s Mental Health Commission Annual Reporrt Fiscal Year County of Santa Barbara

Transcription

1 s Mental Hea alth Commission Annual Report Fiscal Year County of Santa Barba ara

2 Mental Health Commission Annual Report Fiscal Year County of Santa Barbara Contents Letter from the Chair 2 Introduction 3 Accomplishments Vital Signs Committee 4 Full Service Partnership Performance 5 ADMHS Leadership 6 Housing Services 7 SANTA BARBARA COUNTY MENTAL HEALTH COMMISSION 315 CAMINO DEL REMEDIO SANTA BARBARA, CA TEL: (805) FAX: (805) Crisis Services 8 Implementation of Katie A 8 Integration of Services 9 Cultural Competence 9 Laura s Law 10 Mental Health Services Act 11 Appendices 12 1

3 Dear Honorable Board of Supervisors: Please accept the Mental Health Commission s Annual Report highlighting our accomplishments for Fiscal Year This past year the commission has worked collaboratively with the leadership and staff of the Departmentt of Alcohol, Drug and Mental Health Services (ADMHS). We have received regular updates from department executives as well as public testimony from our community. The Commission holds rotating monthly meetings in Santa Barbara, Lompoc and Santa Mariaa to better learn about the entire county and to provide citizenss with an accessible forum to raise concerns. A central responsibility of the Commission is articulated in the W& &I Code a(1) is: To review and evaluate the community s mental health needs, services, facilities and special problems. Implicit in this broad mandate is that the Commission serves as an objective evaluator of a very large service delivery system that includes hundreds of County employees and a large system of non including those who are organized advocates, as well as individual citizens whose voices are equally governmental providers. To achieve this goal, the Commission seeks to listen to many perspectives, important. The Commission further wishes to review data from the extensivee information system operated by the Department. These data not only inform the leadership of the Department, but must inform the Commission as we meet our mandate to evaluate the many programs. The Commission serves at the direction of the Boardd of Supervisors and our goal is to advise not only the Mental Health Director, but the Board of Supervisors, as well. During our next year, the Commission will work collaboratively with the Department to help to improve mental health services in our community. 2 Sincerely, Michael J. Gorodezky, MSW, Ph.D., Chair

4 Introduction Purpose of the Annual Report Mandated by the Welfare and Institutions Code, the Mental Health Commission s Annual Report highlights the most significant endeavors of the Commission members of the past year and recommends areas for future consideration. About the Mental Health Commission Authorized by California s Welfare and Institutions Code 5604, the Santa Barbara County Mental Health Commission advises the local governing body and the Mental Health Director on major issues affecting the public mental health system. The Mental Health Commission: Evaluates the needs of, and services for, individuals experiencing mental health challenges. Reviews and approves the annual Mental Health Services ACT (MHSA) plan update. Ensures citizen, consumer and professional involvement in the planning of services and review of performance outcomes. The Commission is made up of eleven members. Each Board of Supervisor appoints two Commissioners from his or her District. The eleventh member is a member of the governing body (Board of Supervisors). In addition, the Commission has one "alternate" position per each region, also appointed by the Supervisor. Alternates are encouraged to attend meetings, serve on committees and vote when members of their Districts are not present. A second member of the Board of Supervisors serves as an alternate. Commissioners as Liaisons Mental Health Commissioners also serve as liaisons to various committees that affect mental health issues, including the Advisory Board on Alcohol & Drug Problems, the Latino Advisory Committee, the Jail Services Committee, Consumer and Family Member Advisory Committee and ADMHS the Systems Change Steering Committee and action teams. Liaisons help keep communications open, build partnerships, share mental health perspectives and represent the Commission on important community committees. 3

