Gaps in Our Community
The following are gaps in services expressed by NAMI members and volunteers as they navigate our systems of care:
1) Our Western Slope, while having a greater number and proximity of services, lacks a facilitated Community Collaborative focused on improving services and supports. This has been of great benefit in South Lake Tahoe. We advocate for a single community directory and care flow to facilitate access to services/supports. Barton Foundation has championed and facilitated the program in South Lake Tahoe. The new EDC Strategic Plan for Health Communities will hopefully address this need.
2) Protective and vigilantly watchful routing of MHSA$ to programs for the seriously mentally ill. This article captures the essence of the importance of careful spending. Our county does well in inviting public comment and open review of proposed spend. Prevention and Early Intervention Funds were designed to go to early intervention and first episode psychosis but are often diverted elsewhere…the goal is to prevent people with mental illness from having it become severe and disabling. While about 50% show symptoms of mental illness by age 14 most of these cases are not “serious” mental illness. Serious mental illness is primarily (but not exclusively) an adult disorder. Our county has an opportunity to demonstrate why protecting funds for the most seriously ill (the original spirit of MHSA$) outweighs diverting funds to “all others.” NOTICE THAT EL DORADO COUNTY IS NOT ON THE LIST OF COUNTY’S THAT STEPPED UP TO IMPROVE CRIMINAL JUSTICE: THEY COULD HAVE RECEIVED GRANT $ TO IMPROVE! READ REPORT HERE.
3) Need for public transparency of the planning and implementation of the Stepping Up Initiative for reducing the number of mentally ill incarcerated in our local jails. Our Board of Supervisors has signed a proclamation in support of this national initiative in 2015 and the new 2017 Director of H&HS is committed to supporting the initiative’s implementation. A project timeline to show incremental improvements presented twice a year at the Mental Health Commission meetings along with data supporting these improvements would insure progress toward these important goals. In July 2017 the Probation Department assigned a leader for this initiative. As of December 2017 we still have not had a meeting to launch a planning process. We need policy changes, we need probation officers and jail employees trained in mental health to promptly recognize signs of decompensation and skilled in communicating well with those living with serious mental illness. We need fewer put into jail and more put into treatment! We need jail formularies that comply with psychiatrist carefully planned treatment plans. The Treatment Advocacy Center is a valuable resource. NACo is a a valuable resource and provides access to networking webinars (available live and for replay) from county’s across the nation progressing in their implementation of Stepping Up. The public is invited to view the replayable webinars provided by NACo which detail step by step best practices for implementation. Tactically we need best practices such as forms/processes for entry and release such as the GAINS Re-entry checklist adopted and the standard vital 4 questions likely saving lives upon jail entry.
4) We need housing options for people living with serious mental illness that they can afford on SSI or SSDI that are also tied into supports and treatments to help maintain their wellness and keep them out of hospitals and jail. We need housing that heals similar to the needs of larger county’s. Contra Costa county developed this white paper for their Board of Supervisor which parallel’s our county’s housing needs.
5) Need for a fully funded BHC that adheres to national standards. Need implementation of national standard best practices drug testing for those participating in Behavioral Health Court. BHC should be available for those with and without insurance as other county’s have managed. SCRAM Continuous Alcohol Monitoring systems (ankle monotiring devices) are proving useful to many of our loved ones in helping them in their co-occurring recovery along with treatment such as group and individual therapy. Similarly, drug testing provides the same deterrent in conjunction with treatment. Please go to the EDC Legistar – Mental Health Commission AGENDA for Sep 2016 There you will find multiple files including this summary that were the conclusions from the Ad Hoc Committee investigation (Dr. Lynn headed the committee and these are his findings)
Based solely upon the responses received to a numbered list of items of interest to an ad hoc committee of the Mental Health Commission, the following are the observations of R.S. Lynn, PhD, regarding the salient perceived opportunities for improvement of the several processes associated with the Behavioral Health Court of South Lake Tahoe. They are not the result of the personal observations of this writer.
3.2 MHD is in some cases reluctant to support the candidacy of participants. The exclusion of individuals with private insurance is an issue that calls for resolution.
3.5 Some members of the local defense bar are unaware of the BHC. This presents an opportunity for publicity and education.
4.1 Families are essentially nonparticipants in BHC hearings.
4.2 Drug testing is not performed weekly on a consistent basis. Best practice is testing twice weekly. This is the most critical need for improvement.
4.5 Jail medical provider is not generally represented, nor is the Sheriff’s Office.
4.7 Incentives to participate, with respect to charging level (felony vs, misdemeanor), or dismissal following successful completion of conditions set by BHC, as well as other incentives, could be utilized to a greater extent.
