Meeting Minutes March 4, :00 pm 2:00 pm

Transcription

1 BEHVIORL HELTH COMMISSION Meeting Minutes 12:00 pm 2:00 pm

2 MENTL HELTH BORD MINUTES Members Present Beatriz Gonzalez, Co-Vice Chair... Education, District 4 Carole Schaudt... Public Interest Member, District 4 Christina Torres, Co-Vice Chair... Public Interest Member, District 5 Darrell Connerton... BOS Representative, District 3 Daryl Terrell... Public Interest, District 5 Eric Keen...Public Defender, District 1 Greg Damewood... Family Member, District 5 Jennifer Dunaway... Family Member, District 5 Julie Crouch, Secretary... Family Member, District 1 Opal Hellweg... BOS Representative, District 3 Richard Divine, Co-Chair... Family Member, District 4 Rick Gentillalli... Law Enforcement, District 3 Victoria St. Johns... Education, District 4 Walter Haessler, M.D.... Public Interest, District 1 Members Not Present Georgia Smith... Consumer, District 2 Gilbert Espinoza... District 5 James Stuart, Co-Chair... Law Enforcement, District 4 Patricia Carrillo... Family Member, District 2 Phillip McKinnon... Public Interest, District 2 Others Present Steph Cromwell... Public Interest/Guest Kathryn Mauro... Consumer/Guest Kristen Duffy... Consumer ffairs/ RCDMH Leonel Contreras... Latino Commission/Guest Leticia Delara... Regional ccess Project/ Guest Elaine Wright... Consumer/ Guest ngie Rubio... Consumer/ Guest Dr. Bipin Patel... RCRMC/ Guest Speaker Carol Perez... RCRMC/ Guest Maria Mabey... ssistant Director/ RCDMH Cynthia Oma Gray... Soroptomist House of Hope/ Guest Lupe Stoneburner... Soroptomist House of Hope/ Guest Pepe Del Rio... Mid-County Board Member/ Guest Gloria Hernandez... Mid-County Board Member/ Guest Rhyan Miller... Substance Use Program dministrator/ RCDMH Ron Hoffman... Recovery Innovations/ Guest Deborah Johnson... Deputy Director/ RCDMH Claudia Smith... Forensics/ RCDMH May Farr... NMI/ Guest licia Hermosillo... Family dvocate/ RCDMH Barbara Salsberry... Family dvocate/ RCDMH Jim Powell... B109/ RCDMH Claudia Espinoza... Family dvocate/ RCDMH Brenda Scott... NMI/ Guest Sheila Hunt... Pacific Grove Hospital/ Guest Daniel Medina... Help4HD/ Guest Jason Farin... BOS District 2 Representative/ Guest Ryan Quist... Quality Improvement Manager/ RCDMH Barbara Mitchell... d Council gency/ Guest Kim McElroy... Mid-County Board Member/ Guest Tiffany Keeler... Recovery Opportunity Center Sharon Lee... dministrative Services ssistant/ RCDMH Page 1 of 8

3 CLL TO ORDER ND INTRODUCTIONS RIVERSIDE COUNTY MENTL HELTH BORD MINUTES Chairperson, Richard Divine called the meeting to order at 12:02 and Commission members made self-introductions. CHIRPERSON S REMRKS/ CORRESPONDENCE Richard Divine received a letter from California Mental Health Planning Council requesting the Commission begin a discussion about Patient s Rights system and advocacy with the Mental Health Department and Patient Rights dvocates. The Planning Council has requested notification and a copy of the agenda once this matter is scheduled to be addressed by the Commission. CELEBRTE RECOVERY PRESENTTION licia Hermosillo introduced Barbara Salsbury as this month s Celebrate Recovery speaker for the Family dvocate Program. In 2008 Ms. Salsbury s brother committed suicide, which had a traumatic impact on her and her family. s a result of the tragedy, Ms. Salsbury s mother and brother were diagnosed with post traumatic stress disorder (PTSD). Her family received tremendous support from the Family dvocate Program and the Hemet Mental Health Clinic. Recently, her brother suffered from a black out and needed help. He was able to receive services from both the mental health clinic and the substance use clinic. Ms. Salsbury s brother is currently in rehab and is doing well with the program and his medication. She is incredibly grateful for all the services provided by the Mental Health Department. Ms. Salsbury expressed her appreciation for the amount of support, understanding, and compassion that she and her family received during this difficult time. PUBLIC REMRKS/ COMMUNITY CONCERNS/ NNOUNCEMENTS Daniel Medina, a representative from Help4HD, announced that they will be holding their annual conference at the Mission Inn and invited the Commission members to attend. The conference will be held on ugust 22 from 9 am to 5 pm. Help4HD is a nonprofit organization that serves the needs of the Huntington s Disease (HD) community. Brenda Scott, a representative from NMI Mt. San Jacinto announced that their 10 th nnual NMI Walk will be held on November 7 at Diamond Valley Lake in Hemet. Ms. Scott provided two handouts