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Mental Health Reform Update Report

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Mental Health Reform Update Report SF Department of Public Health Behavioral Health Services Current State, Gaps and Opportunities Our City Our Home Committee November 10, 2020 Presentation Outline • Behavioral Health Services • Programs and Clients Served • Budget Details • Outcomes • Mental Health Reform • Background • Milestones to date • Alignment and looking ahead • Gaps and Looking Ahead • Recommendations for Future Investments 2 Behavioral Health Services Mental Health Medi-Cal Managed Care Plan SUD Medi-Cal Managed Care Plan Healthcare Delivery System Health Promotion and Early Intervention 3 Range of Mental Health Services 4 Service Description Services that can include groups, individual, peer-to-peer services, and medication Outpatient prescription/monitoring. Intensive Case Intensive community services for individuals with severe and persistent mental illness that Management/Full-Service are designed to improve planning for their service needs. Services include outreach, Partnerships evaluation, and support. A group of services that is available 24 hours a day, 7 days a week, to help during a mental Crisis Services health emergency. Examples: telephone crisis hotlines, crisis counseling, crisis residential treatment services, crisis outreach teams, and crisis respite care. Residential Treatment Services and treatment provided over a 24-hour period typically in a home-like environment. Services Clients who are able to make appointments and do not need wrap around services such as Private Provider Network case management, etc.. Medical clients only. Acute Services Acute Psychiatric Inpatient (PES) Long-term In-Patient (State Hospital) and Sub-Acute/IMD/SNF (Locked Facilities) Long-Term Care Range of Substance Use Disorder Services 5 Service Description Reducing binge drinking in teenagers, Strengthening Families Program and Communities Mobilizing for Prevention, environmental Change on Alcohol. Truth or Nah, Cannabis informational campaign directed at youth Prevention and harm HIV, overdose. Community naloxone, syringe access reduction Screening for substance use disorder in Primary care; Screening, Brief Intervention and Referral to Screening Treatment (SBIRT) Integrated Buprenorphine Intervention Services, and seven Opioid Treatment Programs, including vans Medication-assisted and office-based. Hospital, ED, Jail and Street Medicine buprenorphine. Adding low threshold tele- treatment (MAT), opioids buprenorphine MAT, alcohol treatment medications in primary care, mental health and SUD. Withdrawal management Inpatient, and three residential withdrawal management programs Severe alcohol intoxication care, with round the clock nursing. Intensive case management field services Sobering Center on site. counseling and groups, including intensive outpatient, and youth outpatient. Some specific to Spanish Outpatient speakers, gender, LGBT specific. Residential adult programs, including perinatal, some specific to Spanish speakers Residential Step Down Transition between residential to outpatient, with safe living spaces. San Francisco BHS Clients Served Health Network FY 2018 – 2019 SAN FRANCISCO DEPARTMENT OF PUBLIC HEALTH N = 24,458 Mental Health Treatment Clients * Total Homeless % Age Group Clients Clients Homeless • BHS serves nearly 25,000 people in our Children & Youth 3,961 228 6% clinical system of care Adults & Older Adults 16,428 5,434 33% Total 20,387 5,662 28% • In addition to treatment services, BHS provides many additional prevention and Substance Use Treatment Clients* early intervention services to tens of thousands of SF residents through its Total Homeless % All Age Groups crisis debriefings, school-based programs, Clients Clients Homeless 99% of clients are 18+ 5,976 3,544 59% peer programs, vocational services, drop- in centers etc. Clients served in both SU & MH services: 1,907 71% Homeless * Source: Avatar clinical encounter data 6 San Francisco Health Network BHS Client Demographics SAN FRANCISCO DEPARTMENT OF PUBLIC HEALTH FY 2018-19 Ethnicity Mental Health Clients 27% • Female 43% 20% • Male 56% 20% 16% • Transgender 1% 15% Substance Use Clients • Female 29% 1% 1% • Male 69% • Transgender 1% 7 Clients Served by Program Type Clients Served FY1819 Estimated % experiencing Program Type (unduplicated) homelessness Outpatient mental health (excluding ICM) 15,136 26% Outpatient substance use disorder 4,471 54% Intensive Case Management 1,630 40% Psychiatric Emergency Services (PES) 3,852 60% Acute Inpatient Psychiatry 956 55% Psychiatric Urgent Care (Dore) 1,250 87% Acute Diversion Units 766 89% Mental Health & Co-Occurring Residential Treatment 471 89% Withdrawal Management & Social Detox 1,343 92% Substance Use Residential Treatment 1,054 96% 8 BHS Funding and