5 Accomplishments Vital Signs Committee In June 2014 the Commission voted to establish the Vital Signs Committee. The goal is to identify vital departmental measures that the Commission will routinely discuss and monitor. The Commission has begun aligning requested data with key metrics identified through the systems change effort. This is sharpening the Commission s focus on key changes. Commissioners Chuck Huffines, Jan Winter, Ann Eldridge and Michael Gorodezky serve on this committee, along with staff and the public. I have been particularly encouraged by the establishment of the Vital Signs Committee, which is examining data supplied by ADMHS, notes Commissioner Jan Winter. I believe that this work is fundamental to the Commission s mission to evaluate how well the Department is meeting the community s mental health needs. I look forward to continuing to serve on the Committee as we widen our examination of data from Full Service Partnerships and other programs. One of the Vital Signs Committee s first requests for data was regarding Full Service Partnership programs in Lompoc, Santa Maria and Santa Barbara. Figure 1 shows the difference between service levels for the three programs. Figure 2 shows the difference in hospital days. Such a comparison is intended to stimulate further analysis and discussion. 20,000 Services Provided to ACT Consumers 10/01/13 thru 9/30/14 Figure 1 15,000 10,000 5,000 Services 4 0 ACT Lompoc ACT Santa Barbara ACT Santa Maria

6 Hospital Days for ACT Consumers 10/01/13 thru 9/30/14 Figure ACT Lompoc ACT Santa Barbara ACT Santa Maria During FY Vital Signs began meetings with active collaboration of ADMHS staff. Analysis such as shown above can stimulate vital dialogues about program operations, identify problems and celebrate success. Full Service Partnership Performance Hospital Days Full Service Partnerships (FSPs) are a category of programs funded through the Community Services and Supports component of the Mental Health Services Act. FSPs are designed to provide all necessary and desired appropriate services and supports to clients and families to achieve goals identified in their plans. FSPs maintain a single point of responsibility with a caseload that is low enough so that staff availability to the individual and family is appropriate to their service needs. FSP staff members are expected to respond to clients and family members 24 hours a day, seven days a week. In Santa Barbara County, FSP programs are Santa Maria, Lompoc and Santa Barbara Assertive Community Treatment (ACT), Supported Housing North and South, the SPIRIT program for children (countywide) and the countywide Justice Alliance adult forensic team. The Commission s initial focus is on the three ACT programs. As individuals, two Commission members led in the formation of an ACT Families Advisory Council to look into South County ACT services to family members. Members of this council have met with members of ACT staff and their supervisors to discuss problems in service delivery. 5

7 An initial Commission review of FSP performance showed substantial differences in the number of services provided and in the number of hospital days of ACT clients among the three ACT programs. The Commission awaits furtherr analysis. ADMHS Leadership ACT programs are critical because they are designed to help individuals with a high level of need remain in the community and reduce levels of hospitalization and incarceration. It is important to continually gather feedback and improve the quality of services. Alternate Commissioner Ann Eldridge Dr. Ann Detrick resigned as Director of ADMHS in November While acknowledging that Public Health Director Takashi Wada, M.D., M.P.H., did an excellent job serving as ADMHS Interim Director, some Commissioners expressed concern that the timely hiring of a permanent director was necessary to effectively guide the department through the systems change process. In December 2013 the Commission wrote a letter to thee Board of Supervisors that stated: we do not want to see the energy and commitment of so many staff and stakeholders begin to wane for lack of a full department leadership team, such as other County departments require. We have benefitted greatly from the leadership and guidance provided by Dr. Wada and are encouraged at thee promotion of Michael Craft to the Assistant Director of Clinical Operation, but it is time for the ADMHS Director position to be filled so that we can move forward with a more permanent and stable leadership at the top. 6 The Commission played an active role in the recruitment process; one of the interview panels consisted of five commissioners. In December 2014 Alice Gleghorn, Ph.D., joined ADMHS as the new Director.