for their Peer Support and Family Support groups located here in Riverside at Pacific Grove Hospital. For services at other locations, please visit COMMISSION MEMBER S REMRKS/ NNOUNCEMENTS - None MINUTES OF PREVIOUS MEETING Darrell Connerton moved to approve the minutes as written, Rick Gentillalli seconded the motion, none opposed and the motion carried. NEW BUSINESS - SECLUSIONS ND RESTRINTS Dr. Bipin Patel, serves as the Chairman of the Psychiatric Department at Riverside County Regional Medical Center (RCRMC) and Staff Psychiatrist for the Department of Mental Health. Dr. Patel began by stating that the hospital is required by law to collect data and provide a report about seclusions and restraints to the state and make it available to the public. RCRMC has specific policies regarding seclusions and restraints and it is their ongoing goal to reduce and eliminate the use of seclusions and restraints. The way they are achieving this goal is by training every staff member, including those not involved in patient care such as housekeepers and clerical staff, in the prevention of seclusions and restraints. They have also instituted a standardized procedure if and when seclusion and/or restraint must be exercised. Staff members are mandated to attend the training yearly as it prepares them to be better able to protect themselves and the patient in the event of a crisis. Every incident that occurs is reported and reviewed by a team of analysts. The purpose of the analysis is to determine if there was a justifiable reason for the use of seclusion and/or restraint, and if there were any violations of policy. ll issues are reported back to the manager of the unit. If there are issues involving prevention or handling techniques, the staff member(s) are either sent back for remediation or disciplinary action. Quality Improvement also compiles the data into a quarterly report, which provides feedback for performance regarding their goal of reducing seclusions and restraints. RCRMC is also participating with the University Health Consortium (UHC) research by providing the data collected for comparison with similar hospitals across the nation. Dr. Patel provided data for 2012, 2013, and 2014 on seclusions and restraints. Dr. Patel stated that reports for seclusion and restraints are reported separately for Inpatient Treatment Facility (ITF) and Emergency Treatment Service (ETS). Dr. Patel Page 2 of 8

4 MENTL HELTH BORD MINUTES noted that in ETS, the patients are in huge crises and thus makes seclusions and/or restraints more prevalent. In ITF, patients are working toward recovery and are less likely to need seclusion and/ or restraint. The data collected for seclusion and restraints are separated by the following categories: seclusion, physical restraint, and mechanical restraint. Physical restraint, as required by law 5-6 years ago, is the act of putting one s hands on a patient because they are harming themselves or other people. Mechanical restraint is the act of placing a patient in restraints with a type of device to hinder movement, such as strapping one to a bed with wrist and ankle belts. In 2012, it was decided that patients requiring to be held down to safely administer medication will be considered as a physical restraint. This particular statistic is an addition to what was previously reported under the category for restraints, which is a contributing factor for its slight rise in numbers in the latter part of 2012 and In 2013, it was also observed that patients brought in by law enforcement are in a much higher agitated state and in the process of changing custody, there are more patients requiring restraint due to their heightened state of crises. These incidents are also reported separately in consideration of the nature in which they occur. The numbers on seclusions and restraints fluctuate constantly, but RCRMC has consistently stayed below the national average. The hospital s policy is much stricter than that of the policies mandated by the Joint Commission, which affects the statistics accordingly. RCRMC s most important effort to minimize seclusion and restraint is the constant monitoring of every patient episode and the continuous training of all staff members. RCRMC believes that seclusion and restraint is not a treatment option, but a failure of treatment. Rick Gentillalli asked if patients are brought into the hospital on a 48 or 72 hour hold. Dr. Patel confirmed that patients brought to the hospital are placed in a 72 hour hold. Mr. Gentillalli also inquired how patients can agree to treatment if they