RIGHT PLACE RIGHT TIME TRIAGING CALIFORNIAS MENTAL HEALTH

PROJECT OBJECTIVES Assess & quantify the impact of patients with unmet mental health needs

INTRODUCTION Recent Healthy People 2010 goal: “improve mental health and ensure access to appropriate,

PUBLIC HEALTH CONTEXT Prevalence: about ¼ adults in U. S. has a diagnosable mental

METHODS Root cause analysis to identify problems & potential solutions Design, administration, & analysis

RESULTS “It is a fight to get our psych patients the care they need”

IMPLICATIONS OF RESULTS Dwindling resources & services Limited alternatives to ED for care LPS

CONCLUSIONS Burden of disability associated w/ mental illness Few preventive efforts: patients w/ severe

FUTURE RECOMMENDATIONS Encourage collaboration and integration of services Integrate mental & physical health care

ACKNOWLEDGEMENTS § § § § § Debby Rogers, Sheree Kruckenberg, Vincent Wales, La Shon

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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

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

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

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

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

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 % of Respondents Average Wait Times in ED, From Decision to Admit until Admission Time, in hours

IMPLICATIONS OF RESULTS Dwindling resources & services Limited alternatives to ED for care LPS Act, deinstitutionalization, & lack of inpatient psychiatric beds California: Total Inpatient Psychiatric Beds 1995 – 2008 (OSHPD) 9500 9000 Bed Count 8500 8000 7500 7000 6500 6000 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 Year

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

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

ACKNOWLEDGEMENTS § § § § § Debby Rogers, Sheree Kruckenberg, Vincent Wales, La Shon Tate, Pamela Lane, Wendy Keegan, & Peggy Wheeler (California Hospital Association) Dr. Stephen Mc. Curdy, 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)