4.8 This information has of now not been made available. 5.2 The lack of this information needs to be corrected.
5.4 A Continuous Improvement Process appears not to have been implemented. This requires a valid set of metrics
5.5 No metrics have been made available.
5.6 There has been no response to this important item.
6) Need for skilled therapists that service moderate-to-severe clients committed and able to follow their treatment plan. We need providers with specific skill in Cognitive remediation therapy (CRT), also called cognitive enhancement therapy (CET), designed to improve neurocognitive abilities such as attention, working memory, cognitive flexibility and planning, and executive functioning which leads to improved psychosocial functioning.
7) Educated therapists and social workers skilled in explaining Brain Science so they can provide the research and evidence about why medication is core to the treatment of first and early episode psychosis. We appreciate the availability of webinars available demonstrating evidence on how anti-psychotic medication helps preserve cognition. Research based information is necessary to combat the misinformation being offered on the internet and in social media. Here is one of several webinars. You can find more at PsychU.org and BBRFoundation.org.
Far too often we see members of the community feeling disinterested in taking medication and assume they can “work harder” to avoid medication. For our most severely mentally ill they may have a symptom known as anosognosia where they do not have insight that they are ill. For many of us (with mild, moderate or severe mental illness) medication is core to our ability to thrive even when we are doing everything else we can: healthy diet, exercise, meditation, avoiding stress, knowing our triggers, etc.
8) We need businesses that are for-profit and those that are non-profit to take a greater interest in providing employee development plans that include brain health education and skills in developing resilience. Most employers provide some employee development. We would like to see a greater focus on mental health and substance abuse training from a brain science perspective. Take the stigma-free pledge and join Mayim Bialik in changing the conversation on mental health and stigma.
9) Greater emphasis on brain health education and skills in resilience in the schools as part of the regular Health curriculum. LTUSD for example has included a Barton doctor as a guest presenter in their freshman science class to help teens understand genetic predisposition matters and why not using alcohol and other drugs are core to healthy brain development. They emphasize appropriately that the brain is not fully developed until approximately age 25 for a woman and late 20’s for a man and that neuroplasticity occurs into our older years but at a vastly reduced rate. Alcohol and other drugs adversely impact brain development and damage our brains intensely – especially during adolescent/teen and young adult years.
10) Educate the community about access to services/supports and continue championing mental health and substance abuse awareness all year long – not just in the month of May for “MH Matters” month.
11) Need to find/designate funding for a mobile outreach safety team where a social worker rides along with a CIT officer proactively helping those in the community that may be at-risk. A family assisted support team as some other larger county’s provide would be beneficial. We are grateful this service concept has started on a very limited basis on the Western Slope; we would like to see this on both slopes and with more days/week covered.
12) More proactive approach to identifying AOT clients (Assisted Outpatient Treatment) and educating the community about this program. The county recently provided a press release about this program inviting referrals and we are hopeful and optimistic that AOT services and supports will evolve into a premier program with incremental improvements quarter-over-quarter. Our jails need to be a source of candidates for AOT. County has funneling over $500,000 towards AOT and the assumption was that the jails would be part of the criteria for qualification. Now, after the launch/approval of AOT, the county’s leaders are reaching to the State of California for advice on how to possibly ensure our jails qualify for the state’s selection criteria.
13) Our community will benefit from EDC H&HS BH acceptance of Medicare/Medi-Cal patients. Currently only Medi-Cal is accepted by El Dorado County Behavioral Health. So when residents are moving here from county’s (such as neighboring Placer County) accept both they must find services & supports on their own. There is a definite cost to the county to accept MediCare patients as well in that additional administration is required to process these claims. Placer County for example accepts both as many county’s across CA do. We hear from many family’s eager to have our county accept both.
14) We advocate for premier services without lengthy drives to support family support and prompt care. Carson Tahoe’s Mallory 24-hour crisis unit and in-patient and outpatient BH services are located in Carson City. Sierra BH Hospital in Reno opens in the Spring of 2018…their leadership has already connected with our local leaders signaling welcome acceptance of Medi-Cal. Our community in South Lake Tahoe specifically will benefit if there is a contract between Carson-Tahoe and El Dorado County where Medi-Cal could then be accepted by Carson-Tahoe BH. Currently Carson Tahoe only accepts Medi-Cal at their hospital (and not by their Behavioral Health unit of operation.) This is a conversation and contract discussion needed. Our county contracts with West Hills in Reno, NV (they accept teens and Medi-Cal via this contract.) We are asking that a contract also be in place for Carson Tahoe and Sierra BH so that improved integrated services locally can be provided.
This discussion is in process and we appreciate the collaboration!
15) Whole-health-care with mental health screenings done routinely. Follow-up at 30 and 60 day intervals post-ED release where suicidal ideation was present.
We have seen significantly greater transparency in reporting by El Dorado County H&HS new leadership team. We encourage the public to embrace the monthly reports produced by H&HS and made available to the public at the monthly Mental Health Commission meeting.
If you have an idea for an improved service/support in our community, please let us know by clicking here and sending us an email to F2Fnami@gmail.com.