Gaps in Our Community
The following are gaps in services expressed by NAMI El Dorado County members as they navigate our community systems of care:
1) Our Western Slope, while having a greater number and proximity of services, lacks a facilitated Community Collaborative focused on improving community services and supports. In South Lake Tahoe the Barton Foundation has provided the leadership and facilitation for a Community Collaborative that meets monthly and has several working sub-teams. We would like to see a community collaborative on the Western Slope. We are encouraged to see the very dramatic growth in services at Shingle Springs Health and Wellness Community. They are passionate about developing a collaborative approach and have welcomed our affiliate as their partner.
2) We would like to see the PERT program in South Lake Tahoe. This program exists on the Western Slope and the data demonstrate’s its positive impact. Essentially this is a social worker and CIT deputy working collaboratively to help those in need. Families in SLT would like a process for this here. That social worker and CIT team should all be trained in CIT, AOT forms/process, AB-1424 and inviting families to provide this information, an understanding of NAMI locally, and services locally. 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. This is referred to as “PERT” in El Dorado County and currently only exists part-time on the Western Slope but not in South Lake Tahoe area. 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.
3) Need highly skilled social workers private or public/county that can go to the seriously mentally ill person (their home/apt/location) and help them get treatment and service their needs even when they do not understand they are ill. The current system of care has a serious gap where families are exhausted, overwrought from support, and not receiving expert relief and services for their loved ones particularly when their loved ones are unable to follow a treatment plan on their own. Referrals to AOT, and public guardianship should be simplified and all case managers should be leveraging.
4) 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.”
5) Need to maintain 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 signed a proclamation in support of this national initiative and pre-planning was initiated nearly 3 years later. In May 2018 we hosted a public event. Board of Supervisors signed a directive for this initiative nearly 3 years ago…..Stepping Up Steering Committees are open to the public and held at Probation in Shingle Springs, CA: [Thank you Sheriff/Jail for implementing brief mental health jail screens in Sep 2018]
- 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.
- 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.We need jail exit process that absolutely connects individuals to service and ensures people do not slip through the cracks upon re-entry.
5) 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.
6) 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.
7) 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.
8) 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.
9) 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.
10) 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.
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. We would like to see a process where AOT is routinely assessed as an option as part of transitions: transitions out of jail, transitions out of hospital, etc. The county has the power to establish such a routine but they must develop a process and greater measures of success.
12) 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.
13) We would like to see a broader bi-state solution which leverage local resources such as Carson Tahoe and Sierra BH so that improved integrated services locally can be provided. We would like to see greater transparency around data/metrics concerning hospital’s utilized.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. Would love to see 24-hour crisis units on both slopes. Sierra BH Hospital, a state of the art BH hospital (in-patient and out-patient) opened in Reno in the Spring 2018. Their CEO signaled he will welcome Medi-Cal yet our county has no bi-state strategy. 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.)
14) We would like to see greater transparency around short-term and long-term residential treatment options available to this community. We would like to simply see a list of options developed and maintained! We are seeking volunteers that can help us develop this as we have data sprinkled about in too many places/agencies on this topic. Families should not have to become research experts to find such data.
15) Need CIT data trends made available to the public; we want to see how many have been trained in the 8 hour model vs 40 hour Memphis model vs something in between AND more importantly how many have not been trained beyond the state-mandated 8 hour police academy training. Have been asking H&HS BH to add this to the monthly report to the BH Commission meeting report. We did see some data over a year ago and when we asked again an action was taken… again. We fail to understand why this is not organically part of the reporting operation across county services. How our community manage operations effectively without such data?
15) Whole-health-care with mental health screenings done routinely. Follow-up at 24 hours and 30 and 60 day intervals post-ED release where suicidal ideation was present.
16) We appreciate being included in sharing perspectives with EDC. For example when re-negotiating various contracts the county will sometimes invite perspective on where the contracted provider could improve.
17) More agencies including County agencies asking via surveys “how could we have made this process easier or smoother for you and your family to lift your family or individual burden of care?”
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. We encourage the county to make these reports more accessible. The current link is only found buried within an agenda posted to a monthly forum called the “Behavioral Health Commission.” We would like to see this and other data transparently posted by the county – and an improved communication plan by the county.
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.