.
I was told to fill out some paper forms. On one of them, I was supposed to put my Social Security number, so that back-office employees could check whether I was a Medi-Cal recipient. I told the clerk that I was uncomfortable with writing my Social Security number down on paper, and that I have private insurance and not Medi-Cal, anyway.
She told me that I needed to write it for the Medi-Cal search, and that I could not proceed without the Medi-Cal search. I wrote my Social Security number down on the paper intake form.
This is a violation of California’s Fair Information Practice Principles: Collection Limitation and Use Limitation, and thereby the California Code of Regulations, Title 9, §1810.435 (4), noted above:
• Collect SSNs preferably only where required to do so by federal or state law.
• When collecting SSNs as allowed, but not required, by law, do so only as reasonably necessary for the proper administration of lawful business activities.
• If a unique personal identifier is needed, develop your own as a substitute for the SSN.
One can plainly see the onerousness of the requirement that clients write their Social Security number on a piece of paper stored at a Medi-Cal service provider, because Medi-Cal recipients get a Benefits Identification Card identifying themselves as such, and have already had to provide their Social Security number to the State of California when applying for Medi-Cal.
I turned in my forms and sat in the bulletproof reception area, awaiting an interview with the clinician. A man came out of the treatment area—an enormous sea of dozens of desks, like a open-floor-plan call center for a large corporation—and sat next to me.
I asked him if he worked at SCHARP, and he told me that he did. He described himself as a “caseworker-slash-clinician”. I asked him what he did in that position. He told me he worked with patients. I asked him whether the clinic was associated with any particular school of psychiatry, and he told me that there were several interns from schools, but no particular school, really. He had misunderstood my question, which was vague, so I refined my question to ask what method the clinic used for therapy. He told me they used Dialectical Behavior Therapy. I asked him what that was. He told me, “it’s like, you have your own issues, and I have my own issues, and we work them out together, and hopefully we get somewhere where things work better.”
This “caseworker/clinician” is in no way qualified to perform therapy with patients, and can explain nothing about the therapeutic method allegedly in operation at SCHARP. This is a clear violation of California Code of Regulations, Title 9, §1810.435 (1), noted above.
The clerk finally told me that the clinician would call me later in the afternoon to complete my intake interview, so I left.
Later that afternoon, I did receive a call from someone at SCHARP, but it was not the clinician. It was another caseworker. She asked me some questions about myself and my mental health, and concluded that I was not distressed enough to receive services and that the program was full anyway.
I was dismissed.
Setting aside privacy concerns for the moment, we know two things about SCHARP’s therapeutic practice:
SCHARP has extremely underqualified caseworkers performing therapy for
only the most severely and persistently mentally ill (SPMI) Medi-Cal–funded clients.
I mentioned the sea of desks manned by “caseworker/clinicians”. Who checks their work? Who is aligning incentives with outcomes? What if a “caseworker/clinician” is mischievous or sadistic, and enjoys tormenting or manipulating patients during therapy? What if a “caseworker/clinician” is distributing pro-illness media or recordings? What if a criminal gang, perhaps run by narcotraficantes, employs “caseworker/clinicians” to identify vulnerable patients for exploitation or employment? What if a “caseworker/clinician” simply doesn’t care anything about anyone who crosses their desk? What if they are just collecting a check?
I don’t know the answer to any of those speculative questions and neither does your office. Because if your office knew anything about SCHARP’s practices, it would not be allowing unqualified caseworkers with associates’ degrees in social work to be performing psychotherapy on the most severely and persistently mentally ill people from the most underserved and historically marginalized populations.
But business appears to be thriving.
We must do better by ourselves and our community.
I have two demands:
Immediately inspect and audit operations at all SCHARP clinics and facilities.
Remove the class tiering in mental health services provision, so that public mental health funds are available for all the public’s mental health, period.
There is absolutely no reason why a person with cash or private insurance in my neighborhood should not be able to avail themselves of mental health services at a publicly funded, county-contracted mental health clinic in their neighborhood. According to the Medi-Cal Mental Health Services booklet,
You have the right to choose your provider. If the provider you select is not under the Los Angeles County MHP, the Los Angeles County MHP does not have jurisdiction in how the services are being provided by that particular provider. Also, some providers may not accept Medi-Cal for payment. It is your responsibility to inquire if the provider accepts Medi-Cal for payment prior to accessing services. If you choose to pay for the services not cover by Medi-Cal, there is no restriction as to the type of services you may receive.
SCHARP’s restriction of service to Medi-Cal recipients is against the stated LA County policy. It makes sense only if Scharp is not primarily a mental health provider, but rather a specific kind of business operation with particular funding needs.