Grand jury calls for changes to county mental health services

May 22--For San Luis Obispo adults in need of county mental health services, accessing those services can be confusing, take too long and offer little help while awaiting an appointment, according to a county grand jury report released this week.

The report found that someone in need of mental health care, but not in immediate crisis, could wait up to 45 days for an assessment and then another 14 days to actually receive care.

"Within those 60 days, a person's condition could escalate to a major mental health event, leaving the county responsible to provide a potentially higher level of care," the report noted.

Much of the wait time was caused by a need for more licensed therapists, psychiatrists and other professionals, the report said. It noted that psychiatrists were particularly hard difficult to hire because the county competes with Atascadero State Hospital and California Men's Colony, which pay higher salaries.

The report acknowledged that the county Board of Supervisors authorized a salary increase last year, which resulted in two psychiatrists being hired. The county also is considering recruitment incentives including student loan repayment programs.

The grand jury also found that two phone numbers listed on the county's website -- a 24-hour suicide hotline and a 24-hour non-emergency number for mental health services -- were confusing and suggested combining them into a single number.

While offering eight recommendations for improvements, the report also noted, "All people interviewed, especially those in their positions for a long period of time, believe the county has instituted best practices and is very good at providing mental health services. These same individuals also recognize mental health services in the county could be improved."

Grand jury reports are advisory only but the county Board of Supervisors and the county health agency are required to file responses.

County already making fixes

The grand jury initiated its analysis after getting a complaint from a resident about a specific person having trouble accessing county mental health services. The panel decided to broaden the scope of its analysis beyond that person, in part because of national media coverage that a lack of mental health services could be linked to tragedies such as the murders of six students in Isla Vista a year ago.

County Behavioral Health Services Administrator Anne Robin said the department is working on a response to the grand jury report but that many of its recommendations are already being addressed. Wait times, in particular, have been substantially reduced in recent months, she said.

"The grand jury report was well-written and, really, nothing was a surprise, although there are a few minor errors. We've already implemented some changes," she said. "Some of the recommendations are interesting, and we will take them under advisement."

Robin said the county undertook a comprehensive analysis of the gaps in its system last year and has been making changes. She said wait times for an initial mental health assessment -- the first step in determining the appropriate treatment -- have been cut in half by filling some vacancies, moving staff and adding appointment times.

"We used to be in the 50-to-60-day waiting range," she said. "We're now 20 to 30 days and less ... and we get them an appointment (for treatment) within seven days now."

The average wait to see a psychiatrist is now 10 days, she said.

The department's statistics for April show wait times for an assessment averaged 15 days at the San Luis Obispo office, 19 days in the North County and 22 days in the South County.

In regard to staffing, Robin said the two new psychiatrists, as well as contracted temporary psychiatric services, have resolved the issue for now. The department is also adding other clinicians, she said.

"We haven't had a lack of psychiatrists," she said. "We've had a lack of permanent psychiatrists."

Confusing hotlines

The grand jury report discussed at length the two phone numbers on the county website.

The first is a 24-hour suicide hotline operated by the nonprofit Transitions Mental Health Association and is answered primarily by trained volunteers. If the caller is not in danger but would benefit from follow-up care with the county, the report notes that federal medical privacy laws prevent the volunteer from scheduling an appointment. Instead, the caller is told to dial the other number.

The other number is to the county mental health agency and is answered during the day by licensed therapists who can determine whether the person needs immediate help or can make an appointment for an assessment. At night, callers can leave a message that will be returned the next business day, or they have the option of speaking to a live person, and in that case, the call is rolled over to the suicide hotline.

The grand jury recommended combining the services into one number, and establishing a system so that volunteers can schedule appointments "while maintaining (privacy law) confidentiality requirements."

The report also criticized the county mental health website for not clearly distinguishing what services are available at each number.

Robin disagreed that the numbers should or legally could be combined because they provide different services and have different privacy requirements. However, she agreed the website could be improved.

"We would like to redesign our website," she said. "We can do some minor things now to make that more clear."

Facility often nearly full

Finally, the grand jury expressed concern that the county's 14-bed Psychiatric Health Facility is often nearly full and recommended creating an outpatient Crisis Stabilization Unit to provide care for up to 23 hours, either to prevent the need for inpatient treatment or to serve as a stopgap until a bed was available.

The county applied for and did not receive a state grant to open a unit in 2014 but is still trying to secure one within two years, the report said.

"The CSU is a great idea," Robin said. "I don't know that it will save the county money, but it's a good program and we're working to make that happen."

The grand jury also recommended reconfiguring the inpatient facility so juveniles -- who have a separate entrance -- don't have to walk through a common area to get to the juvenile treatment area.

Reach Assistant City Editor Janet Lavelle at 805-781-7931. Follow on Twitter @janet_lavelle

___

(c)2015 The Tribune (San Luis Obispo, Calif.)

Visit The Tribune (San Luis Obispo, Calif.) at www.sanluisobispo.com

Distributed by Tribune Content Agency, LLC.