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Home My WebLink AboutMINUTES - 11142006 - D.4 �TOt BOARD OF SUPERVISORS Contra FROM: William Walker, MD Health Services Director Costa �a o DATE: November 14, •C 2006 °°s UCounty T'4Oty� 11 SUBJECT: Report Regarding the Re-Structuring of the Adult Mental Health System of Care SPECIFIC REQUEST(S)OR RECOMMENDATION(S)&BACKGROUND AND JUSTIFICATION RECOMMENDATION: ACCEPT the report from ;the Health Services Director concerning the Re-Structuring of the Adult Mental Health System of Care in Contra Costa County. BACKGROUND: The adult mental health system of care in Contra Costa County is at a turning point. It is time for us to move the system into a different model of care than the current program. Modern best practices inlmental health care are focused upon a continuum of community- based, individualized, multidisciplinary services. Acute hospitalization is an important but very small component of the ideal system of care. Hospitalization is appropriate only for individuals who actually require that very high level of care during an episode of decompensation. Hospitalization is not an appropriate substitute care option for individuals who need other levels of service that are not available. Presently, our Mental Health System of Care is facing both opportunities and challenges as we plan for the future. The intersection of some new funds and some old challenges has prompted HSD to consider and mobilize the following steps toward system restructuring. Restructuring is never easy and in the coming months we will see new challenges and new opportunities to help serve our patients in innovative ways based upon the best practices . and evidenced based standards of modern public mental health. In January, the long awaited funds from proposition 63 (The Mental Health Services Act) will begin to flow into our county and over a year's strategic and community planning will come to fruition with new and innovative programs and services to help mental health consumers spend more time in the community and less time in the hospital. CONTINUED ON ATTACHMENT: _YES SIGN TURE: �G"4e_ ------------------------------------------------------------------------ ------------ --------------------- ---------------------------------- RECOMMENDATION OF COUNTY ADMINISTRATOR RECOMMENDATION OF BOARD OMMITTEE APPROVE OTHER SIGNATURE(S): ACTION OF BOARD ON APPROVE AS RECOMMENDED OTHER VOTE OF SUPERVISORS I HEREBY CERTIFY THAT THIS IS A TRUE AND CORRECT COPY OF AN ACTION TAKEN ,4NANIMOUS(ABSENT ) AND ENTERED ON THE MINUTES OF THE BOARD OF SUPERVISORS ON THE DATE AYES: NOES: SHOWN. ABSENT: ABSTAIN: ATTESTED AID`ID '�? CONTACT: JOHN CULLEN,CLERK OF TH BOARD OF SUPERVISORS AND COUNTY ADMINISTRATOR CC: BY U r ° D UTY 'Page'-2 of'2 Our patient population is shifting and so must our system of care. National experts and experience have demonstrated that acute hospitalization and institutional care do not benefit patients in the long term. A careful evaluation of the best practices and stakeholder participation has encouraged shifting our system toward increased community support and intensive case management. The coordination of intensive outpatient services and assertive, short-term acute stabilization has been shown to decrease and prevent hospitalizations, assisting consumers to lead more independent, satisfying lives. In the coming months, the beginning few hours of our PES services (usually called "Crisis Intervention") will be moved into the medical ED and all patients, regardless of emergency presentation will receive a comprehensive medical evaluation from our own emergency physicians. This will enhance our general ED services by adding psychiatric personnel and consultation to the ED; improving patient safety and ensuring all of our patients, regardless of emergency presentation, receive a uniform medical evaluation. To enhance our outpatient mental health capacity, our crisis residential services and transitional residential services at Neireka, Nevin and Pathways, will open new beds for our consumers. As our augmented outpatient services and Mental Health Services Act programs come up to speed, we will temporarily expand our acute hospital contracts with regional private li facilities to ensure that options for appropriate patient care are available. To support patients after,hospitalization, a new hospital after-care intensive case management team will be developed immediately to track patients intensively in the community after discharge from inpatient psychiatry. The 4-D section of the current inpatient unit will no longer be needed for inpatient psychiatric care. We will close that unit and re-deploy some staff to alternative positions in our health system. Staff RNs, LVNs, and MRCSs will potentially be displaced from their current jobs in this process; however, those employees will have new job opportunities in the clinic and community system of care. ADDENDUM TO DA NOVEMBER 14, 2006 On this day, the Board of Supervisors considered accepting a report from the Health Services Director regarding the restructuring of the County's adult mental health system to capitalize on best practices and evidenced-based standards of modern public mental health. William Walker, M.D.,Health Services Director,presented the Board with an update on changes in the Mentaf�Health Department. He said as part of the Mental Health Services Act community input process, Health Services has undertaken several recommendations about increasing services in the community in terms of beds available for Mental Health patients. Dr. Walker told the Board that over the years, the psychiatric unit has held about 38 patients on a!typical day,but during the past five months, the average daily census has dipped to 31. He noted as a result of the decline in census in the inpatient psychiatric unit, Health Services Department would maintain a 23-bed inpatient psychiatric unit. He said admissions have stopped in the section of 4D and patients would be phased out as they are stabilized and moved to other settings. Dr. Walker noted Health Services Department had a"meet and confer"with the California Nursing Association and Local 1 Unions last week, and stated there would be no job loss as a result of this. The Chair asked for public comment on this item. The following people spoke: Nancy Thomas, resident of Danville, said her schizophrenic son has been in and out of the hospital's locked inpatient unit, and questioned whether the beefed-up community services would be adequate. She said there could be additional stress on police departments and other agencies that deal with people undergoing a mental health crisis. Ms. Thomas said"why would you leave $2.8 million on the table to just slip away?" and "Why not keep those beds open?" Dr. Walker responded, saying the loss would not be that high. He told the Board that number was incorrect!and the loss from federal money would be about$1 million. He said it doesn't make sense to have the staff available for 43 patients when only 31 are there. Dr. Walker said numbers are fuzzy because the loss marks the difference between what the County will receive for each patient in the unit and the amount it would have received at the higher reimbursement rate. By a unanimous vote with District IV absent, the Board of Supervisors took the following action: ACCEPTED a plan to from the Health Services Director to close half of the inpatient psychiatric unit at Contra Costa Regional Medical Center. REQUEST TO SPEAK FORM (THREE (3) MINUTE LIMIT) Complete this form and place it in the box near the speakers' rostrum before addressing the Board. Name: AJ7 ?Yy}L Phony;: Address: City: n�fll L (Address and phone number are optional;please note hat this card will became a public record kept on file with the Clerk of the Board in association with this meeting) I am speaking for myself or organization: CHECK ONE: ❑ I wish to speak on Agenda Item # G: V' Date: !1- ,C t-f.� C>(2:, '',5 !.(1- . My comments will be: ❑ &neral F1 For Against r C1�I wish to speak on the subject of: `v1 yam- ❑ I do not wish to speak but would like to leave these comments for the Board to consider: Please see reverse for instructions and important information ___. REQUEST TO SPEAK FORM (THREE (3) MINUTE LIMIT) Complete this form and place it in the box near the speakers' rostrum before addressing the oard. Name: U �?� Phone: V6 T Address: city: �Q/V fill) (Address and phone number are optional;please note that this card will become a public record kept on file with the Clerk of the Board in'association with this meeting) I am speaking for myself or organization: lyll1 ( O Tl� SDs CHECK ONE: ❑ I wish to speak on Agenda Item # - `l Date: My comments will be: ❑ General ❑ For ❑ Against ❑ I wish to speak on the subject of: i ❑ I do not wish to speak but would like to leave these comments for the Board to consider: I Please see reverse for instructions and important information