are suffering mental illness. Dr. Patel stated that although patients are agitated or paranoid, the hospital deems all patients to be competent and are aware that they need treatment. Patients are given the option to take time to themselves in a room where they can use reading materials or music to calm themselves down. Dr. Walter Haessler observed an upward trend in the use of restraints and a downward trend with the use of seclusions in the last three years. Dr. Haessler inquired if there is a causal relationship between the rise in the use of restraints versus seclusions. Dr. Patel responded that they are still searching for the exact cause as it can vary. One of the reasons they believe is that a large number of patients requiring mechanical restraints are under the influence of substances or noncompliant with medication. Greg Damewood asked if there is a way to increase the use of seclusion in order to reduce physical restraint. Dr. Patel responded that if there is an absolute risk of a patient hurting themselves or others, seclusion would not be an option, as the risk of a patient hurting themselves are still present during seclusion. Dr. Patel continued that restraints typically occur in ETS as patients arrive in a heightened state of crises. Mr. Damewood asked if the hospital s policies have changed since 2009, when they were recognized by NMI with an award for having nearly zero seclusion and restraints. Dr. Patel confirmed that there has been no change in policy, but instead have imposed a more stringent policy on themselves. Dr. Patel stated that the time limit allowed by the Joint Commission was reduced to half by the hospital. For example, if a patient is under a seclusion or restraint, the Joint Commission allows up to 4 hours for the clinician or staff to manage the patient; the hospital s policy has narrowed it down to 2 hours. Julie Crouch remarked that she and many others have observed the increase of seclusion and restraint since receiving their award in Ms. Crouch inquired as to the possible cause. Dr. Patel replied that the cause for this increase varies tremendously. One of the contributing factors is a significant increase in number of patients admitted in ETS. In previous years, patients admitted were in the range of per month, this number has risen to 1,000-1,100 patients per month. The physical space ETS currently has is not sufficient to accommodate the significant rise in patients admitted. With a growing number of patients in a limited space, it further heightens the individual s state of crises and thus results in a much higher rate of seclusions and/or restraints. Inpatient admission has become more selective about admitting patients due to the limited number of beds. One of the ways this is resolved is if a patient can be stabilized in ETS the hospital then refers the individual to outpatient services. The Department of Mental Health is also assisting in finding a resolution by establishing more contracts with other hospitals where they can send patients to be admitted. There have also been ongoing discussions within the hospital about building a larger facility with greater capacity; however, this will not happen for several years. Christina Torres stated that Dr. Dennis established a task force several years ago that provided training and created initiatives to reduce and eliminate seclusions and restraints. Ms. Torres inquired if this task force was still in place and if not, if there is a Page 3 of 8

5 MENTL HELTH BORD MINUTES way to bring them back to reduce those numbers again. Dr. Patel confirmed that the task force is no longer in place and that its various functions have been reassigned to different committees. The review of incidents is maintained on campus by a committee that includes the Hospital dministrator, Investigating Chief, Chairman of Psychiatry Department, and all of the Nurse Managers. The QIC Department at the Moreno Valley campus has taken the function of data collection as they have more resources and statistical analysis experience. When the task force was in place, they were assigned to revise the policy. The task force decided to implement a much higher standard by reducing the amount of hours to manage an individual in seclusion and/or restraint. Before the revision, patients and staff were given four hours to manage a seclusion or restraint, now it has been reduced to one hour for children 10 years of age and under, and two hours for patients 11 and up. Rick Gentillalli asked when the term assessment by a doctor is used, do they mean a psychiatrist or a