The report finds that states’ mental health programs need consistent funding and community involvement

(SACRAMENT)

Mental illness is a major public health problem. According to the Centers for Disease Control and Prevention, more than 20% of American adults live with a mental illness, such as depression and anxiety. For perspective, that’s more than all adults with coronary heart disease (5%) and diabetes (14.7%) combined. However, understanding and addressing mental illness remains very difficult.

A team of experts from UC Davis was tasked with evaluating the services of 15 mental health crisis programs in California. These programs designed for young adults and transitioners (ages 16-25) were funded from 2018 to 2021 by state mental health legislation called SB-82.

The purpose of the evaluation was to draw lessons learned from investment in these programs that could help inform the development of crisis interventions in California.

The team interviewed program providers, users of mental health services, and law enforcement officers. They also reviewed grant proposals, census data and agreements with community partners, and conducted two surveys of grant recipients. They submitted their report to the Mental Health Services Oversight and Accountability Commission.

Their evaluation highlighted ways to promote better mental health crisis management in California and the need for consistent funding and community engagement.

Diversity of mental health services and infrastructures

More than $33 million was distributed to 15 recipients to fund programs for young adults and transitioners. The report showed that 14 of the 15 programs provided a total of 81,643 services from the start of funding through December 21, 2021. These services were provided during 23,485 encounters with 17,408 individual clients. Services fall into four main categories:

  1. prevention
  2. crisis access and lifeline
  3. mobile crisis assessment and triage
  4. post-crisis monitoring

Some of the benefits of providing these services include fewer psychiatric hospitalizations and involuntary holds, referrals to psychiatric hospitals from the emergency department, and law enforcement involvement in crisis care.

The programs operated in counties that were very diverse in terms of infrastructure and geography. For example, population size ranged from 45,670 in Calaveras County to 10.2 million in Los Angeles County. This diversity resulted in a variety of services provided.

“What works in one county may not be right for another. The flexibility and understanding that a small rural county may have very different needs than a large urban county is a really important starting point for the allocation of funds,” said co-senior author Joy Melnikow, professor emeritus of family and community medicine.

The researchers found that giving programs flexibility in using the funds was critical. Much of the money was used in triage, mobile crisis assessment and follow-up with people after a crisis.

Managing mental illness crises requires strong community coordination

They also found it important for programs to offer extended hours.

“Many of the crisis events that we see are at night and on weekends and when those crisis services are not here, that then falls on the emergency departments and law enforcement officers, neither of whom are necessarily better at do it,” said co-lead author Mark Savill, assistant professor in the Department of Psychiatry and Behavioral Sciences.

The report highlighted the role of community partnerships and the need for crisis services and law enforcement coordination.

“Every law enforcement officer we interviewed was incredibly supportive and recognized the real key impact of having mental health professionals in this crisis space. Much of these officers’ time was spent engaging in interactions of crisis care. They don’t have the proper training and resources to deal with these situations. Having an alliance with these programs was critical to better serve the public they engage with,” said Savill.

Need for long-term support and a continuum of care

The report also showed that the funding allowed counties to develop new and useful strategies and partnerships. Some of these efforts allowed for much-needed long-term follow-up.

“When we talked to providers, family members and key partners, we really felt how critical it is to think about supporting that transition to a long-term recovery, so they don’t have another crisis,” Savill said.

Looking at where the money was spent could point to gaps in the system, the report said.

“By following the money, we identified where the gaps in the system tend to be right now,” said Cameron Carter, co-senior author of the report and chair of the Department of Psychiatry and Human Behavior at the University of California, Irvine. . “The need is to prevent future crises, to get people out of that cycle of crisis by linking them to ongoing care. Clients shared how some services were transformative in their lives, like having that support afterwards and some continuity of someone to talk to.”

Cameron Carter, UC Irvine

The need is to prevent future crises, to get people out of this crisis cycle by linking them to continued care.Cameron Carter, UC Irvine

He noted that there is a revolving door phenomenon where clients cycle through the system and eventually lose confidence in finding help.

“Many of the services that were offered are related to monitoring. I think the reason for this was a loophole in the system. You have to link people to follow-up care and help support them so that the things that precipitated the initial crisis don’t just happen again,” Melnikow said.

Someone is giving a helping hand to a needy woman sitting in a dark street
It is important to meet people with mental illness where they are

The need for a sustainable funding strategy to support mental health programs

One of the main problems for program planning was inconsistent funding.

“As you identify the things that work, how do we move from a cyclical funding strategy?” Melnikow asked. “There should be a way to make successful programs more sustainable. It’s hard to plan and build on success when the grant ends, and you have to find another source of funding. This is really important because this insecurity prevents counties from building systems that can last.”

Ideally, he said, there would be a coordinated policy that would be sustained over time.

Joy Melnikov

There should be a way to make successful programs more sustainable. It is difficult to plan and build success when the grant ends, and another source of funding must be found. Joy Melnikow, UC Davis

Demanding work that needs support, recognition and promotion

Melnikow also raised the issue of appreciation and compensation for those working in the mental health field.

“It’s important to recognize that this type of crisis care is really demanding and hard on the people who provide it. It’s hard to find people who want to do it. They may not feel supported in what they’re trying to do with the customers, making it difficult to recruit and retain staff.”

Mentoring and a career path for members of the mental health crisis team are also important.

“They are asked to work in difficult conditions, after hours, in a mobile way. They need supervision and support. This is essential in all areas of mental health care, but most important for those in the field. They need a career,” Carter explained. “They need to have a place in the system where they can do what they’re doing, but also develop and move into more responsible and better-compensated roles within the system.”

Young man in a blue shirt and blue jeans.  He looks down and leans forward.  A female psychologist holding a folder in one hand and placing the other hand on the man's left elbow.  Both individuals have dark skin.
People with mental illness need ongoing care to prevent another crisis

Other recommendations

The success of mental health crisis programs also depends on community organizations working together.

“It’s critical to know people where they are. Working on mental health crises has to be community-based. You have to foster very strong ties with your community. That includes the sheriff’s department, law enforcement, housing, other mental health services and charities. These community connections are critical to gaining referrals, delivering effective care and supporting long-term recovery-oriented services later on,” explained Savill.

Mark Savill

It is essential to know people where they are. Work on mental health crises must be community based. You need to foster very strong ties to your community.Mark Savill, UC Davis

About the Investing in Mental Health Wellbeing Act 2013

The goals of SB-82 are:

• cover the needs of people in crisis in the least restrictive way
• reduce the costs of avoidable use of the emergency service
• reduce the participation of law enforcement
• reduce hospital admissions

Funds provided by the legislation were intended to improve access to and delivery of crisis triage services in California. These services focused on building capacity across the spectrum of mental crisis care. This included crisis prevention, intervention, stabilization, mobile crisis support and connection to post-crisis mental health services.

Read the full final report and recommendations: California State Evaluation and Learning Support for SB-82 Triage Grants. (pdf)

Co-authors of this UC Davis report are Bethney Bonilla-Herrera and Katrine Padilla of the Center for Health Policy and Research and Jamie Mouzoon of the Center of Excellence in Behavioral Health. Other co-authors are Lindsay Banks and Matthew L. Goldman.

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Image Source : health.ucdavis.edu

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