Emergency Mental Health Services in Merced County Internal Investigation 15-12-04 The impact of the mental health

Recommendations 3

• R1

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  That Merced County needs to attract more qualified mental health providers to this county. However, there is a real issue in getting mental health professionals to come and practice in Merced County. It isn’t clear if this is because of insufficient money or opportunities, but it is clear this issue needs to be addressed.
• R2

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  That Merced County do all they can to bring psychiatric facilities to the County to accommodate the mental health patients.
• R3

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  That a program be created and implemented to begin mental health services for minors as they wait in the ER. REQUESTED RESPONSE(S) Merced County Board of Supervisors “The Board of Supervisors appreciates the Civil Grand Jury’s attention to and recognition of mental health issues in our community. This Board recognizes that there is a shortage of mental health professionals in our immediate area and that these positions can be difficult to fill. It is our understanding that the Mental Health Department has applied for two separate grants totaling $274,356 that would be used to recruit psychiatrists and psychiatric nurse practitioners. The funding would be used for advertising, sign-on bonuses and the use of a recruitment firm. Additionally, the Mental Health Department is reviewing its classification structure and specifications, as well as working on a formal Training and Development Plan to promote retention. The Department also collaborates with local universities to provide internships for graduate students in social work. Under the Senate Bill 82 Investment in Mental Health Wellness Grant Program, the Merced County Department of Mental Health was awarded a $1,089,000 grant to further develop mental health services. Not only will the project improve access to services, but it will also expand treatment options and the number of beds available to clients. While this effort will go a long way toward expanding Crisis Stabilization Unit services, it will also expand comprehensive patient treatment through the creation of a Crisis Residential Unit. The Crisis Residential Unit will serve a valuable role locally in the care of clients. Currently, someone with a severe mental health issue is placed in the Marie Green Psychiatric Center. This facility provides them crisis services and 72 hours or more to stabilize. The Marie Green Center does an excellent job in efficiently alleviating issues with clients. But it is not long before many of those same clients re-enter the facility with another crisis or emergency. While the patients were stabilized during their stay at the 48 Marie Green Center, the treatment offers more of a triage of services rather than providing them with the tools to transition back into the general public and be self- sufficient. The Crisis Residential Unit is designed to address this revolving door issue. The Unit will provide clients with more comprehensive treatment during an extended stay of up to 30 days, allowing staff to work on longer-term solutions to improve the health and well-being of clients. Regarding mental health services for minors in Emergency Room settings, the Board of Supervisors recognizes the efforts that take place amongst Triage staff to provide suitable assistance, update family members and focus on communication and documentation of various efforts. Triage staff has been advised that if a minor is present at the emergency room and meets eligibility requirements and a family member/care giver voluntarily agrees to services, that the Crisis Stabilization Program will be initiated and 30 days of intensive home-based mental health services will be implemented, according to the Department. This serves as a step-down from the emergency room setting.” Merced County Mental Health Department Response to Recommendation #1: “The Merced County Mental Health Department concurs with the need to attract and retain qualified mental health providers. Overall psychiatric care services are severely impacted in Merced County (County). Based upon data analyzed by OSHPD, the County has approximately .4 psychiatric nurse practitioners per 100,000 people. Compared to the State average of .7 PNP-to population ratios, California had fewer nurses with psychiatric-prescribing privileges (CHCF, Mapping the Gaps: MH in CA, July 2013). In addition, the County prevalence of mental illness is above the state average of 7.6% of youth with seriously emotionally disturbed (SED), and 4.3% of adults with SMI. The County’s prevalence is 8.06% for youth, and 5.97% for adults (CHCF, MH in CA, Painting a Picture, July 2013). The County is also designated as a “Mental Health – Health Professional Shortage Areas (HPSA), geographic designation” demonstrating a shortage of mental health providers (HRSA.gov, 2016). Recruitment efforts over the past several years show that certain professional positions are very difficult to fill and the County receives few applications for vacancies. For instance, only 2 applications for Psychiatric