San Luis Obispo County Grand Jury
• 2014-2015
We Are Waiting: Access to County-provided Mental Health Services
⚠️ Translation Notice: This content has been automatically translated. The original English text is the official version. Translation may contain errors.
⚠️ Este contenido ha sido traducido automáticamente. El texto original en inglés es la versión oficial. La traducción puede contener errores.
Findings and Recommendations 11 findings
F1
The county website lists two different toll-free phone numbers for the county mental health hotline with no clear differentiation of the services offered. Both are available 24 hours every day.
Related Recommendations (1)
R1
List one toll-free number for hotline access to all mental health services on the county website.
F2
One hotline number is operated by Department employees during business hours who can schedule appointments for an assessment. After regular hours, this hotline automatically transfers to Transitions Mental Health Association.
No recommendations for this finding
F3
The second hotline number is operated by Transitions Mental Health Association volunteers. While this staff is trained to handle mental health issues, such as suicide, the volunteers are unable to schedule appointments for an assessment due to medical records privacy concerns.
Related Recommendations (2)
R2
Establish a system to allow both the county and Transitions Mental Health Association staff and volunteers to schedule appointments while maintaining HIPAA confidentiality requirements.
R3
If a solution is not developed to allow Transitions Mental Health Association’s volunteers to make the appointment, the county should contact the caller within the next business day to schedule.
F4
The Mobile Crisis Unit is a substantial safety net with great responsibility since it serves the entire county and establishes the initial face-to-face contact by a licensed mental health professional for those in crisis.
No recommendations for this finding
F5
The 16-person capacity Psychiatric Health Facility is the only facility in the county for in- patient psychiatric treatment with an average census of 15 patients that stay for an average of 4.3 days. The county has no plan to increase capacity.
Related Recommendations (1)
R5
A Crisis Stabilization Unit should be established to handle those in crisis for up to 23 hours, which could alleviate some of the capacity pressure at the PHF and save the county money if diversion from the PHF is achieved.
F6
If the Psychiatric Health Facility is above capacity, the state is notified and the county must file a Plan of Correction. This must be approved by the state or the state can take corrective action, up to revocation of the operating license.
No recommendations for this finding
F7
The Psychiatric Health Facility also houses juveniles who enter the facility through a separate entrance, walk through the common area that has been cleared of adult patients, and receive care separately from the adult population.
Related Recommendations (1)
R4
Reconfigure the juvenile entrance to the PHF so that adult patients do not need to be cleared when a juvenile is admitted. Alternatively, separate the juvenile population to a separate site away from the adult population of the PHF.
F8
A Crisis Stabilization Unit can temporarily shelter an individual in crisis up to 23 hours which is often sufficient time to prevent a more severe crisis, potentially alleviating some burden on the Psychiatric Health Facility.
Related Recommendations (1)
R5
A Crisis Stabilization Unit should be established to handle those in crisis for up to 23 hours, which could alleviate some of the capacity pressure at the PHF and save the county money if diversion from the PHF is achieved.
F9
After initial contact, the time to receive an assessment can be up to 45 days, with the average being 26.9 days. This exceeds the county’s target of 14 days by nearly 100%.
Related Recommendations (1)
R6
To decrease wait time for patients and potentially handle greater caseloads, the county should increase psychiatric support staff, such as psychiatric nurse practitioners, physician assistants and therapists.
F10
There is an approximate 30% failure to appear rate for scheduled appointments. There is no procedure to ensure clients follow through on their intended appointment, such as call reminders, personal contact or inquiry into availability of transportation.
Related Recommendations (1)
R8
The county, whether by clinic staff, interns, temporary or part-time employees, should institute contact with those clients awaiting appointments to decrease the number of no-shows who prevent the scheduling of another client. This could also determine if the severity of the individual’s condition has improved/stabilized/worsened and if the client has transportation.
F11
It is challenging for the county and local nonprofits to find sufficiently qualified individuals to staff various licensed positions for mental health services.
Related Recommendations (1)
R7
If psychiatric positions continue to be difficult to staff, the county should implement options to improve recruitment such as student loan repayment programs and use of telepsychiatry.
Conclusions 1
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CL1The Behavioral Health Department has the responsibility to provide mental and behavioral health services in San Luis Obispo County. All people interviewed, especially those in their positions for a long period of time, believe the county has instituted best practices and is very good at providing mental health services. These same individuals also recognize mental health services in the county could be improved. One of the challenges facing this county is the geographic distances that individuals may travel to provide or receive treatment. This especially impacts a department with a limited therapeutic staff. The Grand Jury found two hotlines to be problematic as the county website lists both. The description of which number to call is duplicative and interchangeable, and therefore confusing. The Grand Jury is unsure of the reason for listing the two hotlines on the county website, nor why one hotline could not be staffed in conjunction with the county and TMHA. Also, the fact the team at TMHA which receives the call cannot set an appointment seems to be a lost opportunity to help someone who may need it. While recognizing the importance of a patient’s medical records’ confidentiality, the county could investigate whether there were a system that would allow TMHA volunteers to schedule an appointment with the county, or at least place the burden on the county to contact the individual to schedule such an appointment. The wait time for an assessment or further appointment was cited by the Department as the most concerning statistic, and local nonprofits were not surprised by the length of these delays. The Grand Jury is concerned that someone deemed to not be in a crisis or brought down from a crisis on day zero might not have an assessment for the underlying problem for up to 45 days, and then may wait an additional 14 days for a follow-up appointment for care. Within those 60 days a person’s condition could escalate to a major mental health event leaving the county responsible to provide a potentially higher level of care. In a document submitted to the Board of Supervisors, the Department acknowledged “[i]ncreased wait time for psychiatric assessments and proper treatment increases risk of adverse outcomes17”. Even though the state does not have a defined standard for this wait time, the county should meet its target goal of 14 days. 17 Addendum to Item 14, SLO Board of Supervisors Agenda June 17, 2014. Submitted May 19, 2015 13 Since the delays are due to caseloads, the county will need more professional staff to adequately handle new and on-going clients. If recruiting and retaining psychiatrists remains difficult, the county should expand the use of psychiatric nurse practitioners, or physician’s assistants if appropriate, to alleviate the burden. Another option that can aid the county’s staff is evolving technology, such as the use of telepsychiatry. The higher pay rate for psychiatrists approved by the Board of Supervisors should assist with retaining qualified professionals. Since many of the management staff within the Department are licensed therapists, these individuals should absorb some caseload by handling a few cases when the therapeutic staff is overly burdened. This would also expose management to the current demands experienced by its therapeutic staff in the field. The Grand Jury emphasizes the importance of the PHF and accepts the consensus that the capacity of the PHF is adequate at 16 beds. However, the Grand Jury is concerned about the burden on this facility as the county’s population continues to grow. The county should explore whether to continue to use the PHF for both adult and juvenile populations. Since the Department does not want to exceed the census of the PHF, a Crisis Stabilization Unit might alleviate some of the burden on the PHF. With the expense of inpatient care, such a facility might provide cost savings to the county by diverting inpatient care.
No Responses Found 2
Government entities assigned to respond to this report. No response documents have been linked in our database.
San Luis Obispo County
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San Luis Obispo County Board of Supervisors
Elected County Office