I spent an exhilarating morning listening to speakers at the Fresno County Community Forum on Mental Health at the Piccadilly Inn. The question at hand was supposed to be whether to consolidate Fresno County mental-health services for adults and children into a single agency or leave their care in the hands of two independent departments. The decision affects more than 21,000 county residents with illnesses such as schizophrenia, bipolar disorder, anxiety and severe depression. It was great to have such an eager crowd focused on mental health.

The short answer from a distinguished panel of experts seemed to be that we are asking the wrong question. For Fresno County, it's putting mascara on a heart-attack patient. While it's, of course, good that the forum is happening at all, the very irrelevance of the question reveals a lot about how clueless the county is about the essence of its deficiences.. Many forms of organization can work if there is, first, a strong vision for what the mental health care system should be and, second, if you have the right people in place to carry that out. At the moment, neither exists and, as one speaker bluntly pointed out, the county is in a big mess.

The Fresno County Board of Supervisors now is basically faced with 1) getting a consensus vision on what a dynamic mental health care system for this area should look like and 2) hiring the right people to carry that out.