Allegheny County’s Department of Human Services (DHS) leaves the task of maintaining waiting lists for most mental health treatment programs to contracted providers and does not require these agencies to meet best practices for maintaining these lists, an audit of Behavioral Health Services by the office of County Controller Corey O’Connor found.
For 13 of 17 mental health services examined, DHS did not provide updated lists of clients waiting for services. For the one service for which DHS does directly maintain the waitlist, Community Residential Services (CRS), there were 58 people awaiting services as of December 31, 2024, with records indicating delays exceeding 2,100 days.
The lack of a centralized waitlist system for most services requires clients to navigate waitlists across different providers on their own, which can lead to frustration or a reduction in motivation to receive treatment, the audit states. Clients may also sign up with multiple providers in an attempt to reduce their wait time, which can lead to a higher ‘no-show’ rate, wasting resources that could be used by other clients.
Best practices in case management and administrative oversight require that client service waitlists be up-to-date, accurate, and regularly reviewed to ensure timely access to care. The Substance Abuse and Mental Health Services Administration (SAMSHA) also emphasizes prompt access to services and the elimination of administrative barriers.
“While funding and capacity limitations are unavoidable, we cannot allow administrative hurdles to prevent or deter individuals from accessing potentially life-saving services,” O’Connor said. “This report follows on our audit of homelessness services, which showed that existing capacity was not being maximized due lack of administrative coordination and consistency. Our finding concerning mental health waitlists shows a similar problem and another opportunity to see more people helped with existing resources.”
O’Connor’s audit examined services funded through Pennsylvania’s Human Services Block Grant (HSBG) and Department of Drug and Alcohol Programs (DDAP). Clients are directly served through 17 contracted general mental health services and 12 contracted general drug and alcohol services, with coordination by DHS’s Office of Behavioral Health (OBH) and contracted managed care organization Community Care Behavioral Health (CCBH).
The County received over $107 million in HSBG and DDAP payments for these services during the 2023-24 fiscal year, and more than $616 million from all public and private sources.
The audit found that DHS pays inconsistent rates to providers for the same services. Fees are generally paid based on a schedule determined by the managed care organization CCBH, though that agency may also negotiate different rates with individual providers. For more than 100 service rates examined by auditors, nearly half did not match the CCBH rate schedules.
Paying different rates for identical services reduces transparency, increases the risk of inequitable treatment of providers, and may give the appearance that the process is not impartial, the audit states. Auditors recommended that DHS formally document its rate-setting policy for all mental health and drug and alcohol services.
“Our policymakers and taxpayers simply must know what they’re paying for, and that favoritism doesn’t play a part in which providers receive referrals or what they are paid,” O’Connor said. “This is basic government transparency.”
In some cases, claims rejected by CCBH may be referred directly to DHS and then approved for payment. In these cases, claims should be paid according to rates set in the controlling contract between the provider and DHS. Of nearly 100 fees for service paid in these circumstances, nearly a quarter did not match the contract rate.
OBH mental health, drug and alcohol, and general/program operations were budgeted for 87 staff positions as of December 31, 2024. Of these, 26 were unfilled. As of August 25, 2025, and there were still 25 unfilled positions.
The vacancies included six of nine Program Specialist positions, which are responsible for monitoring and providing technical assistance for adult mental health programs and ensure services are delivered in accordance with state regulations, County policies, and established contracts.
“While hiring is a challenge across nearly every employment sector and the County faces serious funding constraints, we should do all in our power to avoid shortchanging positions that ensure that County-provided services operate efficiently for our taxpayers and are being maximized to ensure that every individual possible is being helped,” O’Connor said. “These critical services strengthen families and communities and, ultimately, save lives.”
Mental health and drug and alcohol crisis services are available through resolve Crisis Services via phone (1-888-7-YOU-Can) or the walk-in center at 333 N. Braddock Ave., Point Breeze. Other resources are also available to assist individuals experiencing a crisis including the national 988 Suicide & Crisis Lifeline, the PA Crisis Text Line (text HOME to 741741 or chat at www.crisistextline.org), and the emergency department at local hospitals.
***