Where Arukah is, what changes on September 2nd, and what I need from you.

Where we are

Four grants have ended or are about to. Our grant money drops by 65 percent this year.

The rest of the leadership team went through all of this on Friday. I am showing it to you today because I wanted to walk you through it myself.

The dates

Here is the whole calendar. You are hearing all of it before any of it happens.

• Today, August 26th. You and the leadership team, in this room.
• Friday August 28th. The board gets the full plan and has the weekend to comment on it. No names in it, only job titles.
• Monday August 31st. Their comments come back to me.
• Wednesday September 2nd. We tell staff everything on one day: the job cuts, the service changes, and the new time off policy.
• Friday September 4th. Board meeting. They vote on the time off policy. Nothing else needs their vote.
• December 1st. The board decides what happens to Arukah.

I know what it looks like when a place like this shuts with no warning, and some of the people who walked out of that are our clients now. That will not happen here. You will not find out about a decision after it has been made.

Psychiatry

Psychiatry loses about $194,000 a year. About a third of its appointments never happen.

This is about how the service is funded, not about how you do your job. An empty appointment costs us the same as a full one, and no amount of working harder changes that.

One correction before the board reads it. Our stabilization plan tells them psychiatry no-shows are 60 percent. That is wrong. It is 14 percent no-shows plus 20 percent cancellations.

What your colleagues wrote

Their plan asks for three things. The first is what fixes your empty appointments.

• Someone other than you is responsible for each psychiatry client. They watch whether the client is turning up, taking the medication, and getting better or worse between your appointments. They hold the treatment plan and do the reassessment every 180 days. That is how clinics cut no-shows.
• Most psychiatry clients should also be in one other service, where it is clinically warranted. It does not have to be therapy. Case management or community support counts. Nobody is being put into weekly therapy to tick a box.
• You keep diagnosis, medication, how a client responds to it, and your psychiatric recommendations. The other person takes daily functioning, housing and social needs, treatment goals, risk monitoring and coordination. Right now all of that lands on you in a medication appointment.

I did not write this and I am not going to argue clinical practice with you. Your colleagues wrote it after I asked them one question: if you had fifteen minutes in Dr Shepherd's office, what would you say integration means?

What it protects

Five things their plan deliberately does not do.

• You are not the one who has to explain or enforce this. The expectation gets set with the client before they ever reach you, so you are not selling the organisation's model during a medication appointment.
• Nobody is discharged for missing therapy. If a client stops turning up, the first question is what is in the way, not whether to cut them loose.
• Clients who already have a therapist elsewhere keep them. We get a release and coordinate. We do not make anyone drop a working relationship to see us.
• Stable medication-only clients are looked at one at a time, never cut off, and never left without a way to get their medication.
• There is a written exceptions process. When a second service is not clinically indicated, that gets documented once and reviewed, instead of being argued client by client.

The one hard rule in the whole document is school-based psychiatry: those students have to be in therapy, so the therapist, the family, the school and you are all talking to each other.

What it does not answer

Three questions their plan leaves open. I need you on two of them.

• 1. Does a second service earn us anything? If we are paid one flat amount per client, adding a second service costs staff time and brings in nothing. If we are paid for each service, it brings in real money. Erin is finding out which one we are. The whole thing turns on it.
• 2. Who does the work? Every client in this plan needs a named person and a reassessment every 180 days. The revised staffing list has no therapist, no case manager and no community support worker on it, so the people this model leans on are staying. What goes is a supervisory layer above case management. I still need your read on whether the remaining hours are there.
• 3. Where does a client actually go? The plan says stable medication-only clients go back to a family doctor or another prescriber. I need to know whether those prescribers exist across our five counties before we make this a rule.

Question three is the one I need you on most. It is the only part of this that could hurt somebody, and you are the only person here who knows the answer.

The ask

What I need from you, and what you can count on from me.

If you think this plan is wrong, tell me today. Changing it this week is far cheaper than changing it in November.