InTouch - Five Stars for Our Work on Mental Health

It’s one thing for me to tell you we do excellent work. But there’s nothing like hearing it right from our customers. Like this message from a grateful parent:

Yes, that’s a Yelp review, a place it may surprise you to see feedback on such a serious matter. Take it as one more sign of the changing environment we find ourselves in as we work on mental health and substance use issues, which we refer to together as behavioral health. The changes, the challenges, and the opportunities we’re seeing in this realm are as dramatic as any we’re grappling with. Maybe most noteworthy for you as employees is that our efforts are affecting more of you than ever before.

It is an enormous challenge. Nearly one in ten adult San Diegans suffers a psychiatric crisis in any given year. About the same number has a substance use disorder. The rise in opioid misuse and overdose deaths has made national headlines, and it’s a troubling trend here as well. Suicides have increased. Behavioral health is a major factor in homelessness.

And as with homelessness, we can’t deal with behavioral health in isolation. It’s become increasingly clear that the issues we see are interwoven with an incredibly complex set of social factors, in addition to each person’s unique needs. Complex issues will take complex, multidimensional approaches to address.

At the same time, the hospital industry is undergoing shifts of its own. It’s typically been designed to set a broken arm rather than tend to the less straightforward care of a broken psyche.

People like our Yelp reviewer will attest to the quality of care we offer. But the County has always been just one part of a health care system that includes hospitals, treatment facilities, and a variety of medical providers. And while collaboration is not new, we are really stepping up the ways we coordinate care, both internally across our departments and with the whole medical community. Let me give a few examples of things we’re doing and areas for future focus.

The availability of psychiatric beds in the region has recently jumped up our list of priorities. The County’s expansion plan will add roughly 150 long-term care and step-down beds, the latter helping people transition out of acute care. We’ll also build the ability to serve 300 people through Assertive Community Treatment, an array of services paired with housing for those in that step-down phase.

The number of staffed beds at the County Psychiatric Hospital will increase to 82. We’re having conversations with health care providers throughout San Diego County on ways we might collaborate to offer treatment.

No Place Like Home is a state initiative voters approved last November to help people with serious mental illness who are, or at risk of becoming, homeless. We’ve requested $125 million from the program to help develop supportive housing, which is a place to live combined with behavioral health services. That’s in addition to several other supportive housing efforts targeting the nexus of homelessness, housing affordability and ongoing care, such as Project One For All and several hundred units made possible through Mental Health Services Act funds. Our Children, Youth and Family System of Care is working with a contractor and the City of San Diego to develop the first family-oriented supportive housing program.

We’re looking at taking currently unused County property and creating a behavioral health services hub. An initial site in Hillcrest would take advantage of nearby hospitals to create integrated, whole person care. But we may eye other County property for critically needed behavioral health services.

That potential expansion is important, because in a region as large as ours, and a population as spread out as it is, we need to make sure resources are distributed broadly. That includes those proposed hubs, but any of the behavioral health services we’ve been talking about.

This past year has seen a dramatic increase in the availability of care through what’s called Drug Medi-Cal, which makes it possible for the state insurance to cover substance use treatment programs. As part of that, the providers of those programs are now paid by services delivered, rather than simply reimbursing their costs, making them more effective for the client.

One area we’ll strengthen even more is the coordination between behavioral health and the justice system. That includes expanding PERT: psychiatric emergency response teams, which pair mental health clinicians with law enforcement officers. Not just more teams, but more follow-up with the people they help. Again, moving from cases in isolation to a more comprehensive approach.

We will be focusing on the development of community-based crisis stabilization centers, where people can easily access trauma-informed care and law enforcement can efficiently transport people for care close to their homes.

As we are with many County operations, we’re ramping up our use of data to drive our efforts. With something so big and complex, that number-crunching is invaluable to getting our resources focused in the right direction.

As a department, Behavioral Health Services is second only to our Sheriff’s Department in levels of funding you’ll see in the County budget. It’s getting $658 million this year and added more than 100 positions. Final details are being hammered out for the coming year’s budget, out in a few days, but expect more dollars and staff. The total we devote to these services shows it is now a top priority. Credit to our Board of Supervisors for showing their commitment to addressing these needs by bringing many of the ideas forward and then backing them up with resources.

I can’t mention this topic without a reminder to be aware of the behavioral health needs of our employees and their families. Please remember our Employee Assistance Program is there for you. It offers counseling, free and anonymous. Don’t hesitate to bring up concerns with your primary care doctor. Our Access and Crisis Line is not just for the public. Anyone can use it, 24/7, at 888-724-7240.

May is Mental Health Month, a time to raise awareness about this essential aspect of our well-being. It’s also a good time to spread awareness about some of what the County is doing. Often in my columns, I’m barely scratching the surface. If tackling behavioral health is not an audacious goal, I don’t know what is. Thank all of you who have a hand in, and will continue to be involved with, helping us serve these vulnerable residents.