When someone experiences a crisis – a fire, crime, or medical emergency – they call 911 with the expectation of getting immediate emergency services. However, when that emergency is a behavioral health crisis, there is currently no timely and clinically appropriate response, which too often results in unnecessary suffering, loss of life, criminalization, or incarceration. A3 addresses this enormous need by making behavioral health part of the emergency response system throughout Contra Costa County.
In the United States, 25% of adults are living with a behavioral health concern, yet more than half do not receive treatment. For those seeking out services, their Primary Care Providers deliver about 70% of all behavioral health treatments. Integrated care models provide primary care and behavioral health management in the same setting, making it easier for patients to access and for providers to communicate.
We face an escalating addiction epidemic, with more than 100,000 people dying of drug-related overdoses in the US in 2021—the highest number of deaths ever recorded. San Francisco has the highest overdose death rate in California. At SFGH, more than 1/3 of hospitalized patients have a substance use disorder (SUD). Our patients with SUD have longer lengths of stay (3 v 5 days), 1.5x higher 30-day readmission rates, and 5x higher self-discharges than those without SUD.
Due to the aftermath of COVID-19 and the global pandemic, we are experiencing an unprecedented demand for behavioral health (BH) services. As a Federally Qualified Health Center (FQHC), whole-person care has only been available to patients within the mild to moderate level of impairment, resulting in referrals to county and other specialty mental health clinics for patients that are in crisis, require psychiatry and/or a higher level of care. Unfortunately, current wait times for patients seeking psychiatry and a higher level of care are reportedly between 6-8 months.
Patients with Mental Health (MH) conditions have poorer quality outcomes and experience persistent barriers in accessing care than those without MH conditions. Individuals with a Serious Mental Illness (SMI) or Substance Use Disorder (SUD) die over 20 years earlier than individuals without such a diagnosis. People with MH diagnoses incur costs more than those without MH disease. While the current health delivery system is shifting, it often separates Physical and Mental Health care.
My project aims to provide access to Countywide therapy groups for adults suffering from severe mental illness. Monterey County Behavioral Health (MCBH) Adult System functions within regional silos composed of 4 different regional clinics in Salinas, Marina, Soledad, and King City. Currently, a behavioral health client can only obtain therapy group services offered by a regional clinic actively serving the client.
How do we continue to provide high quality behavioral health services to clients during a global pandemic? Research suggests that the interventions most essential for pandemics necessarily disrupt the very social processes that facilitate mental health, including social support availability, day-to-day interaction, and social influences on coping (Marroquín et al., 2017).
As indicated in the subtext of my CHIP title, I’m sharing a mix of project and leadership journeys. Especially in the pandemic era, it seems (at least for me), the threads of personal and professional experience are increasingly intertwined. For my CHIP, I started with the question of: How might we develop and implement a respectful, comprehensive, and trauma-informed model of care for pregnant and parenting people that better coordinates existing medical, behavioral health and social services and creates continuity across the birth divide?
People returning from incarceration face a myriad of health inequities, including increased emergency department utilization, hospitalization and death. In the first 2 weeks post release, people are 12 times more likely to die than their community counterparts from health conditions that could be treated in the primary care setting (including SUD, cardiovascular disease, mental illness and cancer).
I wanted to leverage resources to support standardization for county behavioral health plans. County behavioral health plans are responsible for the provision of behavioral health services to person with severe and persistent mental illness and services for substance use disorders to Medi-Cal beneficiaries in their counties. There are 58 counties in California ranging in size from smallrural to extra-large with much variation in how services are delivered.