County of San Diego Health and Human Services Agency Behavioral Health Services Fiscal Year 2012-2013 Mental Health Board Report
Board of Supervisors Greg Cox District 1 Dianne Jacob District 2 Dave Roberts District 3 Ron Roberts District 4 Bill Horn District 5 2
County of San Diego Mental Health Board Mission Statement The mission of the County of San Diego Mental Health Board (MHB) under Welfare and Institution Code 5604.2 is to review and evaluate the community s mental health needs, services, programs, facilities, special problems, impacts of Realignment, and procedures used to ensure citizen and professional involvement in the planning process, and to advise the Board of Supervisors and the Behavioral Health Services Director on any aspects of the above. In addition, the MHB has responsibility to: Review the County s Performance Contract with the State; Review and make recommendations on the appointment of the local mental health director; and Provide an annual update to the Board of Supervisors on the needs and performance of the local mental health programs, and to the California Mental Health Planning Council on the County s performance outcome data. Mental Health Board Members District 1 Joy Villavicencio, LCSW - Mental Health Discipline District 2 Gloria Harris, Ph.D Family Member Judith Yates - Mental Health Discipline Michael Matthews Consumer District 3 Curtis-Lee Whitehead - Consumer Ami Strutin-Belinoff Mental Health Discipline District 4 John Sturm (Chairman) - Consumer Tom Behr (1 st Vice-Chair) - Family Katherine Quinn, Ph.D Mental Health Discipline District 5 Cory Delaney - Consumer Susan Pallinger - Family Phillip Deming, MFT (2 nd Vice-Chair) Mental Health Discipline 3
Message from the Local Mental Health Director Alfredo Aguirre, LCSW Behavioral Health Services Director The achievements of the MHB would not be possible without the leadership of its Chairperson, John Sturm and the Executive Committee consisting of 1 st Vice-Chairperson, Tom Behr, 2 nd Vice- Chairperson, Dr. Phillip Deming and our Member-at-Large, Lynn Howell. With the Board s support, there are a number of areas of system development and quality improvement worthy of mention in my report. BHS continued to enhance services despite the poor economy and reduction in traditional revenues through the strategic use of Mental Health Services Act (MHSA) funding and transformation of services to meet the unique needs of San Diego County. All components have either been implemented or implementation has been initiated. 4 1. In preparation for Health Care Reform, BHS has made significant gains in integrating behavioral health care with physical health care services and establishing medical homes for mental health clients. Community forums have been held for contractors and consumers to keep them informed of the changes and the resulting impact. 2. Over the years BHS has established and enhanced our services to individuals who are seriously mentally ill and are resistant to treatment. On September 27, 2011 (7), the Board of Supervisors approved the implementation of the In-Home Outreach Team (IHOT) pilot in the North Coastal, Central, and East regions of the County as an alternative to Laura s Law. The program was implemented in January 2012 and provides intensive in-home outreach to adults with serious mental illness who are reluctant or resistant to receiving mental health services. The primary goal is to engage individuals so they can more readily accept services that will meet their unique needs, and to link them to services within the existing treatment system. Additionally, staff continues to study the feasibility of moving towards implementation of Laura s Law in the San Diego County. 3. We are working in collaboration with the City of San Diego and other agencies involved with the homeless to develop housing and service support options. Our contribution includes MHSA funds to provide full service partnerships for individuals served by two homeless initiatives: one for the most vulnerable, high-risk homeless (Project 25) and one for high utilizers of multiple systems (Vulnerability Index).
4. BHS worked in collaboration with Public Safety partners and the Court to establish the first ever San Diego Behavioral Health Court and to implement an effective screening process for the offenders who are now supervised by the county under the provisions of AB109. 5. Through partnerships with the community, BHS continues to develop prevention and early intervention and treatment programs to address underserved populations such as children under the age of five, Transition Age Youth (TAY), between the ages 16-25, older adults,, and Veterans, along with their family members.. 6. BHS lead the way on making strides to educate and reduce suicide, bullying, and the stigma associated with mental health illness. Special campaigns have been initiated throughout our county to address the variety of cultures and languages. The County s Behavioral Health Division looks forward to working with the MHB as we continue to seize opportunities and overcome challenges to continually build a better system that improves our communities overall health, safety and self-sufficiency in alignment with Live Well San Diego. Respectfully, Alfredo Aguirre, LCSW, Behavioral Health Services Director 5
Mental Health Board Key Issues and Accomplishments Quality of Services Supporting Best Practices: There continues to be a strong focus by the Board to ensure that individual s rights to timely treatment and responsible prescription drug utilization are in place. The Board prompted an outreach prescription medication program to educate physicians on over medicating and need for knowledge of a client s prescription medication utilization for physical disorders. Continuous Quality Improvement and Client Satisfaction: Implementation of continuous quality improvement and client satisfaction is a priority of the MHB. This includes discussions involving policies and procedures of community clinics, contractors and local law enforcement. Access Reaching Unserved and Underserved populations: o The MHB focused on the severely mentally ill individuals who are resistant to treatment with an extensive review of the AB1421 (Laura s Law). The MHB supported the Behavioral Health Division s analysis and recommendations for expansion of the In-Home Outreach Team (IHOT) countywide and continues to consider the feasibility of potential implementation of Laura s Law contingent upon funding availability and legislative remedies to address current shortcomings of the legislation. o The MHB continued to focus on the Veterans population and enhancing services for them and their families. o The MHB worked closely with the Community Corrections Partnership to establish a strong screening and treatment linkage system for offenders. Economic Realities Planning Setting Priorities in Times of Diminishing Financial Resources: o Housing is the number one concern of clients. Additionally, safety net services are relied on for the treatment of the severely mentally ill. o Working with law enforcement, probation and correctional institutions to ensure the public s safety by providing quality mental health treatment services for offenders. 6
