Health System: Mental Health Adult Services (6140P)

Program Outcome Statement

Increase the percentage of consumers attaining wellness/recovery goals.

Program Services

  • Outreach
  • Assessment
  • Treatment
  • Linkages to Health Care Services
  • Case Management
  • Medication and Medication Support
  • Supported Employment
  • Education
  • Socialization

Overview

Behavioral Health and Recovery Services (BHRS) for Adults and Older Adults provides outreach, assessment, treatment, linkage to healthcare services, case management, medication and medication support, supported employment, education, and socialization. The program also works with consumer and family groups to support the development of self-help resources.
Mental health and co-occurring substance use disorder services are provided to almost 10,000 adults and older adults annually. Additionally, psychiatric emergency and inpatient services are provided for people in crisis, intensive case management, residential and supported housing alternatives are provided for the most vulnerable BHRS population, and services are provided to people discharged from jail. Services are co-located with primary care and are offered through specialty mental health teams for those who have greater needs. BHRS works closely with community partners to provide opportunities for individuals and families to improve their wellness and recovery.
BHRS for Adults and Older Adults promotes individual recovery, improved well-being and quality of life, and independent living in the community for adults who suffer from serious mental illness. Evidence-based mental health services improve functioning and stability and avoid unnecessary hospitalization, arrests and other negative outcomes such as homelessness. The Mental Health Services Act funded Full Service Partnerships (FSP), that “do whatever it takes” to keep their clients living safely in the community, have contributed to these results. All programs serving adults and older adults focus on fostering healthy outcomes, reducing isolation and keeping clients engaged in meaningful activities and promoting their safety and well-being.
The provision of services for clients on probation with Criminal Justice Realignment eligibility will continue to be provided through Service Connect. This collaborative program with the Human Services Agency and Probation works to reduce recidivism and maintain public safety by engaging with clients upon release from prison/jail and helping them integrate successfully into the community. BHRS provides mental health and alcohol and substance use services for these clients and helps connect them to medical care.

Percent of Clients Stating they have Benefited from Services Remains High

Percent of Adults who Attend a Follow-Up Visit with a Clinical Provider within 7 Days of Being Discharged from a Psychiatric Hospital Below Target

Percent of Adult Clients Receiving Full Service Partnership Services who Experience a Reduction in Hospitalizations Below Target

FY 2017-18 Year-End Story Behind Performance


Percent of Clients Stating they have Benefited from Services

The percentage of BHRS clients who report that they have benefited from services received remains high. In part, this is due to embedded staff working directly with other providers, such as the Primary Care Interface, which allows direct access to BHRS staff in primary care settings. It also reflects the ability of BHRS to provide timely services through the Same Day Assistance Program, where folks are able to get a service the same day they inquire, and the ability of most callers to our ACCESS Call Center to receive an appointment before the first call ends. An emerging focus within BHRS is on Peer Support Workers who are mental health clients that have become employed, providing guidance to those navigating the system and those running the system, which also helps ensure high customer satisfaction.

Percent of Adults who Attend a Follow-Up Visit with a Clinical Provider within Seven Days

BHRS has concentrated follow-up services after hospitalization for young adults so that most of the services are now being provided before discharge reducing the need for follow-up visits. However, for adults and older adults, the percent who do see a provider within seven days is under target at 50 percent. Work with the Health Plan of San Mateo and the BHRS contract evaluator, brought to light deficiencies in the data collection instruments used to measure performance in follow up to hospitalizations. Nonetheless, BHRS continues to employ strategies to improve performance, including: the recent opening of the Geriatric Behavioral Health Unit at Seton Medical Center, which provides 20 beds for the acute care of patients 65 years of age and older; the recent acquisition of four inpatient beds nearby that are available 24/7 in a facility with enhanced services that are easily accessible to BHRS staff, as opposed to placing patients in facilities located across the Bay area making it difficult to engage and transition patients; and, the development of a new contract template with significant performance expectations that is in the process of being executed with all acute inpatient hospitals where BHRS patients are placed.

Percent of Adult Clients Receiving Full Service Partnership Services who Experience a Reduction in Hospitalizations

Full Service Partnerships have had significant impacts on clients and have resulted in major reductions in homelessness, incarceration, and hospitalizations. On average, the clients in this measure experienced 17 less days of hospitalization per individual as compared to the year prior to entering into the program. As the program matures, a number of the more than 300 slots are occupied by the same individuals. Therefore, as the universe of clients that can continue to improve for the measure of reduction in hospitalization shrinks, the total percentage that experience a reduction is less because most have already achieved few to no hospitalizations. This measure would be effective if all Full Service Partnership slots completely turned over from year to year, but this not the case as only about 20 of the slots change annually. After a couple of years in the program, participants experience little to no hospitalizations as is the case for nearly 80 percent of program participants, many of whom have been in the program for five or more years.  To address these issues, the measure will be limited to clients in the program one year or less in fiscal year 2018-19.

Future Priorities

  • Improve client flow from acute inpatient services to community based services.
  • Expand Medication Assisted Treatment into primary care.
  • Increase initiation and engagement of clients in the BHRS provider network.
  • In partnership with HPSM, fully implement services to individuals with mild and moderate mental health conditions.


Author: Gina Wilson; Chief Financial Officer, Health System     Contact Email: gwilson@smcgov.org     Last Updated: 08-30-2018