The URL can be used to link to this page

Home My WebLink AboutMINUTES - 06041991 - 2.1 a. i THE BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA. Adopted this Order on June 4, 1991 , by the following vote: AYES: Supervisors Fanden, Schroder, Torlakson, Powers NOES: None ABSENT: Supervisor McPeak ABSTAIN: None ------------------------------------------------------------------- ------------------------------------------------------------------ SUBJECT: Status of Mental Health Services The Board received the attached report from Joseph Hartog, MD, Health Services Department, on the status of mental health services for adults and the consequences of budget cuts and staff reductions in the fall of 1990 . IT IS BY THE BOARD ORDERED that the report on the status of mental health services is ACCEPTED. cc: Health Services County Administrator 1 hereby car*thd this to a true and corroW am of an action taken end entered on the ndnutee of the Board of SuW on the date shown. ATTESTED: 9 PHIL BtVCHELOR,Clark of the Board of Supervisors and County Administrator er Deputy • 2-001 !' CONTRA COSTA COUNTY HEALTH SERVICES DEPARTMENT To: Board of Supervisors Date: May 16, 1991 From: Joseph .Hartog, M.D. Subject: Status of Mental Medical Director Health Services This report will refer to the period from August 1990 through March 1991, which includes most of my tenure as Acting Mental Health Director. The subject of this report is the status of mental health services for adults and the consequences of the mental health budget cuts and outpatient staff reductions resulting from those cuts in the fall of 1990 . Up to the fall of 1990 , Adult Outpatient Services was providing services in the manner and quantity that had been characteristic for the last five years or so. The services mainly included evaluations, assessments, brief and long-term psychotherapy, medication sessions, and some group therapy. Waiting lists and intake procedures required potential patients/ clients to wait four to six weeks to receive help, and the most severely disturbed patients often were not able to receive needed services. The average percentage of face-to-face sessions for adult outpatient therapists was 25 percent or about two per eight hour workday. Under the pressure of budget reductions, a decision was made to eliminate most long-term adult psychotherapy services and 9. 5 (two-thirds) of the psychotherapist positions. The goal (in addition to fiscal savings) was to increase access to care for the most seriously ill and those in crisis. The adult outpatient clinics were to provide assessments, brief crisis intervention and brief psychotherapy, short-term but extendable group therapy, long-term case management and long-term medication management. The immediate result of these decisions, endorsed by the Board of Supervisors last August, was the bumping and layoff process which disproportionately impacted children services staff with six lay- offs. This was a very stressful time for line staff with uncer- tainties about their jobs and new and different job expectations. The vast majority of affected staff have made a good adjustment and are performing very well. In fact, some staff are thriving with the new challenges, and have done outstanding work. A-41 :iJ81 Board of Supervisors May 16, 1991 Page 2 The effect on patients/clients has not been detrimental. With the absence of waiting lists, adult patients have more immediate access to services. There have been no untoward incidents, e.g. , suicide attempts, etc. , as a result of the changes. We established a backup Clinical Review Committee in case there were clinical situations that could not be managed in the local clinics. The Committee has had very little work to do regarding such situations. The crisis unit visits and hospital admission rates have decreased slightly. The number of adult clients served and the number of units of service decreased by about ten percent. There has been a decreased demand for services, even affecting children outpatient services. There are many private practitioners in the County who have agreed to accept patients at reduced rates. We have supplied the clinics with the names of 96 Marriage, Family, and Child Counselors, 44 Licensed Clinical Social Workers, 6 psychologists, and 10 psychiatric physicians who, responding to my request, have agreed to see patients/ clients who require longer term therapy than we can provide, and at reduced fees. Altogether this has been a difficult but positive transition. Although productivity, i.e. , .number of face-to-face contacts by the noh-medical staff., has not yet increased significantly, staff have begun to reorient themselves to the new priorities. They have been quite receptive to special trainings provided to them in brief therapy and group therapy. Case managers are getting more support and acknowledgment for their difficult tasks and are about to begin extensive training in the newest concepts of case management. The psychiatric physicians have been swamped by the number of patients they are responsible for and vacant physician positions have been difficult to fill, but the addition of outpatient nursing staff is beginning to help. The future of care for the most ill psychiatric patient is hopeful for the first time in years. The mental health system is positioning itself to give priority services to the neediest. We continue to support patient advocate services for patients, and now plan to create a position for a family advocate. We are on the verge of having local control of the State mental health dollars, so that we can plan programs ahead for' the first time in a decade. We are about to develop a wholly new case management system for the most difficult patients employing professionals, paraprofessionals and former consumers. This development is in synchrony with the State' s development of the rehabilitation option. This is the outcome of two years of planning in line with P.L. 99-660 which will, with the concurrence of the Health Care Financing Administration, allow patients/clients to receive treatment outside of the usual hospital and clinic settings and Board of Supervisors May 16 , 1991 Page 3 be billable in many different treatment settings. This is the plan that resembles in intent the priority planning concepts that were put forth by the Mental Health Division two years ago, the ultimate goal being the treatment of the persistently mentally ill as priority number one. We are developing programs for the dually diagnosed after successfully completing our NIMH project in Richmond. We are piloting projects for mentally ill jail inmates in joint cooperation with Probation, Sheriff, and criminal justice/court staff. There are actually more psychiatric patients in the jail than in the hospital. We are upgrading the quality of nursing throughout our system with the hiring of highly trained specialists. We are buying out Napa State Hospital beds which will allow us to provide services and expensive new promising medications for many more patients than the ten beds (of our total allotment of 94) we are not able to use (because of our inability to access the beds at the State Hospital due to overcrowding) . Over the past six months, we have reorganized our administration to increase efficiency, effectiveness and teamwork, and with a new systems analyst will be making better use of our management information system. We will shortly begin recruiting for a housing development coordinator in order to develop the 200 units of housing we estimate is required for our persistently mentally ill. Significant federal funds are available for this purpose. We are working to increase services to our most needy ethnic populations, an outstanding example of which is the Southeast Asian clinic in West County where we will be adding a psychiatric physician resident this summer. I will mention the children' s and older adults programs even though adults are the focus of my presentation, since these programs are so outstanding. The children' s programs in the schools (primary intervention projects) continue to expand, now nine in five school districts. Children' s Services is also looking at brief treatment as well as family modalities in order to reduce waiting time and are planning a pilot to treat adolescent sex offenders in coordination with Juvenile Probation, where they also serve the Byron Boys ' Ranch. The Older Adults Program continues as the model for the Bay Area, now with clinics in Richmond and Concord with rapidly increasing caseloads served by experts in geriatric medicine, and the medical geropsychiatric unit at Merrithew Memorial Hospital. With the arrival of Patricia Roach, our new Mental Health Director, along with the opportunities, challenges and Board of Supervisors May 16, 1991 Page 4 initiatives already begun, I am looking forward to some exciting , and productive years for the Mental Health Division, providing increasingly better and more accessible services to the mentally ill of Contra Costa County. JH:vn cc: Phil Batchelor, County Administrator Mark Finucane, Health Services Director Patricia Roach, Mental Health Director