Managed Health Care
A new tenet for the SIMS foundation: heal thyself
From the smiles and oversized check, you'd think they just won the Publishers Clearing House Sweepstakes. Such is the scene every March at the Austin Music Awards, when KGSR's Jody Denberg and Peyton Wimmer pose for their annual photo-op. That, of course, is the occasion of KGSR's donating proceeds from sales of its annual Broadcasts CD to Austin's SIMS Foundation, a nonprofit health care organization providing low-cost mental health services to local musicians. After five years, the presentation has become a Music Awards tradition, same as the packed VIP tent.
Four months from now, Denberg will once again smile for the cameras, this time behind a cardboard blowup of a check for nearly a quarter of a million dollars from sales of the just-released Broadcasts Vol. 10 (see review, p.56). For the first time, the booklets for the 25,000 CDs pressed include the SIMS mission statement and a thumbnail-sized photo of Sims Ellison, the local hard rock bassist whose 1995 suicide served as the catalyst for the organization.
There will be one noticeable difference in this year's presentation, however: Wimmer, SIMS' founding executive director, won't be there. Denberg will, but only after taking heed of the music community's growing concern about the efficiency and financial future of SIMS. His fears were so profound, he says, that he came perilously close to earmarking the Broadcasts money for a different charity.
"I didn't want to look stupid," says Denberg.
By all accounts, not even SIMS' board of directors felt Denberg's fears were unwarranted. They knew full well that for most of its seven-year run, SIMS has been overextended and underfunded. By last fall, it was clear that an organization reaching out to others had found itself in need of critical care. At that point, there were three major concerns:
While the cause and effect of these three main issues came to represent an interwoven series of Catch-22s, the third item was the most damning. While SIMS wasn't designed as a crisis hotline, its founding mission had been to provide services to uninsured musicians falling between the health care system's cracks.
"It was frightening to hear that calls weren't being returned," recalls Denberg. "You lose people that way."
Although a contentious exchange of letters in the Chronicle's "Postmarks" section this past March and April opened the door to public debate over the foundation's effectiveness, SIMS had already begun plans for reorganization. For starters, founding board member Don Ellison (Sims' father) had already resigned the previous winter, citing the problems above. In May 2002, Wimmer resigned as well, replaced by a pair of transitional consultants under six-month contracts: founding board member and musician Don Harvey and nonprofit consultant and professional counselor Luniece Obst.
"We knew we had to move forward," says founding board member Wayne Nagel. "Before we could, our dirty laundry and growing pains got aired in public. That'll happen when you're part of a small community."
Harvey and Obst have been dealing with just such growing pains in an organization that has become a victim of its own success. Initially, there were questions about whether musicians would use a service like SIMS. Today, that point is moot. It has saved lives. While a cornerstone of the service is anonymity, Wimmer claims nearly 24,000 people called SIMS for assistance in its first six years. The program now serves nearly 400 new clients a year.
With each client costing the organization as much as $1,250 in counseling fees, SIMS finds itself delicately balancing its service and financial feasibility. The SIMS board acknowledges the danger in the foundation living KGSR check to KGSR check. It's why Denberg asked SIMS to provide concrete plans for additional fundraising before turning over last year's check and agreeing to earmark the proceeds from Broadcasts Vol. 10 for SIMS.
"Jody was right to guard the money," says Harvey. "He was right to ask for an assurance that we wouldn't burn through his money and risk the organization not being able to survive."
Obst was brought onboard largely because organizational survival is one of her businesses. In addition to her counseling practice, she serves as strategic planner for nonprofits. Obst says SIMS' growing pains aren't particularly unusual or fatal.
"If you look at its history, SIMS is a grassroots organization born out of people coming in good faith to create access for people who didn't know where to go," she explains. "Did well-seasoned people initially step forward and volunteer the leadership ability to make this happen? No. A lot of people from a lot of different business backgrounds came together, reached in their pockets, and did the best they could.
"They themselves are self-employed people trying to keep their heads above water. That there are some roadblocks is only natural."
Sims Ellison died in June 1995. A shotgun was the instrument of his demise, depression its root cause. Just two months after his death, SIMS (Services Invested in Musician Support) was formed. The idea was to offer what Ellison might well have benefited from if it had been available: an outreach program matching Austin musicians and their families with professional mental health counselors.
The initial idea was to use an awareness campaign to reduce the fear and embarrassment commonly associated with seeking help and to make the resulting counseling itself financially feasible. Because the majority of local musicians are uninsured, SIMS offered counseling at just $10 a session.
After drafting both a charter and mission statement, Don Ellison, musician-attorney Walter Taylor, and Austin Rehearsal Complex co-owners Don Harvey and Wayne Nagel became the foundation's board of directors, with Peyton Wimmer signing on as SIMS executive director in April 1996. Wimmer was both a part-time musician and licensed counselor, a combination that proved effective almost immediately. He provided the organization's public face, and by all accounts, musicians trusted him because he was one of their own.
