CALAVERAS COUNTY MENTAL HEALTH BOARD ANNUAL REPORT 2007 TO THE BOARD OF SUPERVISORS 1. INTRODUCTION The membership of the Calaveras County Mental Health Board (MHB) is respectfully submitting the 2007 Annual Report to the Board of Supervisors, as required by the California Welfare and Institutions Code section 5604.2(5). The Annual Report will provide a very brief review of the subject areas contained in the past two year s reports and provide information on the changes in Behavior Health Services (BHS) brought on primarily by implementation of the Mental Health Services Act. A. Community Services and Supports On December 29 th, 2006, the California Department of Mental Health (DMH) approved the Calaveras County Mental Health Services Act 3-Year Community Services and Supports Plan. The Plan calls for a Children s System of Care with full Wraparound services for children with serious emotional and/or behavioral disorders, and an Adult System of Care program for adults with severe mental illnesses. The Plan was the culmination of more than a full year effort of planning including 9 community meetings, 31 focus groups with other agencies who work with BH, and interviews with consumers and their families in total involving 561 individuals. During the 2007 calendar year the implementation of these programs began in earnest. More about the MHSA planning efforts will be discussed later in this report. At the January meeting of the MHB, members met the new supervisors of each program. The goal of the Children s System of Care (CSOC) is to serve children at risk of out-of-home placements, and to keep them at home, in school, out of trouble. In order to accomplish this goal, the team has developed good communication with the schools, Children s Services, foster homes, the courts, etc., and is developing a full panoply of services to address the needs of the children and their families. The Adult System of Care (ASOC) provides comprehensive services to support the recovery of transitional-age youth, adults and older adults recovering from mental health disorders, while providing individual case management and outreach to integrate individuals back into the 1
community. Intensive case management is provided as well as enhanced opportunities for socialization activities. Recruitment of staff for each service began immediately. Interviews for professional staff and community liaison positions to provide outreach and coordinate services continued through the spring and early summer. In July, the MHB learned that that the Mental Health Services Act (MHSA) revenues had increased and an MHSA expansion plan was required. The expansion plan was submitted to DMH in the Fall of 2007 to expand fiscal and administrative support for the new programs. For the three years of the Plan the County is to receive $2,739,042. New office space was acquired (the Annex, 373 W. St. Charles) for the ASOC and a Clubhouse for recovering consumers. The space is being shared with the new Perinatal Program, serving pregnant and parenting women and their children. B. Additional MHSA Planning Efforts 1. Workforce Education and Training The effort is to develop a formal plan that will address shortages in professional staff and needed skill sets in the public mental health system. The department is reviewing its current and projected workforce needs. In addition, education and training is to be provided to all individuals who provide or support services in the mental health system. This includes family members and consumers. Each county s workforce education and training programs will be part of the DMH 5-year plan when approved. This planning process is underway in the County concentrating on five categories workforce staffing and support, training and technical assistance, mental health career pathway programs, residency and internship programs and financial incentive programs. The County has been appropriated $225,000 for this purpose to be used over a three year period. Focus groups and meetings with individual staff have been held to identify training needs. 2. Permanent Supportive Housing Seventy five million dollars of MHSA money is to be appropriated by the Department of Mental Health each year for permanent supportive housing. On May 12, 2006 the Governor mandated the development of the MHSA housing program with a stated goal of creating 10,000 additional units of permanent supportive housing. Although planning has begun in the County, a great deal of effort to date has been directed at changing state guidelines to meet small county needs and capacity. The County has been appropriated $639,500 for this purpose for a three year period. 3. Prevention and Early Intervention, This MHSA fund is designed to assist counties in providing early intervention activities designed to prevent the development of mental disorders in children, youth and adults. Prevention activities will be conducted on a statewide basis, and the Department of Mental Health intends to hold back 50% of the allocation for this purpose. The guidelines for the MHSA Prevention and Early Intervention Plan were released in 2007, and a community-wide planning will occur in the first six months of 2008. 4. Capital Facilities and Informational Technology This is one fund with two distinct purposes. Capital funds will be allocated to counties to be used to develop or improve facilities in which mental health services will be provided. The Informational Technology (IT) fund is to be used to assist counties to develop the technology infrastructure to support the provision of mental health services. These funds may be used to improve technological infrastructure supporting mental health systems, for consumer uses, and 2