8 Housing Services The Mental Health Commission has participated in the Housing Empowerment, Action and Recovery Team (HEART) during the past year and stronglyy supports the team s efforts to createe a mental health system that is more collaborative,, and one that better serves the varying housing and supportive services needs of its clients. By gathering baseline data from stakeholders and studying existing housing options for ADMHS participants, the group has been able to develop a strategy for expanding the range of housing and treatmentt options for ADMHS clients, as well as improving access to these resources. On April 15, 2015 the Commission hosted two presentations related to housing for individuals with severe mental illness. ADMHS Compliance Officer Celeste Andersen noted that ADMHS is seeking to increase safe and stable housing options forr clients with complex challenges. A contract was completed with the Mental Wellness Center to establish Alameda House, a new residential program that will provide short term treatmentt for six individuals found incompetent to stand trial (IST) for misdemeanor offenses. As space permits, Alameda House will also serve individuals on Lanterman Petris Short (LPS) Mental Health Conservatorships. The projected opening date is July Representatives from the Central Coast Collaborative on Homelessness (CH3) also provided an update on the Point in Time Homeless Survey that emphasized the need to strengthen collaborative efforts to house the most vulnerable persons with mental illness. ADMHS has a duty to ensure that members off the community experiencing mental illness have the opportunity to live safely and affordably within their own communities. The department should playy a central role in ensuring that sufficient options exist for the clients they are charged with serving. A continuum of housing options must be clearly identified that can meet the varying range of needs for these vulnerable community members. As a Commission, we are resolute in our commitme nt to ensuring that our local housing continuum is accessible, nimble and accepting of individuals and families with complex needs. Commissioner Alice J. Villarreal Redit, Vice Chair 7

9 Crisis Services In 2014 ADMHS was awarded $10.9 million in California Senate Bill 82 (SB 82) funds to expand crisis services. As a result, a number of new components to crisis service delivery are being added, including countywide crisis triage teams, a Lompoc mobile crisis team, a peer respite house in Santa Barbara and crisis stabilization units in Santa Barbara and Santa Maria. The Commission reviewed the impressive plans to evaluate the large expansion of crisis services. The Commission received regular reports on the substantial expansion of crisis services throughout the county and has heard from managers and line staff regarding the newly expanded mobile crisis and crisis triage teams. The Commission also noted the expanded collaboration with local police and Sheriff s deputies. Fiscal Year will see the opening of the final SB 82 components the county s first Crisis Stabilization Unit (CSU) and a peer respite house. The Commission will continue to monitor all crisis services and seek data driven analyses to evaluate their effectiveness. During the next fiscal year, the Commission will carefully review the various outcome measures proposed as part of the SB 82 grant proposal. Implementation of Katie A Katie A. v. Bonta is a federal class action lawsuit filed on behalf of California foster youth and children at risk of out of home placement to improve access to intensive home and community based mental health services offered through Medi Cal. The parties reached a landmark settlement in September ADMHS hired and trained new staff to serve youth in foster care with behavioral health challenges throughout the county. During FY the Commission heard several Katie A implementation progress reports from ADMHS staff members. No significant problems were brought to the Commission s attention. The Commission was informed that the mandated expansion of services for foster youth was fully implemented. One of the priorities of the Commission in the coming year is to build stronger links to advocates for children and transition age youth. 8

10 Integration of Services Improved integration of alcohol, drug and mental health services is a longstanding goal of ADMHS because optimal outcomes for clients occur when all of their behavioral health needs are successfully addressed. On April 7 and June 1,, 2015, the Mental Health Commission and Advisory Board on Alcohol and Drug Problems held joint meetings to explore opportunities for greater communication and collaboration in serving individuals with co occurring mental healthh and substance use conditions. Continuing joint meetings are expected in an effort to exchange information and encourage the integration of services within ADMHS. Commissioner James Rohde Cultural Competence Individuals with co occurring disorders are best served when they can get alcohol, drug and mental health issues addressedd in a single visit. We will continue to monitor progress in achieving true service integration. Cultural competence has been defined as a set of congruent behaviors, attitudes, and policies that come together in a system, agency, or among professionals that enables effective work in cross cultural situations. (Cross et al, 1989.) Striving to provide culturally competent services is a principle of ADMHS, the Systems Change Steering Committee and the Mental Health Services Act. Commissioner Dr. J. Manuel Casas has been a leader in advocating forr culturally competent services for members of the Latino community. (A resolution honoring his community service is included in the appendices at the end of this report.) In February 2014 Dr. Casas stated that the Latino Advisory Committeee is working with ADMHS policies and procedures (P&P) staff specialist Yaneris Muñiz to recommend revisions to ADMHS P&P 73, Criteria for Indigent Outpatient Mental Health Services. 9