"People identified with him," confirms Ellison. "They felt like he knew the pressures and anxieties that go along with being a musician."
Wimmer also got along famously with providers: They appreciated his knack for matching clients' needs with counselors' strengths. From the beginning, Wimmer had a set idea on how SIMS should serve clients; he believed treatment should be as much or as little as a client needed, even if it meant putting the client's needs ahead of the organization's. On rare occasions, treatment for one client might exceed $40,000. Wimmer admits there were times when paperwork had taken a backseat to the care itself.
"I'm not managed-care oriented," says Wimmer, who was known to dig into his own pockets when funds were unavailable and critical care was necessary. "I didn't want to load the clients down with paperwork. It can be intimidating for someone coming in for help.
"While we had large monthly operating expenses, my core belief is that you don't cut back services because you can't cover the cost. Limiting services keeps people in need. We had to be able to look at each case and say, 'What can we do so we don't lose this person?' And I never had to say, 'There's nothing we can do.'"
Wimmer was instrumental in arranging partnerships with national nonprofits that offered similar or complimenting services to musicians -- services like MusicCares, M.A.P. (Musician's Assistance Program), and Sweet Relief. Not that SIMS' fundraising had been keeping pace with its growing clientele and expenses.
SIMS benefits were high-profile but only moderately profitable. Wimmer estimates that the popular "Day in the Life" series of local club benefits would bring in $10,000-$13,000 a year, roughly the income of a part-time musician. Over time, the publicity those events generated and word of mouth from musicians created demand for SIMS' services.
Even in the face of rising debts, Wimmer says he began to envision a wider role for SIMS; a 1999 SIMS survey concluded local musicians would like to see SIMS operate a clinic, tending not just to its patient's mental health, but also their physical health. By February 2000, without alerting the SIMS board, Wimmer told the Chronicle of his interest in joining forces with a group hoping to open a clinic in the late Doug Sahm's honor.
"There were other organizations where you could get physical help, but nothing like SIMS," says Ellison of his objections. "I thought that if we spread ourselves too thin, it would kill SIMS. It would not only take us off mission, but offline."
Wimmer doesn't deny that the success of a nonprofit is directly related to how closely it sticks to its mission. The problem, he says, is that the gulf between his ideas and the mission's mandate were widening. "Eventually I felt we needed to either change the statement or change the leadership," says Wimmer.
Late last year, Wimmer began discussing that change of leadership with the board. As an exit strategy and transitional plan were being negotiated, SIMS' troubles went public. A week after receiving KGSR's $219,000 check from the proceeds of Broadcasts Vol. 9, a letter to the Chronicle charged that calls to the foundation from volunteers and therapists were going unreturned.
Worse yet, it charged that SIMS hadn't been returning calls of musicians in need. By April, both Wimmer and Ellison had their own letters published; Wimmer touted SIMS' success rate, but suggested hotline alternatives for crises. Ellison's statement, meanwhile, concluded with, "Inaction on the part of the foundation, either by ignorance or apathy, only adds to any public perception of ineffectiveness on the part of the foundation."
Ellison could speak freely because he had resigned his post as board member three months earlier. He says he resigned because the board had grown too polarized to be effective. He says the yardstick he used to measure SIMS' effectiveness was the foundation's namesake.
"I always asked myself, 'What would Sims have done?'" he says. "Would he have called? And what would have happened if he called and didn't get a timely response? My personal feeling was that for someone already depressed, that would make them more depressed. I believe it was our mandate to make sure if someone called, there was somebody on the other end of that call that cared. We weren't getting that done."
It's important to note that board members past and present praise how effectively and selflessly Wimmer almost single-handedly built the organization from scratch. For his part, Wimmer admits his do-it-right, do-it-yourself approach may have limited his effectiveness once the volume of interest in SIMS exceeded what one man could do in a 14-hour day.
In fact, Wimmer says that in the last few years, he was asking the board nonstop for additional help. He estimates that by last year, SIMS was receiving 50 calls a day, seven days a week, and that he was often showing up to work to find three voice mail systems, each with 20-30 call capacities, overloaded. He says at least a third of those calls came from new clients he needed to spend time with, all while managing a network of close to 150 providers and overseeing fundraising efforts.
"Those letters of criticism didn't do much more than bolster the fact we needed help," says Wimmer. "The public didn't know that I was getting 50 calls a day. We were designed to catch people falling through the cracks, and if people felt they were falling through those cracks, we weren't doing our job.
"We had to find a way to make sure that didn't happen. The people that fall through the cracks are what's most important. And yet with the amount of phone calls coming in, I had to hope and pray that if someone was in real crisis, their call got through. It was a terrible way to live."
Don Harvey is very clear about what he did on his first day of work in April.
"I used Excel to draft a message log," he says. "Every call identifies the caller, when the call came in, who answered or returned it, and what the outcome was. If somebody called for assistance, it's in the log."