for other consumer and/or staff technology supports. Guidelines will be released in early 2008 for counties to begin a planning process. 5. Innovative Funds Funds will be available on an allocation basis for counties to develop innovative services. It is not known when the guidelines for this fund will be released. II. EVALUATION & RECOMMENDATIONS REGARDING THE MENTAL HEALTH SYSTEM In last year s report, it was clear that significant progress had been made in reducing the number of cancellations and no shows, communication with other agencies on shared issues and problems was significantly better, the after-hours crisis service had been revamped and was working better. Significant improvement existed in relations between jail staff and BH leading to greater continuity of service to inmates with mental health problems. Improvements continue to be made, but some issues still need to be addressed. Those issues will be addressed in this section. A. Appointment Cancellations and No Shows All mental health agencies have problems with appointment cancellations and patients who do not show up for appointments. For the last couple of years BHS has had a goal to reduce cancellations and no shows to 10%. This is a goal that is hard to reach, but the BHS clinic has made inroads in reducing no shows and cancellations. A couple of years ago there were months where over 30% of the appointments were cancelled or patients failed to show up. Last year those numbers were reduced to a high of 26% and a low of 15%. Interventions by BHS have continued to keep the numbers at about 16% per month. These interventions include contact with the patient by the therapist, providing transportation, the development of Drop-in- Days on alternating Fridays where patients can visit with a therapist or psychiatrist in a casual atmosphere. It has also become clear that not all data is being captured on cancellations and no shows, although the sense is that the percentage would not change significantly. A new software program should aid in gathering accurate data. At this point the MHB continues its recommendations that transportation be continued, that the best practices of other mental health agencies be replicated here, and that services be provided at remote locations where there is a demand for services. B. Crisis Services During business hours, all requests for crisis services are handled by the Worker of the Day or the backup Worker of the Day. After-hours phone crisis services are provided, through Crisis Support Services of Alameda (CSS). This contracted provider is available to answer crisis calls and provide referral to on-call crisis workers in the event a W. & I. code section 5150 evaluation is needed at the Emergency Room. Requests for crisis services increased 20% over last year. BHS monitors the quality and accessibility of services by test calls to CSS. One or two test calls were made each month-of the 17 test calls made last year 10 responses were in accordance with protocols, while 7 were not. The 7 unsatisfactory responses were due to CSS staff failing to log calls for the most part. BHS works with CSS to clear up all issues and the MHB recommends that test calls and follow continue until there are no more unsatisfactory responses. Since most crisis calls occur between 4:00 p.m. and 8:00 p.m., the MHB recommends that consideration be given to extending BHS clinic hours to 8:00 p.m. BHS continues to provide training in crisis services for the Sheriff s Department and personnel of Mark Twain Saint Joseph s Hospital. The cooperation between these agencies continues to 3
work well and it seems that crisis service is far superior and more responsive than a couple of years ago. C. Criminal Justice Issues A great deal of progress has been made in the coordination of services by various agencies to the jail. BHS services include crisis assessments, brief counseling, case management, as well as advocacy services for inmates with mental illnesses at the jail. As part of the advocacy work, BHS staff work with jail staff and California Forensic Medical Group (CFMG) staff to ensure continuity of psychiatric medications and mental health services. Last year a Criminal Justice Committee was established. Membership includes BHS staff, MHB members, the District Attorney, the Public Defender, the Probation Chief, the Court Administrator, the Sheriff s Department and one of the Superior Court judges. The Committee has established a protocol for dealing with inmates who are unable to understand the charges against them or assist in their defense. This is a very significant protocol which will assist all agencies in preventing those with serious mental illness from getting lost in the criminal justice system. One of the goals of the Committee is to establish a Mental Health Court in order to provide alternatives to criminal trial and sentencing to those who are not a danger to society, and for whom their mental health status may be the cause for criminal conduct, and for whom life skills, employment, education and housing, appropriately managed by the Court, will best integrate this population into society. In order to assist the Court in this endeavor, the Court must be provided resources including assistance of the various agencies involved in the criminal justice system and referral resources for teaching life skills, providing housing, education and other services. Although there is not a Mental Health Court in name, Judge Mehwinney has added to his Drug Court calendar cases involving mental health consumers. When a mental health consumer goes to Court, he or she is accompanied by BHS staff who, at the Court s request