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

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)