County of San Luis Obispo Health Agency Behavioral Health Department Michael Hill, Health Agency Director

R1

Increase financial support to Behavioral Health from the County General Fund to accomplish the following within the next fiscal year. (Note: Some of this expense is reimbursable by Medi-Cal.): a. Reduce the wait time to enter the Full-Service Partnership program from months to weeks. b. Add clinicians and case managers to the mental health clinics thereby reducing wait time below the 10-day requirement and reducing the time between maintenance appointments. c. Add full time system navigators to all mental health clinics and encourage Cen-Cal (the local Medi-Cal affiliate) to add them at medical clinics. d. Add two additional Mental Health Evaluation Teams, one in North County and one in South County. Response: This recommendation will not be implemented as it is not reasonable. The County will continue to seek additional funding sources to expand mental health services through grants, federal, and state funds. Three new case managers for the Adult Mental Health services division are included in the FY 2018-19 recommended budget, with funding from MHSA. The County recently received a Children’s Triage Grant which will expand crisis response for youth in FY 2018-19. A Clinician was approved to be added to the San Luis Obispo Police Community Action Team for outreach to homeless and crisis response, and will start during the summer of 2018. The Adult Full Service Partnership will increase its open caseload to 40 slots at all times, and additional funding for (cid:522)service slots(cid:523) will be evaluated through the MHSA stakeholder process

R3

Improve efforts to reduce stigma through County sponsored educational programs and public service announcements. Response: This recommendation has been implemented. There are a number of State MHSA funded media materials which have included public service announcements. The Department is also implementing a (cid:522)Tell our Story(cid:523) project to send personal stories of perseverance, resilience, and recovery to local media outlets to encourage accurate portrayals of individuals and their families impacted by mental illness and addiction. In the past three years the Department has increased its data collection and reporting to monitor the impact of MHSA stigma reduction programs and activities. Since 2014, over 7,500 individuals have been served, with 3,264 individuals surveyed. The primary stigma reduction campaign (including "SLO the Stigma") and educational events (e.g. "Journey of Hope") have yielded the following individual participant/respondent results, on average:  11% increase in empathy  17% increase in understanding mental illness challenges  17% increase in knowledge of recovery and wellness concepts Some stigma reduction activities target populations are known to have high levels of stigma. Some results over the past three years include:  90% of veterans reported a reduction in stigma association with mental illness after participating in County outreach programs.  87% of college students report more understanding of mental health issues and stigma after completing program activities. Finally, community partners focus on stigma reduction education as part of ongoing services to engage consumers and family members seeking mental health services. The County contracts with Transitions Mental Health Association (TMHA) using MHSA resources to provide a vast menu of education programs. This includes the Family Orientation and Education programs, developed by the National Alliance on Mental Illness (NAMI). On average, TMHA trains over 100 family members who, when surveyed, demonstrated a 32% increase in improved responses to the stigma associated with their loved one’s mental illness.

R4

Combine drug and alcohol treatment with mental health treatment, having all clinicians cross-trained to manage dual-diagnosis patients. Response: This recommendation will not be implemented because it is not warranted. The County’s contracts with the State Department of Health Care Services are very prescriptive for the provision, documentation, and billing for mental health and substance use disorder services. Professional certification and licensure for addiction treatment and for mental health treatment are also specialized and require concentration in specific areas of practice. Clients served within behavioral health may present with needs for co-occurring treatment. Other clients may not be impacted by either substance use disorder or serious mental illness and would not require co-occurring treatment. However, the respondent has increased the number of staff who have training in both mental health and substance use disorder treatment and offers trainings in both specialties to all treatment staff, including contract agency staff.

R5

Reorganize the agency to concentrate on the complete behavioral health treatment process. Response: This recommendation will not be implemented because it is not reasonable. The organization of the Agency is not a factor on the ability to provide appropriate treatment services. As reflected in

R6

Use innovation and incentives, such as County backed bonds or tax breaks to support the building of private psychiatric and substance abuse facilities within the County. Response: This recommendation will not be implemented as written. However, the County continuously seeks methods and funding to enhance behavioral health services to the public.