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Right Place, Right Time: Triaging California’s Mental Health Care Delivery System

This project assesses the impact of unmet mental health needs on EDs, explores community resources, and recommends policy changes to enhance care delivery. Results indicate challenges in access and resource availability.

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Right Place, Right Time: Triaging California’s Mental Health Care Delivery System

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  1. Right Place, Right Time:Triaging California’s Mental Health Care Delivery System Ashley Stone University of California, Davis Master in Public Health Program California Hospital Association Preceptors: Debby Rogers & Sheree Kruckenberg Faculty Advisor: Marlene von Friederichs-Fitzwater

  2. Project Objectives • Assess & quantify the impact of patients with unmet mental health needs on emergency departments (EDs) • Identify how community mental health resources affect access to appropriate levels of care • Recommend changes in existing policies & laws

  3. Introduction • Recent cuts to local & state-funded mental health programs • Deinstitutionalization & the Lanterman-Petris-Short (LPS) Act • “Revolving door” of hospitalization, homelessness, & incarceration • ED utilization Healthy People 2010 goal: “improve mental health and ensure access to appropriate, quality mental health services”

  4. Public Health Context • Prevalence: about ¼ adults in U.S. has a diagnosable mental disorder • Inappropriate ED usage indicative of inadequate care in community • Ideal public health solution: prevention of severe mental illness (www.urgentmatters.org)

  5. Methods • Root cause analysis to identify problems & potential solutions • Design, administration, & analysis of statewide survey for hospital ED directors in CA • Historical overview of mental health care delivery • Produce White Paper for advocacy of appropriate alternatives to the ED

  6. Results • “It is a fight to get our psych patients the care they need” • -ED Director • 123 survey responses from ED directors; 42 counties • Long wait times for psychiatric patients, need for inpatient beds, lack of access to community & county resources Average Wait Times in ED, From Decision to Admit until Admission % of Respondents % of Respondents Time, in hours Time, in hours

  7. Implications of Results • Dwindling resources & services • Limited alternatives to ED for care • LPS Act, deinstitutionalization, & lack of inpatient psychiatric beds

  8. Conclusions • Burden of disability associated w/ mental illness • Few preventive efforts: patients w/ severe mental illness must become “dangerous” before they can get treatment • “I wanted the LPS Act to help the mentally ill. I never meant for it to prevent those who need care from receiving it. The law has to be changed.” • -Frank Lanterman, co-author of LPS Act

  9. Future Recommendations • Encourage collaboration and integration of services • Integrate mental & physical health care • Adequately fund mental health resources & provide payment incentives • County by county service gap analysis • Advocate for counties to adopt Laura’s Law (AB 1421), which makes assisted outpatient treatment (AOT) available

  10. Acknowledgements • Debby Rogers, Sheree Kruckenberg, Vincent Wales, La Shon Tate, Pamela Lane, Wendy Keegan, & Peggy Wheeler (California Hospital Association) • Dr. Stephen McCurdy, Amber Carrere, & Dr. Diana Cassady(MPH Program) • Marlene von Friederichs-Fitzwater (UCD Advisor) • Randall Hagar (CA Psychiatric Association) • Carla Jacobs (Treatment Advocacy Coalition) • Dr. Glen Xiong(Sacramento Mental Health Treatment Center) • John Boyd & Mark Grip (Sutter Center for Psychiatry) • Dr. Joseph Bick (California Medical Facility) • Deb Trainor(UCDMC)

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