psychologist. Dr. Patel responded that the hospital has a psychiatrist in the building 24-hours a day. Ms. Torres inquired about any updates on the expansion of ETS. Dr. Patel replied that he is not informed on the details regarding expansion and can only confirm that there has been discussion about a new psychiatric hospital to be built closer to the Moreno Valley campus with plans to have more beds available. OLD BUSINESS 1. MHS UPDTE: Bill Brenneman provided an update on the 3-Year Plan. Currently we are in the process of drafting the nnual Update for FY 15/16. Mr. Brenneman provided a handout that shows how the flow of information occurs from our community stakeholders to our planning committees. It begins with our Key Specialty Informants, Data Research, and Cultural Competency/Reducing Disparities. Our Key Specialty Informants include the Criminal Justice Committee, PEI/ WET Steering Committees, Consumer/ Family dvisory, Veteran s Committee, Contract Providers, Education, NMI, Public Health, Department of Public Social Services, and Office on ging. The Data Research team provides the planning committees with performance outcome reports and information on demographics/ population, age/ gender, race/ ethnicity/ language considerations, and risk factors. Cultural Competency/ Reducing Disparities is a committee made up of many cultural brokers that help us engage our underserved communities and advise us on a variety of cultural and ethnic issues and language barrier issues. ll the information gathered from these groups is submitted to our age specific committees: Children s, Transitional ge Youth (TY), dult, and Older dult. Each group has subject matter experts in those age categories and they take the information and make recommendations to the department. Once all the information is collected, the first draft of the nnual Update will be provided to the Commission by pril 1. On May 6, the Department will ask the Commission to assist by hosting a Public Hearing, to receive face-to-face comments on the Plan. The Commission will then establish an ad hoc committee to review all the comments received and provide further input and recommendations to MHS. ny amendments that need to be made to the plan will be incorporated in the final nnual Update and submitted for approval to the Mental Health Director and the County Board of Supervisors. Once approved it will be forwarded to the Mental Health Services Oversight and ccountability Commission to be filed. 2. SUBSTNCE USE UPDTE: Rhyan Miller provided an update regarding the Substance Use Program s nnual Report. Mr. Miller announced that the nnual Report will be ready to present at the next meeting as soon as Jerry Wengerd approves it for distribution. The report will be forwarded to the Commissioners along with the meeting materials to be reviewed. Mr. Miller and Forensics Deputy Director, Deborah Johnson, attended Western Regional Board s February meeting. s requested by the Commission, they have assigned a supervisor to attend and present at the Mid-County Regional Board for the March 5 meeting. Mr. Miller gave a quick thanks to all the providers that are going the extra mile to broaden services by going through the drug and medical certification process for residential treatment in lieu of the waiver coming into effect. By getting certified in advance, the providers will be prepared to provide services across the board once the waiver is in effect. Lastly, Mr. Miller announced that there will be a state training on Thursday, March 5, to formalize a process for providers requesting amendments in their contracts. The new procedure requires all requests be documented and routed through Mr. Miller, the fiscal department, and the contract department. Once a decision is made, a written response will be given to the provider. Page 4 of 8

6 Page 5 of 8 RIVERSIDE COUNTY MENTL HELTH BORD MINUTES 3. B109: Jim Powell provided an overview and description of B109. B109 is comprised of referrals from state prison called Post Release Community Supervision (PRCS) and county jail, which are on mandatory supervision. ll individuals who might have been on parole in the past are now on probation with Riverside County Probation. To qualify for release under B109, the individual s last controlling charge must comply with the 3-Nons nonviolent, nonsexual, and non-high risk, serious. Despite this criterion, we still receive a number of violent offenders, sex offenders, and high-risk serious offenders. n example of this would be a sex offender released on parole that failed to register at the local