Mental Health Services Act Implementation The MHB has provided input and support for continuing MHSA implementation since its inception. The MHB has participated in all 30-day public reviews for MHSA components and MHSA Housing projects. The MHB has been supportive of the It s Up to Us stigma reduction campaign. Continuing Collaborative Efforts with Law Enforcement and the Superior Court The Psychiatric Emergency Response Team (PERT) has provided updates to the MHB on its ongoing goal to increase the number of trained PERT officers and their involvement with the IHOT program. The MHB supports and encourages these efforts. San Diego Police Department provides triennial updates to the MHB on the department s ongoing efforts to train staff on managing interactions with the mentally ill. The Sheriff has also provided updates on the behavioral health services within the jail system. Behavioral Health Court is a collaborative court program that provides qualifying mentally ill offenders with individual treatment, goals and supervision rather than jail time. The partnership consists of the District Attorney s Office, San Diego Superior Court, Public Defender s Office, Sheriff s Department, Probation Department, San Diego City Attorney s Office, HHSA s Behavioral Health Services and Exodus Recovery. Community Relations The MHB now has a dedicated page on the Network of Care Website. The public may access meeting agendas, minutes and reports. The public meetings of the MHB allow for public comment from consumers and community partners to provide their constructive feedback and/or concerns. Members of the MHB sit as liaison on the Older Adult Council, Housing Council, Veteran s Council, Children s Council and other ad hoc committees. The Chair is the Dual Diagnosis Advocate and is the representative to the California Association of Mental Health Boards/Commissions. Executive Committee members also attend the Alcohol and Drug Services Advisory Board meetings as a liaison for the MHB. 7
Building Core Competencies Through presentations by County staff and community partners, the members regularly receive overviews of ongoing services, and the challenges, mitigation and successes of their programs. These include triennial reviews by law enforcement and consumer advocates. Presentations to the MHB Veteran s Treatment Review Calendar Juvenile Drug Court and Adult Drug Court Behavioral Health Court In-Home Outreach Team (IHOT) Mental Health Services Act (MHSA) Update Southern Caregiver Resource Center: Prevention and Early Intervention (PEI) for Hispanic caregivers providing care for family with Alzheimer s or dementia Father2Child: PEI for African American fathers Weapons Reporting Requirements for Mental Health Clients Patient Pain Medication Consent Physician Guidelines: Safe Rx Prescribing Work Plan: Quality Improvement Work Plan HHSA Operational Plan Updates BHS Budget overviews Up2Us: Stigma Reduction Campaign Courage to Call (Veteran Focused) In-Home Outreach Team (IHOT) Annual Report and update on Laura s Law Review of Services for Individuals with serious mental illness that are resistant to treatment Affordable Care Act Overview: Health Insurance and System Changes Jewish Family Services Patient Advocacy Program Annual Report 2012-13 CCHEA/Legal Aid Update UCSD Community Psychiatry Fellowship Program MHSA Update 30 day Public Review Triennial updates by: Law Enforcement ( San Diego Police Department and San Diego Sheriffs) Advocacy Providers (Jewish Family Services and Consumer Center for Health, Education, and Advocacy) Optum Family & Youth Roundtable and Recovery Innovation 8
Support for Board of Supervisor Actions FY2012-13 The MHB heard and voted to support the following Board of Supervisor Actions: Action Items Supported by the MHB Mental Health Plan Contract and Revenue Agreement for Medi-Cal Specialty Mental Health Care Services with the California Department of Mental Health and the California Department of Health Care Services Behavioral Health Services Authorization For Competitive Solicitations And Extensions Of Contracts Mental Health Services Fiscal Year 2012-13 Federal Block Grant Spending Plan Approval Of Lanterman-Petris-Short (LPS) Act Facilities And Adoption Of The LPS Designation Guidelines And Process For Facilities Within San Diego County (District: All) Memorandums Of Understanding Between The County Of San Diego And The Cal Mediconnect Health Plans Designation Of LPS Facilities To Provide Involuntary Detention Of Mentally Disordered Persons For Evaluation And Treatment FY 13/14 BHS-ADS Revenue Contract With State Conditional Release Program (Conrep) FY 13/14 MHSA Annual Program And Expenditure Plan Procurement Of Psychiatric Services Medical Services Group Review Of Services For Individuals With Serious Mental Illness Who Are Resistant To Treatment Maximizing Juvenile Prevention And Early Intervention Resources 9
Looking Forward: Mental Health Board Goals Aggressively support Live Well San Diego agenda Continue focus on customer service/satisfaction o System improvements Conduct more site visits Continue stigma focus o Suicide prevention o Bullying related to perceived differences, for example, sexual orientation Continue focus on homelessness issues o Supportive housing o Employment opportunities Focus on co-occurring disorders issues Focus on long term care continuum and gaps o Hospital discharge issues Achieve a fully seated Mental Health Board Monitor services to the seriously mentally ill that are resistant to treatment Focus on reducing disparities Continue progress toward an integrated Behavioral Health Services Advisory Board 10