11 In July 2014 Dr. Casas reported that the Latino Advisory Committee and the Cultural Competence Action Team were conducting countywide research to learn more about how culture affects initial client visits at clinics. In September Commissione er Casas reported that a review of ADMHS assessment tools found them lacking in adequately collecting relevant cultural information. In December the Commission was informed that the Cultural Competency Action Team has created a workgroup on LGBT issues. In April 2015 a Cultural Competency Questionnairee was posted to the ADMHS website and incorporated into ShareCare software and is now in use by some clinicians. In June 2015 the Commission focused on obtaining a clearer demographic picture of the County's Latino/a population. Special attention was given to data about accesss to, and utilization of, mental healthh services by Latinos. Commissioner J. Manuel Casas The Mental Health Commission works closely with the Department s Cultural Competency Action Team and the MHSA s Latino/ /a Advisory Committee to keep informed of the mental health needs and concerns of the Latino/a community and, subsequently, makes relevant servicee recommendations to the Department. Laura s Law Commonly known as Laura s Law, California Assembly Bill 1421 requires compulsory outpatient treatment for individuals with severe mental illness who meet a series of criteria based on the frequency of recent incarcerations, hospitalizations and/or incidents of violent behavior. Laura s Law was passed in 2002, but the decision to implement it was left to each county. 10 The Commission supports the implementation of Laura s Law in Santa Barbara County. In March the Commission unanimously passed a motionn in support of a small Laura s Law pilot program. The Commission also sought to work with the Department on the development of the size and representative sample, which will be thee focus of the pilot, and strongly recommendedd that the pilot project include an independent evaluator. At the conclusion of

12 the pilot project, the evaluation results should be presented to the Board of Supervisors for a decision regarding full implementation. Mental Health Services Act Passed by the voters of California in 2004, the Mental Health Services Act (MHSA) authorizes a one percent tax on California incomes over $1 million to fund mental health programs and services. Each year California counties prepare an MHSA Plan Update, a progress report and recommendation for new programs and modifications. The Commission is responsible for evaluating and approving annual Plan Updates. The Fiscal Year MHSA Plan Update is the most important Santa Barbara County MHSA document since the original proposal, providing a roadmap for ADMHS systems transformation by restructuring outpatient programs and elevating the importance of the MHSA guiding principles systemwide. Individual Commissioners and the Commission as a whole weighed in on the Plan Update throughout the year, requesting more information about specific programs and advocating for the document to be more user friendly. The Commission also emphasized the need for the MHSA plan to include data showing the level of service and the cost of each MHSA program. In addition to reviewing numerous updates at Commission meetings, some Commissioners also met with ADMHS staff members to learn more about fiscal and programmatic issues. The Commission will actively review and provide input as the FY MHSA Plan Update is developed. 11

13 Appendices COMMISSION ROSTER DISTRICT MEMBER/ALTERNATE TERM EXPIRES 1st/CARBAJAL J. MANUEL CASAS MEMBER PUBLIC INTEREST June 30, 2015 JAN WINTER MEMBER FAMILY MEMBER August 1, 2017 CAROLYN WOOD ALTERNATE FAMILY MEMBER August 1, nd /WOLF MICHAEL GORODEZKY MEMBER, FAMILY MEMBER July 1, 2015 CHAIRPERSON ALICE J. VILLARREAL REDIT MEMBER, PUBLIC INTEREST June 30, 2016 VICE CHAIR MICHELLE BRENNER ALTERNATE FAMILY MEMBER July 1, rd /FARR LORRAINE NEENAN MEMBER FAMILY MEMBER June 30, 2015 JAMES M. ROHDE MEMBER FAMILY MEMBER July 1, 2016 JULIE SOLOMON ALTERNATE FAMILY MEMBER July 1, th /ADAM THOMAS URBANSKE MEMBER PUBLIC INTEREST January 1, 2017 SANDRA BROWN MEMBER PUBLIC INTEREST February 19, 2016 VACANT 5 th /LAVAGNINO KEN BONNER MEMBER PUBLIC INTEREST August 1, 2016 CHARLES HUFFINES MEMBER CLIENT June 1, 2015 ANN ELDRIDGE ALTERNATE FAMILY MEMBER September 8, 2018 GOVERNING BOARD STEVE LAVAGNINO MEMBER 5 TH DISTRICT SUPERVISOR January 1, 2016 PETER ADAM ALTERNATE 4TH DISTRICT SUPERVISOR January 1,

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