police department as they are required to do so by law. His failure to register would qualify under the 3-Nons and is eligible to be released under the B109 terms. When an inmate is released from county jail or state prison, the county requires them to report to probation within hours. They are given a compass survey that consists of 164 questions, which helps determine the individual s risk factor. Depending on the outcome of the survey, the individual will be placed under one of three categories: high risk (which is subcategorized under armed and unarmed case load), medium risk, and low risk. During this survey, if it is determined that the individual suffers from a mental health or substance use issue, they are immediately referred to an onsite Clinical Therapist or Behavioral Health Specialist III whom performs a screening to review the needs of the individual. If the individual requires immediate treatment, they are referred to one of our outpatient clinics or transferred directly to a residential treatment facility. Currently there are 5 B109 clinics across the County Riverside, Hemet, Cathedral City, Banning, and Blythe. Each clinic is comprised of a Clinical Therapist, a Behavioral Health Specialist III, a Peer Support Specialist, and a Psychiatrist. Each clinic is medical, alcohol, and drug certified. The clinics offer individual and group therapy, such as Wellness Recovery ction Plan group (WRP), anger management, Seeking Safety, co-occurring recovery, criminal and addictive thinking, and substance use treatment. Substance Use treatments are offered only in our substance use treatment program clinics, which also provides psychiatry and medication. Clinics can also furnish referrals for detoxification treatment and residential substance use treatment. Currently, the duration for residential substance use treatment is 45 days. Emergency housing is provided through the HHOPE program, which contracts with various hotels throughout the county. The duration of stay is up to 28 days. Sober living facilities are also available for those in need of stable housing during the continuance of their recovery. Full Service Partnership (FSP) is offered to individuals with intensive care needs. ll individuals that fall into the high-risk and medium-risk category are mandated to attend the Day Reporting Center, which is located in Riverside. The Day Reporting Center is organized and operated by the Probation Department. It is a collaborative community effort where various county agencies provide assistance with education, employment, and obtaining benefits. The Day Reporting Center also has mental health staff and substance use staff to provide information regarding mental health and substance use services. The Probation Department mandated attendance of the Day Reporting Center because B109 allows treatment to be voluntary, which provides individuals the option to accept or refuse treatment. Without being properly informed, individuals released under B109 may refuse treatment and/or services. Presently, the only Day Reporting Center is located in Riverside. second location is scheduled to open in Temecula and they hope to open a third location in Indio. DIRECTOR S REPORT Maria Mabey provided the director s report on behalf of Jerry Wengerd. The Department recently closed escrow on Rustin and the first phase of the move will begin in pril. The new facility features a Conference Center and will house the Western Region programs for dult, Older dult, Children s, Substance Use, Integrated Healthcare Program, and MHS dministration. The aforementioned programs will be moving out of leased spaces, which saves the County a great deal of money. Notices will be sent out to clients and the community prior to the move. lso, the request for a bus stop along Rustin was recently approved. The bus stop will be located right along the campus main entrance. cquisition of the property was funded mostly through Prop 63 capital facility funds, which allowed the County to acquire the property for community outpatient mental health services. The Department s concerted efforts to assist our clients in their benefits applications have been successful. Data shows that the percentage of uninsured clients was at 28% before the ffordable Care ct and has dropped to 21% as more people have successfully applied for Medi-Cal benefits. We have gained 11% new population of Medi-Cal clients under the ffordable Care ct, which is fully funded by federal funds. The Department will continue the ongoing efforts of outreach and assisting clients in applying for benefits.

