1. Presentation to Mental Health Board January 14, 2013 Eva Lomeli, LCSW

2. Referral Process: APS *Multiple consults Linkage for Clients already in the system

3. Some engagement efforts Others regular contacts And crisis interventions. Some Clients had more than 15 face to face contacts and countless collateral contacts.

4. 8 Clients with SMI: 5 with Bipolar I with Psychosis 1 Anxiety DO and Hoarding 1 Anxiety DO, Dependent Personality DO and to r/o Developmental delay 1 diagnosed with Schizophrenia 7 OA caregivers living with Individuals with SMI who were refusing M.H. Treatment 1 Care recipient with late Onset Psychosis 1 OA family member caregiver with Bipolar II and caregiver burnout 5 Care recipients with Bipolar I DO with paranoia and psychosis or Schizoaffective Bipolar Type 3 Individuals in their 60s with late onset Psychosis All three educated professionals with long work history and no history of Mental Illness. All lacked insight about their psychosis and refused mental health treatment. Theme: Electromagnetic fields and biosynthetic engineering

5. 5 Clients with Dementia based Paranoia or psychosis: 2 Clients with severe Axis II Borderline Personality Disorder 2 Clients with housing and financial stressors 1 Client with APS financial abuse 1 Client with severe life losses related to medical condition

6. Age 4 Clients under 50 8 Clients in their 60s 7 Clients in their 70s 8 Clients in their 80s 2 Clients in their 90s Language: 28 Primarily English speaking Clients Ethnicity: 20 Caucasian Clients 5 Hispanic Clients 2 Middle Eastern Clients 1 African American Client 1 Greek Client Insurance type: 8 Medical 7 Medicare only 10 Kaiser or HMO 1 Private pay 1 uninsured 2 unknown Housing: 14 Home owners 11 Renters 3 in subsidized housing 1 Homeless 6 Clients at risk of losing, or lost housing: 3 due to SMI, 1 due to Dementia, 1 due to financial abuse, 1 due to financial stressors (Cal fresh access barrier for SSI recipients)

7. Medicare only Clients and lack of access to needed resources: 81 yo female Bed bound. No access to IHSS, as a result, with abusive caregiver. 70 yo male legally blind and with hoarding problem. No access to IHSS 83 yo female completely isolated with deteriorating health with no access to On Lok services. Also evicted due raise in housing cost. 400 sq ft studio rent $1,159.00, SDI income $1,158.00 mo. Clients with SMI refusing treatment: Stigma about mental illness Clients right to self determination Possible liability issues: Providing Crisis Intervention to Cts who are refusing services but need them

8. Expand services to this underserved, unreached Client population Create a service team or have APS M.H. provider working out of a service team