Nurse Practitioner were received over a 20-month period. The Mental Health Department has recently applied for 2 grants totaling $274,356. The funds would be used for recruitment of both Psychiatrists and Psychiatric Nurse 49 Practitioners, including advertising, sign-on bonus and hiring a recruitment firm. The sign-on bonus will serve as an incentive to join our organization, and will be required to be repaid if an individual leaves County employment before a specified period. Additionally, the Department is reviewing its classification structure and specifications, as well as working on a formal Training and Development Plan to promote retention through the establishment of career paths for employees so we can ‘grow’ our own. Finally, the Department collaborates with local universities to provide internship opportunities for graduate students in social work. It also supports use of the State of California’s Mental Health Loan Assumption Program, which helps to retain qualified professionals working within the Public Mental Health System by providing loan forgiveness in exchange for a 12-month service obligation. While recruitment and retention challenges are serious and prevalent for mental health professionals, the Department is striving to do everything possible to overcome these challenges.” Response to Recommendation #2: “Merced County Department of Mental Health, under the SB 82 Investment in Mental Health Wellness Grant Program – California Health Facilities Financing Authority, recently received an award in the amount of $1,089,000 to expand and renovate the facility where the present Crisis Stabilization Unit (CSU) is currently located to create a dedicated four (4) bed CSU for youth crisis services (ages 0-17 years old). Also this funding is dedicated to renovate the connecting Wellness Center that is set to relocate to another facility (tentative date October 2017). The renovation of the connecting Wellness Center, will allow for the current 4 bed adult CSU to expand crisis bed capacity in Merced County to eight (8) beds serving adults. The completion date for the renovations and occupancy for the CSU is tentatively set for February of 2018. The new and renovated units will focus on serving youth and adults experiencing psychiatric crisis. For youth in particular, the crisis stabilization unit would provide monitoring and stabilization of psychiatric needs in a controlled setting without having to be held in the local hospital emergency rooms. Also, for minors this would allow for the engagement and collaboration for ongoing services with Children System of Care. Preference for the occupants of each of the Crisis Stabilization Units shall be provided to Merced Medi-Cal Beneficiaries and/or the uninsured. In addition to the expansion for CSU services within the County, Merced County has partnered with five (5) Counties for the purpose of creating a Crisis Residential Unit (CRU). The collaborative partnership has been awarded grant funding to develop a 6-bed Crisis Residential Unit (CRU) located in Merced County. Funding is made available 50 through California Health Facilities Financing Authority. The CRU is currently under development, as the current renovations are being made to the formerly know Merced Community Medical Center. This six-county collaborative is comprised of Stanislaus County, Tuolumne County, Mariposa County, Madera County and Calaveras County. The goal of the Crisis Residential Unit to provide intensive 24-hour therapeutic environment on a voluntary basis to consumers as a method for diversion from, and an alternate to psychiatric inpatient services, and step down unit for individuals who are stable and on administrative days, pending placement, at Marie Green Psychiatric Center. Tentative set date for completion and occupancy is set for October of 2017.” Response to Recommendation #3: “For minors who are currently at the local ER, at a minimum, updates to involve family members and care providers should be occurring on each shift to the best of the Triage staff’s ability. It is recognized that the demands upon Crisis Services are high; however, striving to keep all individuals informed and documenting our efforts of communications are of paramount importance. There is a significant impact with wait times and prolonged transfers from ER to an accepting facility due to the limited Psychiatric Health Facilities designated for youth within the State of California. Triage Staff have been advised, that if a minor presents at the ER and meets the eligibility requirements as well as family/care giver voluntarily agrees for services, to initiate Crisis Stabilization Program (CSP) referral for up to a thirty (30) day intensive home based mental health service. CSP program revolves around safety of consumer and preventing psychiatric hospitalization. If a minor is pending a transfer to a psychiatric health care facility for in-patient services, CSP will make continued contact with the minor and family as they wait for the transfer. Once the minor has been discharged from an inpatient hospital, CSP could be utilized as a step down intervention to ensure that the consumers mental health needs are met and family are supported during the transition.” 51