7 MENTL HELTH BORD MINUTES s reported last month, the State submitted the drug Medi-Cal demonstration waiver to Centers for Medicare and Medicaid Services (CMS). This is known as the Drug Medi-Cal Organized Delivery System waiver and its aim is to promote the objectives of the healthcare reform. The state is awaiting review and response from CMS. Meanwhile, Department of Healthcare Services (DHCS) has drafted an implementation plan for counties review and preparation to assess the counties readiness in implementing the waiver. The implementation plan includes assessment of capacity, access, and timeliness to services, along with proposed rates. The federal government requires budget neutrality, meaning this waiver should not cost more to implement. Input from stakeholders in the development of county implementation plan is required. This Commission will be actively involved in gathering stakeholder input along with county providers and partners forums. DHCS recently issued a draft timeline proposing to implement the waiver into four phases. Riverside County, along with neighboring counties: Orange, Los ngeles, San Bernardino, San Diego, Kern and others is on Phase 2. Based on the draft timeline for Phase 1 counties, implementation for Phase 2 counties will begin in ugust of this year. With most documents still in draft and review, it is difficult to say with certainty how the implementation of the waiver will pan out. We do know that the request for IMD exclusion allowing residential providers over 15 beds to become Medi-Cal certified providers has been submitted to CMS. Ms. Mabey provided a handout entitled Five Point Plan to Improve the Nation s Mental Health from the Substance buse and Mental Health Services dministration. The handout outlines five steps the nation can take to improve the lives of people with mental illness. The plan includes: 1) Increase prevention, treatment, and recovery services; 2) Expand the mental health workforce to alleviate shortages; 3) Widen the use of Health Information Technology, which we have implemented through ELMR Electronic Health Record System; 4) Educate the public to eliminate stigma; and 5) Invest in research and evidencebased care practices. These are the same principles our department has been operating under utilizing California voterapproved Prop 63 funds for community mental health outpatient services. SITE REVIEWS There were two site reviews completed by Mid-County, which were forwarded to the Commission prior to the meeting. One site review was completed by George Middle for Lake Elsinore Clinic Wellness and Recovery Program for Mature dults and the second was completed by Kimberly G. McElroy for San Jacinto Wellness and Recovery Clinic for Mature dults and SMRT Program. ORGNIZTIONL STRUCTURE BYLWS Darrell Connerton informed the Commission that the Bylaws Committee met on February 18 via conference call to address all the suggestions and comments submitted by Commission members on February 16. In consideration of the suggestions and comments, revisions made to the Bylaws are as follows: rticle I, Section 2: WIC 11800, was replaced with the Health and Safety Code et seq. It was found that WIC does not exist under California Codes. rticle 4, Section 3: The meeting place address was removed due to the upcoming move of MHS in pril. The language now states meeting places will be designated by the Chairperson by written notice given to the members and public in accordance with the Brown ct. rticle 7, Section1: sentence was added at the end of the first paragraph, which states The commission shall also have the authority to assign a liaison to attend other public agency and/or organization meetings. Various sections of the Bylaws that state mental health services has been revised to behavioral health services. Much discussion was had about the removal of the Bylaws Structural and Function Committee and Substance Use/ Dependence Committee as standing committees. fter much debate it was agreed by the Commission members to keep both on the list of standing committees and will be activated when needed. Composition of membership was also heavily discussed and it was later agreed by the Commission to remove the term shall from line items 4-8 and replace it with should. Lastly, it was agreed by the Commission to submit nnual Report updates by June 30 of every year, which will be submitted to the Board by September. Page 6 of 8

8 MENTL HELTH BORD MINUTES Mr. Connerton moved to adopt the Bylaws as amended. Julie Crouch seconded the motion, all were in favor, none opposed, and the motion carried. DJOURN Greg Damewood moved to adjourn the meeting, Richard Divine seconded the motion, all were in favor, none opposed, and the motion carried. The meeting of the Behavioral Health Commission adjourned at 2:16 pm. Maria Roman Julie Crouch, BHC Secretary Maria Roman, Recording Secretary Page 7 of 8

9 2015 Behavioral Health Commission ttendance Roster RIVERSIDE COUNTY MENTL HELTH BORD MINUTES MEMBERS J N F E B M R P R M Y J U N J U L S E P O C T N O V Beatriz Gonzalez, District 4 Carole Schaudt, District 4 Christina Torres, District 5 Darrell Connerton, District 3 Daryl Terrell, District 5 Eric Keen, District 1 Georgia Smith, District 2 Gilbert Espinoza, District 5 Greg Damewood, District 5 James Stuart, District 4 Jennifer Dunaway, District 5 Julie Crouch, District 1 Opal Hellweg, District 3 Patricia Carrillo, District 2 Phillip McKinnon, District 2 Richard Divine, District 4 Rick Gentillalli, District 3 Victoria St. Johns, District 4 Walter Haessler, District 1 Present = bsent = pproved Leave of bsence = LO Minutes and agendas of meetings are available upon request and online at. To request copies, please contact the BHC Liaison at (951) or at MYRoman@rcmhd.org. Page 8 of 8