Officials work to create integrated health model, new housing and services

NORTH BAY – Faced with budgets “cleaned to the bone,” North Bay county mental health care directors said this year will mark a distinctive transformation of the system.

Sonoma, Napa and Marin officials are moving forward with new strategies for doing more with less and said intensified collaboration with community partners and integration with physical health is central to the change.

“With the recent round of budget cuts and dramatic anticipated loss of sales tax, Mental Health Services Act and vehicle tax revenue, those are three big hits. At this point it feels like there is nothing left to adjust,” said Jaye Vanderhurst, mental health director for the Napa County Health and Human Services Agency.

“We are really facing dramatic programmatic changes and in a lot of ways we are back to the beginning; we will have do adjust completely how we do business.”

Napa was recently host to a forum of the California Mental Health Directors Association that focused on adaptive new strategies for adjusting to economic turbulence. The two-day event included directors from across the state and a presentation by the president and chief executive officer of the California Institute for Mental Health. Central to strategies for transforming the system is better focus on preventative care as a method for reducing expensive hospitalization.

With expansion of pre-emptive care in mind, local mental health departments are in various stages of implementing integrative health programs meant to coordinate physical and mental care and catch issues early. These programs are organized in different models, including mental health staff stationed in local health centers and primary care doctors making visits to county mental health care facilities.

“We have been looking for opportunities to redesign the system, and now is definitely a time of transformation,” said Sonoma County Mental Health Director Mike Kennedy.

To absorb the immediate budget cuts, all three counties have left unfilled positions vacant or made small staff reductions. Others have collapsed programs and reduced the number of individual visits or transferred to a completely group-visit format. At the same time, new programs and services will come online this year through increased work with community partners.

Napa is in the beginning stages of forming an integrative physical and mental health program with federally qualified health center Clinic Ole. Last year, the county’s medical director participated in a psychiatric medication forum at the clinic meant to help doctors become more comfortable with prescribing. Soon the department would like to co-locate county staff with clinic providers.

In Sonoma, the county already funds mental health professional hours within the Southwest Community Health Center system and officials are piloting a drop-in psychotherapy program in Petaluma.

“Demand for our mental health services has continually increased, and we are working to offer more services, but right now our waitlist continues to grow,” said Southwest Director of Mental Health Services David Anglada-Figueroa.

Also, the county is collaborating with partners to offer new services to children and families, trainings for law enforcement, a wellness and empowerment center and new mental health housing. Mr. Kennedy also reorganized outpatient teams to better fit the recovery model of care, including staff for dual-diagnosis patients, the homeless and transitional-age youth.

“Really in the past four to five years we have really concentrated on partnering with the community, particularly to help to deal with some other reductions,” Mr. Kennedy said.

“In the past this was not always the situation, and it did not really feel like a complete system.”

[caption id="attachment_15720" align="alignright" width="360" caption="n collaboration with Community Housing Sonoma County, Burbank Housing Development Corp. is constructing the $19.5 million Fife Creek affordable housing complex, which will include a number of units specifically for people suffering from mental illness."][/caption]

The county assisted in the opening of the Vida Nueva housing project in Petaluma last year, and leaders hope to open several other homes from stimulus funding meant to rehab foreclosed homes. The county is also collaborating with NAMI Sonoma County, Community Housing Sonoma County and Burbank Housing to reserve several rooms for mental health patients in the new Fife Creek affordable housing project in Guerneville.

“Everyone in the county department agrees early intervention is key, and they have been an incredible partner as we all face new budget constraints,” said Rosemary Milbrath, executive director for the local NAMI.

In Marin, the mental health department has implemented some reductions to programs and staff, but at the same time it has launched a fully integrated physical and behavioral health system others are looking to as a model.

“When demand is high and resources are down, you just have to be creative,” said Marin Health and Human Services Division of Mental Health Director Bruce Gurganus.

“What we don’t want to do is create a budget based on false savings or cuts that in the long-run will cause increased costs. This concept is what has caused a lot of shift in the way we provide mental health care from the institutionalized model to nurturing independence and wellness: helping people versus forcing people.”

The department has introduced peer support groups, drop-in activity centers, subsidized housing for clients and new funding for community clinics’ behavioral health programs through grants and other sources.