Mental Health Initiatives For Unfunded People Delia Rochon Community Benefit – Mental Health November 2008

Co-location of Services Pharmacy  Percentage of patients refilling medications improved from 75 – 99% (Midtown Clinic)  99% of patients pick up Rx’s when prescribed at on-site pharmacy (4 th Street Clinic)  Coordination of psychotherapy and psychotropic medication on site (Doctors’ Volunteer Clinic)

Funding for Unfunded People  Historically, CMHC could use efficiencies in their Medicaid operations to extend services to unfunded or under-funded clients including IP service  In 2004, this practice was disallowed, and all Medicaid funds needed to be expended on Medicaid clients only

Funding for Unfunded People  Utah’s mental health system lost access to over $7 million in federal fund that had been available to provide services to non-Medicaid population.  Thousands of Utah residents were unable to access to services because they did not meet the requirements to qualify for Medicaid, increasing the service gap for uninsured and underinsured population.

Uninsured Utah Adults In Need of Mental Health Treatment 1Adults in Utah 1,748,321 2Number of adults without insurance 290,221 3 The number of uninsured Utah adults who have serious psychological distress and need treatment according to a national survey (11.95%) 34, % receive some services: ER visits, health clinics, etc16, % do not receive any treatment at all18,034 DSAMH 2006 Report

Cases Presenting & Admitted Totals Behavioral Health - UHA 2006 Report

Uncompensated Care Totals

Strategies to Increase Capacity and Quality of Mental Health Care  Identify and/or establish partnerships between community clinics and healthcare facilities to provide transitional care to discharged patient needing follow up  Identify innovative strategies to provide mental health care in cost effective settings  Document processes, evaluate, and share results

Partnerships  Midtown Clinic, McKay-Dee Hospital, Weber HS  4 th Street Clinic, LDS Hospital, Valley Mental Health  Wasatch Mental Health, Utah Valley Regional Hospital  Central Utah Counseling Center, Sanpete Valley Hospital, Gunnison Hospital  Doctors’ Volunteer Clinic, Dixie Regional  NAMI, Salt Lake County, Health Clinics of Utah, Midvale Family Health Clinic, State Division of Mental Health, University of Utah

Best Practices  Case management  On-site eligibility coordinator  Co-location of services  Timely follow up care  Documentation of processes, measurement/evaluation

Co-location of Services Primary Care  Universal screening of all health care patients for mental health care needs has been implemented, and mental health care has been assigned according to the severity of symptoms. (Whole Health Project)  Close collaboration between medical providers, mental health providers and pharmacy staff. (4 th Street Clinic)  Integrated mental health and primary care services. (Doctors’ Volunteer Clinic)

Timely Follow Up Care  Patients seen within 48 hours after first call (4 th Street Clinic)  Patients seen within a week from discharged:  82% of patients discharged from IP receive follow up care at the clinic  48% of patients discharged from ER receive follow up care at the clinic (Doctors’ Volunteer Clinic)

Documentation of Processes

Medical Provider Visit Referral to Behavioral Health Patient fills out intake form Seen by Behavioral Health Provider Referral back to Medical Provider Ongoing Psychiatric Management MH Concern Identified 1 st PHQ9 PHQ9 with each visit Collaboration on Medical & Psychiatric

Measurement/evaluation  Health outcomes  Consistent use of evaluation tools such as OQ-45, PHQ9, Clinical Global Impressions Scale  Recidivism  Cost-effectiveness