Unlike most of Wimmer's tenure, Harvey had help steering SIMS. As a licensed counseling practitioner and experienced strategic planner, Luniece Obst's initial role was to find a more efficient way to get clients into the system and to restructure the network of providers. Right away, Obst narrowed the field from 150 providers to 40. For the first time, SIMS had a copy of their counselors' licenses and proof of liability insurance, as well a list of their specialties.
SIMS new policies started with a promise to return all calls within 24-36 hours and 48 hours on weekends. Currently, Monday is intake day; after an initial phone consultation, clients come in for a one-on-one meeting in which they're presented with the names of three available counselors. (A typical Monday introduces six new clients into the system.) Clients pay $10 a session for up to 12 weekly sessions, with SIMS paying the provider $35 for each of those sessions. When necessary, SIMS also pays $65 for psychiatric evaluations and $35 a month for six months of med management.
Also new is a policy that providers must petition the organization for additional time with clients in the event that 12 sessions aren't enough, although all clients are offered six months of group care or continued one-on-one counseling at a discounted rate.
"Long-term therapy is great in an ideal world, it's just not something you can provide as a public service," says Jim Maxwell, one of SIMS first counselors seven years ago.
"Six months ago, there were people coming in for therapy indefinitely," reveals Harvey. "It was never the way the organization was set up by its founders. It's not about a lifetime of analysis, nor is it about a quick fix.
"If people come into the system and nobody is leaving, it becomes a huge balloon ready to burst. Who's gonna pay for it when you have 1,500 people in the system?"
Even without 1,500 people in the system, "Who's gonna pay?" still plagues SIMS. Since KGSR's demand that SIMS become more proactive in its fundraising, there has been a flurry of activity, including a recent "signature" event that sold more than 100 $150 plates for an event honoring Denberg.
Along with establishing a weekly music series, the Hard Rock Cafe also worked with SIMS in producing a line of collectible guitar pins, the sales of which benefit the organization. The first featured Asleep at the Wheel's Ray Benson, one of SIMS' newest board members. The foundation has also revived or reconfigured programs Wimmer started.
A holiday card series featuring art from local musicians hit stores in September. They were actually commissioned and printed last year, but never sold. In August, in lieu of the annual SIMS Supper which took a smaller percentage of receipts from restaurants across town, Shady Grove donated 50% of a day's sales, totaling over $11,000. Similar events are planned with other restaurants, as is a membership drive for local businesses, which would shift fundraising efforts away from musicians playing benefits to contributions from those that depend on those same musicians: music stores, nightclubs, restaurants, and studios.
"Why have musicians do umpteenth benefits to pay for their therapy?" asks Harvey. "They might as well pay for their therapy."
While SIMS is also readying an initiative that would invite increased participation from the high-tech community, KGSR will likely remain the group's largest benefactor for some time. By combining revised health care policies with a renewed fundraising push, however, founding board member Walter Taylor believes SIMS has already begun turning the fiscal corner.
"In past years, by September or October we had discussions about whether we needed a bridge loan to tide us over until the next KGSR check in March," points out Taylor. "It's late November, and that hasn't come up yet. It's my understanding bills are paid.
"But I wouldn't want to convey the impression that we don't need money. I'd say we're proving ourselves as a worthwhile investment, not that we don't need the contributions."
Don Ellison says he's so convinced that SIMS has made a turnaround that he recently made a financial contribution to the group he publicly criticized just six months ago. And yet, for all of SIMS' strides toward stability, it's also currently without permanent leadership. Harvey and Obst's six-month contracts, and a subsequent month-long renewal, have expired.
Taylor says a search is underway for a replacement and could be complete within 90 days, even if there is dissension on the board over whether hiring just one executive director wouldn't be asking someone to step back into Wimmer's overworked and underpaid shoes.
The other issue is whether it's more important to have a musician whom clients can relate to, a counselor, or an experienced fundraiser hold the post if one candidate doesn't emerge possessing all three skills. One idea is to complement the board of directors by installing a board of elders composed of counselors, while Taylor favors expanding the board to nine members, each taking on clearly assigned roles within the organization.
Jody Denberg is adamant that he's not interested in one of those board positions, but he says he's already feeling good about sticking with SIMS. As the man with the $250,000 check, that's good news for SIMS and the musicians that count on it for help.
"It's so important," stresses Denberg. "I can't imagine during my troubled times if I didn't have the wherewithal to get help. I can't imagine if my friends didn't have a place to turn.
"I was talking to Luniece about this recently, and she said, 'And you're not on the frontlines. You don't realize the amount of people being helped and how grateful they are for this.'
"She said if I were to sit around with the volunteers and watch it all, I might not be able to handle emotionally how intense it is. I'm sure she's right."
Austin musicians seeking counseling can call SIMS at 494-1007, although for emergencies, they suggest 472-HELP or 1-800-SUICIDE. For information on donating to SIMS or volunteering, call their business office at 472-1008. You can also find more information online at www.simsfoundation.org