Contracts • More than 40 funding sources • 127 contracts with 89 CBOs • These CBOs operate over 427 programs • 800 FTE 9 San Francisco Behavioral Health Services Health Network Budgeted Revenue SAN FRANCISCO DEPARTMENT OF PUBLIC HEALTH FY20-21 Total Budget: ~$536 million County General *all values in millions Fund , 151m, 28% 1991 Realignment, 63m, 12% Substance Children's Mental 2011 Use Disorder, Realignment, Health, 87m, 86m, 16% 41m, 8% 16% Medi-Cal and Other Revenues, 72m, 13% Grants, 17m, 3% Mental Health Adult Work Orders, and Older PropC Homeless, 27m, 5% Adult, 362m, 98m, 18% 68% Mental Health *Funding on reserve Service Act, 47m, 9% SR Comm Health-COVID Stim-FED, 20m, 4% Expenditures by System of Care Funding Sources 10 San Francisco Behavioral Health Services Health Network Budgeted Expenditures SAN FRANCISCO DEPARTMENT OF PUBLIC HEALTH FY20-21 Total Budget: ~$536 million Prop C Homeless *all values in millions (including $5m salaries and fringes), 98m, 18% SR Comm Health- COVID 19, 20m, 4% Rent , 9m, 2% Contractual Services, 282m, 52% Salaries & Fringes, 112m, 21% Services of Other Departments, Material & 4m, 1% Supplies, 9m, 2% Expenditures by Type 11 Performance Measurements ACCESS TO CARE CLINICAL OUTCOMES CLIENT SATISFACTION • Timely access to • Decrease behavioral health • Access to care treatment needs and increase strengths • Quality and appropriateness • Successful linkages to • Decrease frequency of of care lower levels of care substance use • Consumer participation in • Reduce readmission to treatment inpatient and PES • Cultural sensitivity • Overall satisfaction 12 San Francisco Health Network Behavioral Health Client Assessments SAN FRANCISCO DEPARTMENT OF PUBLIC HEALTH • Mental Health • Adults Needs & Strengths Assessment (ANSA) • Child & Adolescent Needs & Strengths (CANS) • Pediatric Symptom Checklist (PSC-35) • Data Collection & Reporting System (DCR) • Substance Use • California Outcomes Measurement Systems (CalOMS) 13 Identifying Needs: Intensive Case Management Intensive Case Management UCSF CCRT Linkage • High impact service model Funded by Homeless Mentally Ill Outreach and Treatment Grant • Currently capacity to serve 1,200 Works with clients who frequently visit PES and other vulnerable clients clients Results 74 clients in • Continuously long waitlist cohort 100% assessed by Coordinated Entry 97% lacked 29 permanently housed housing at 33 in housing pipeline baseline 26 linked to intensive case management 14 Mental Health Reform Dr. Anton Nigusse Bland 15 Behavioral Health Strategic Alignment Mental Health Reform Mental Health SF Common Priorities • Target population -- homelessness and co-occurring behavioral health Mental Health SF disorders Legislation • Increased access points and hours • Care coordination and case management expansion • Expanded harm reduction policies and Ongoing Behavioral service sites Health System (BHS) Quality Improvement 16 Background In March 2019, Mayor London Breed appointed Dr. Anton Nigusse Bland as the Director of Mental Health Reform for a two-year assignment. Goal: Develop a strategy to improve San Francisco’s approach to mental health and substance use treatment for at-risk people experiencing homelessness. 17 Contributions from Prior Efforts Reports Reviewed Common Themes • Improve linkages and care coordination • Increase intensive case management through increased staffing 1. Homelessness and Behavioral Health; JSI – Tipping Point, and improved ability to step patients down to lower levels of 2019 care 2. BHS Performance Audit; BLA, 2018 • Expand field-based services and improve technology for these 3. Whole Person Care Stakeholder Discovery; WPC, 2018 outreach teams 4. Acute Adult Psych Recommendations; Mary Thornton, • Increase co-location of services (e.g., mental health at shelters 2018 and on streets, benefits and housing navigation) 5. BHS External Quality Review Organization Report; FY1819 • Create a database and/or tracking system for behavioral health 6. Justice that Heals Report, District Attorney, 2017 beds and wait times 7. CARE Task Force; 2014 • Expand harm reduction housing for chronic alcoholism 8. Hospital Council Mental Health Task Force; 2009 (managed alcohol programs) 9. SFDPH Community Programs – Stakeholder Engagement • Expand data sharing, increasing the ability to share information Process, 2009 among providers and agencies in order to improve care coordination for shared clients 18 Reform Vision For our clients People experiencing homelessness have low-barrier access to welcoming, high quality behavioral health care that matches their needs. For our system of care Design a system of care grounded in evidence-based practices that reduces harm, increases recovery, and is suited to efficiently deliver behavioral health services to people experiencing homelessness. 19 Reform
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