assist with recommendations. Judge Mewhinney has indicated that he appreciates the assistance he is getting. The MHB continues its recommendations that the Criminal Justice Committee continue working toward the establishment of a Mental Health Court, and that there continue to be cooperation of all agencies providing mental health services at the jail. D. Patients Rights Advocate The Department recently contracted with a patient s rights advocate on a part-time, as-needed basis. The individual holds a similar part-time position in Amador County. This seems an entirely appropriate response to the requirement that one have such a position. There were only 7 grievances and complaints filed in calendar year 2007. These were all resolved at the first level of dispute. E. Access Issues The goal set for BHS from the time of initial contact to a scheduled intake was to be within 14 days. Although the Department has met this standard historically, it had difficulty doing so this year. For six months the 14-day standard was met. However, during the other 6 months the standard was met from 14% to 96% of the time. Part of the reason for this was staff shortages and another issue was a delay caused by the closing of Health Link. The answer to this problem includes recognizing high utilization periods and being sure there is staff to respond to the demand and shifting responsibilities of staff to meet high periods of demand. At any time, if a person is in crisis, they are served on the same day, and usually within the hour at the clinic. 4
III. ADULT SYSTEM OF CARE AND CHILDREN S SYSTEM OF CARE Both the ASOC and CSOC programs have become operational in 2007, and service statistics have exceeded original goals. It was originally estimated that ASOC would serve an additional 140 persons while 502 actually received services. For CSOC, it was estimated that an 80 more children, youth and their families would receive services but an additional 244 were served. Outreach activities have increased significantly. Consumer/family staff are now available to reach out to geographically or emotionally isolated persons, and have developed and are maintaining stronger linkages to resources for consumers. For example, adult and older adult consumers with severe mental illnesses are now getting home visits from Consumer Liaisons who assist them to access socialization activities and community resources. Creative solutions are being developed to help children and youth remain in the community and out of group home care. Since the start of the Children s System of Care program, no youth have been referred out of county to Level 14 group home care, and one has been discharged to his family with much assistance and case management from the team. Socialization opportunities are now available at the Consumer Clubhouse and through Drop-in Day. Transportation has been made available to assist people in getting to mental health appointments as well as to socialization activities. BHS also provides funding to assist with NAMI-Gold Country weekly events for consumers. MHSA funding has provided significant training on the Recovery Model, in particular travel for staff and consumer/family members to 3- day immersion programs at The Village in Long Beach, a model program upon which Prop 63 was developed. Additionally, staff have become more educated in the issues of co-existing disorders, for example, persons with mental illnesses who also have a substance use disorder. New treatment groups have been developed to address these issues for both adults and transitionalage youth. The Clubhouse socialization activities are scheduled for every Friday at the Annex, and Drop-in-Day continues every other Friday at the main clinic for socialization activities, and as an opportunity to meet with the psychiatrist. NAMI SECTION OF ANNUAL REPORT NAMI Gold Country is the Calaveras County affiliate of NAMI, The National Alliance on Mental Illness. The stated goal of NAMI is to constantly work to improve the quality of life for persons with serious mental illnesses. NAMI approaches this mission through advocacy, community education and support for people with mental illnesses and their families. NAMI Gold Country was founded in 1993. In 2008, its 15 th anniversary, NAMI Gold Country offers a variety of supports to consumers and family members. NAMI reaches out to the community with a booth at the yearly Health Fair in October. NAMI s Socialization Program, run by consumers and supported by a grant from Calaveras Behavioral Health, offers weekly outings in the community for people with mental illnesses. As people reintegrate into the community, they regain their sense of health and normalcy. For families of people with serious mental illnesses, NAMI provides a monthly family support group, as well as the free12-week Family-to-Family Education Course. Family-to-Family Course graduates were invited to give an in-service training for Behavioral Health Staff on the topic of What Families Know About Living with Serious Mental Illness. NAMI has no paid staff; all work is done by volunteers. Three NAMI members serve on the Mental Health Board and its committees. 5
Two long-held goals of NAMI Gold Country are supported housing and employment opportunities for people in Calaveras County with serious mental illnesses. With MHSA funding, BHS is taking steps toward both of these goals. NAMI heartily endorses and embraces the changes brought by the MHSA, which encourages inclusion of consumers and family members in the decision-making process, as well as the providing of mental health services. The MHSA has brought about greater collaboration, cooperation, and a focus on recovery. 6