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Extracted from Consolidated Report
This investigation was originally published as part of a larger consolidated report containing multiple investigations. View the consolidated PDF for the complete document.
San Luis Obispo County Grand Jury
• 2014-2015
Energy Used, Time Lost, Results Missing
⚠️ 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 11 findings
F1
Page 80
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.
F2
Page 80
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.
F3
Page 80
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.
F4
Page 80
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.
F5
Page 80
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.
F6
Page 80
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.
F7
Page 80
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. 2014-2015 San Luis Obispo County Grand Jury Final Report 69 WE ARE WAITING: ACCESS TO COUNTY- PROVIDED MENTAL HEALTH SERVICES
F8
Page 81
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.
F9
Page 81
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%.
F10
Page 81
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.
F11
Page 81
It is challenging for the county and local nonprofits to find sufficiently qualified individuals to staff various licensed positions for mental health services.
Recommendations 8
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R1Page 81List one toll-free number for hotline access to all mental health services on the county website.
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R2Page 81Establish a system to allow both the county and Transitions Mental Health Association staff and volunteers to schedule appointments while maintaining HIPAA confidentiality requirements.
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R3Page 81If 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.
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R4Page 81Reconfigure 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. 2014-2015 San Luis Obispo County Grand Jury Final Report 70 WE ARE WAITING: ACCESS TO COUNTY- PROVIDED MENTAL HEALTH SERVICES
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R5Page 82A 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.
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R6Page 82To 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.
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R7Page 82If 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.
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R8Page 82The 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.