Transcript PowerPoint Presentation - California Institute for Mental Health (CiMH)

Community Clinics and Health
Centers & Mental Health
Services
California Primary Care & Mental Health
Integration Policy Initiative
January 12th, 2009
Molly Brassil, Assistant Director, Policy
California Primary Care Association
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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
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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
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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.
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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.
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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.
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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.
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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).
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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.
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Integrated Behavioral Health
• Primary clinics often become the
de-facto mental health system
for those unable to access care
elsewhere.
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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
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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.
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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
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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
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Policy
Barriers
&
Opportunities
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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
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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.
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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.
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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 communitybased mental health and primary care system
including community clinics and health centers
(Enclosure 3, Page 14-15).
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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
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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 telepsychiatry, promotores & case managers, home
visitors, homeless programs, mobile vans, and
many other innovations required to link services to
people in need.
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Clinics & County Departments of
Mental Health
• Commitment to holistic health, populationbased & 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
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Questions?
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Contact Information
Molly Brassil, Assistant Director, Policy
[email protected]
California Primary Care Association
1215 K Street, Suite 700
Sacramento, CA 95814
(916) 440-8170
www.cpca.org
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