1. 1-12-20091 Molly Brassil, Assistant Director, Policy California Primary Care Association Community Clinics and Health Centers & Mental Health Services California Primary Care & Mental Health Integration Policy Initiative January 12 th, 2009

2. Snapshot of California’s Clinics There are over 750 licensed community clinics and health centers (CCHCs) in California. CCHCs provide a vast array of primary care services, including medical, dental, mental health, and care management services. * Source: OSHPD, 2006 1-12-20092

3. Snapshot of California’s Clinics Nearly 4 million patients are served every year in California’s CCHCs. 50% of CCHC patients’ primary language is not English. 80% of CCHC patients have incomes under 200% of the federal poverty level. * Source: OSHPD, 2006 1-12-20093

4. 4 Clinics & Mental Health Services Primary care is often the first point of contact for identifying and beginning to address mental health issues. Primary care community clinics & health centers fulfill an often unaddressed demand for mental health services.

5. Clinics & Mental Health Services For many minority communities there exists significant mistrust and fear of traditional mental health treatment, as well as taboos and stigma around mental illness. Most people see their primary care provider about 4 times a year, posing an incredible opportunity for preventing & addressing mental health issues. 1-12-20095

6. 6 Summary As trusted medical homes in the community for many underserved, ethnically and racially diverse individuals & families, CCHCs can play a unique role in providing access to mental health services for those who may never seek out or have access to traditional mental health services.

7. 1-12-20097 Clinics & Mental Health Services Mental health services differ by clinic, varying from… Highly developed & integrated systems of care On-site mental health assessments & treatment Reliance on referral to outside providers.

8. 1-12-20098 Clinics & Mental Health Services About 1/3 of community clinics & health centers employ 223 mental health professionals (OSHPD, 2006). Annually, clinics report nearly 300,000 mental health encounters (OSHPD, 2006).

9. Integrated Behavioral Health Integrating primary care and mental health care can allow individuals to access the help they may need without fear of stigma. Stigma in seeing your primary care provider is practically non-existent. 1-12-20099

10. Integrated Behavioral Health Primary clinics often become the de-facto mental health system for those unable to access care elsewhere. 1-12-200910

11. 1-12-200911 Integrated Behavioral Health The integration of mental health into primary care simply means to treat mental health like any other health condition. The mind = part of the body

12. 1-12-200912 Integrated Behavioral Health Barriers to mental health services include: Cost Fragmentation of services Lack of availability of services Societal stigma toward mental illness Race, ethnicity, cultural beliefs, religion, gender, age, sexual orientation, geography, immigration status, etc.

13. 1-12-200913 Integrated Behavioral Health The “ Model ” : Mental Health Professional or Behavioral Consultant = team member Added support to the primary care provider ’ s decision-making. The “ warm hand-off ” to the on-site assessment/treatment

14. 1-12-200914 Integrated Behavioral Health Early & accurate identification of mental health challenges and psychological distress: Reduces high costs for utilization of emergency services Improves prognosis for long-term outcomes Reduces overall medical utilization Reduces potential for negative family/social outcomes

15. 1-12-200915 Policy Barriers & Opportunities

16. Policy Barriers & Opportunities Same-Day Visit Billing Barrier Payment for Case Management Services Utilization Limitations Reimbursement for Marriage & Family Therapists Mental Health Services Act Collaboration with County Departments of Mental Health 1-12-200916

17. 1-12-200917 Same-Day Visit Billing Barrier Same-day services are a critical component of the Integrated Behavioral Health Model. Medi-Cal will not reimburse FQHCs & RHCs for a patient to see a primary care provider and a mental health provider on the same day. While same-day dental services are permitted, mental health services are excluded.

18. 1-12-200918 The Mental Health Services Act & Community Clinics Challenging to advocate within the complex MHSA and MHSOAC processes Clinics and regional consortia that had strong relationships/partnerships with counties have fared well, others have not. Process inconsistent in the inclusion and funding of clinics and other CBOs.

19. 1-12-200919 Prevention & Early Intervention According to the PEI Guidelines: …programs are generally delivered in a natural community setting (e.g. among others…primary health care, community clinic or health center) (Enclosure 1, Page 8). Plans must describe how the PEI component will strengthen and build upon the local community- based mental health and primary care system including community clinics and health centers (Enclosure 3, Page 14-15).

20. Clinics & County Departments of Mental Health Collaboration between clinics & counties is a critical element in improving mental health services for community members. In several counties, clinics and counties partner within a mental health contractor network for planning, sub-contracting and support for primary care integration. One county convenes quarterly meetings between county and clinic administrators 1-12-200920

21. Clinics & County Departments of Mental Health Training, cross-training, and shared training Consultative and/or direct psychiatric care Assistance to primary care providers in diagnosing, treating and prescribing medications for their patients with mental illness. Use of innovative practices such as tele- psychiatry, promotores & case managers, home visitors, homeless programs, mobile vans, and many other innovations required to link services to people in need. 1-12-200921

22. Clinics & County Departments of Mental Health Commitment to holistic health, population- based & client-centered care Universal assessment for mental health issues using a variety of tools that can be re-administered over time to track outcomes Collaborative community culture 1-12-200922

23. Questions? 1-12-200923

24. 1-12-200924 Contact Information Molly Brassil, Assistant Director, Policy mbrassil@cpca.org California Primary Care Association 1215 K Street, Suite 700 Sacramento, CA 95814 (916) 440-8170 www.cpca.org