R IGHT P LACE, R IGHT T IME : T RIAGING C ALIFORNIA ’ S M ENTAL H EALTH C ARE D ELIVERY S YSTEM A SHLEY S TONE University of California, Davis Master in Public Health Program California Hospital Association Preceptors: Debby Rogers & Sheree Kruckenberg Faculty Advisor: Marlene von Friederichs-Fitzwater

P ROJECT O BJECTIVES Assess & quantify the impact of patients with unmet mental health needs on emergency departments (EDs) Identify how community mental health resources affect access to appropriate levels of care Recommend changes in existing policies & laws

I NTRODUCTION Recent cuts to local & state- funded mental health programs Deinstitutionalization & the Lanterman-Petris-Short (LPS) Act “Revolving door” of hospitalization, homelessness, & incarceration ED utilization Healthy People 2010 goal: “improve mental health and ensure access to appropriate, quality mental health services”

P UBLIC H EALTH C ONTEXT Prevalence: about ¼ adults in U.S. has a diagnosable mental disorder Inappropriate ED usage indicative of inadequate care in community Ideal public health solution: prevention of severe mental illness (

M ETHODS Root cause analysis to identify problems & potential solutions Design, administration, & analysis of statewide survey for hospital ED directors in CA Historical overview of mental health care delivery Produce White Paper for advocacy of appropriate alternatives to the ED

R ESULTS 123 survey responses from ED directors; 42 counties Long wait times for psychiatric patients, need for inpatient beds, lack of access to community & county resources % of Responde nts Time, in hours Average Wait Times in ED, From Decision to Admit until Admission Time, in hours % of Respondents “It is a fight to get our psych patients the care they need” -ED Director

I MPLICATIONS OF R ESULTS Dwindling resources & services Limited alternatives to ED for care LPS Act, deinstitutionalization, & lack of inpatient psychiatric beds

C ONCLUSIONS Burden of disability associated w/ mental illness Few preventive efforts: patients w/ severe mental illness must become “dangerous” before they can get treatment “I wanted the LPS Act to help the mentally ill. I never meant for it to prevent those who need care from receiving it. The law has to be changed.” -Frank Lanterman, co-author of LPS Act

F UTURE R ECOMMENDATIONS Encourage collaboration and integration of services Integrate mental & physical health care Adequately fund mental health resources & provide payment incentives County by county service gap analysis Advocate for counties to adopt Laura’s Law (AB 1421), which makes assisted outpatient treatment (AOT) available

A CKNOWLEDGEMENTS  Debby Rogers, Sheree Kruckenberg, Vincent Wales, La Shon Tate, Pamela Lane, Wendy Keegan, & Peggy Wheeler (California Hospital Association)  Dr. Stephen McCurdy, Amber Carrere, & Dr. Diana Cassady (MPH Program)  Marlene von Friederichs-Fitzwater (UCD Advisor)  Randall Hagar (CA Psychiatric Association)  Carla Jacobs (Treatment Advocacy Coalition)  Dr. Glen Xiong (Sacramento Mental Health Treatment Center)  John Boyd & Mark Grip (Sutter Center for Psychiatry)  Dr. Joseph Bick (California Medical Facility)  Deb Trainor (UCDMC)