In a move that’s being welcomed by public health advocates, two Orange County supervisors are inviting the public to tell them what they think about the county’s massive array of mental health services.
Supervisors Andrew Do and Lisa Bartlett have scheduled a four-hour hearing Friday specifically to get feedback about how the county is doing at delivering these services, what their experience has been, and ways to improve the way things are done.
The hearing is scheduled for this Friday from 2 to 6 p.m. at the county Hall of Administration (333 W. Santa Ana Blvd., Santa Ana).
It’s a critical system that has huge impacts on local communities’ health and well-being. In California, counties are the main providers of public mental health services, with Orange County alone having over 200 different programs.
Public input is key for supervisors to improve issues like a sharp rise recently in children being hospitalized for mental health crises, experts say.
“This is an excellent initiative from the board of supervisors,” said Dr. Dele Ogunseitan, the chair of UC Irvine’s public health program, who months ago encouraged supervisors to take a leadership role in bringing together researchers, policymakers, medical providers, and the public in a dialogue about the mental health system.
There are numerous benefits to improving the county’s $320 million mental health system, he added.
“Mental health problems are among the most insidious of all public health issues because of their impacts on other social problems such as homelessness, violence, drug abuse, and sub-optimal economic productivity,” he said.
Public input is the most important part of supervisors’ efforts to improve the system, Do said.
“For me, that’s the most critical part of this process, because they are the users, right? If we think of them as customers, then the whole organization exists to serve its customers,” Do told Voice of OC in an interview.
Bartlett said she was looking forward to the hearing.
“I’m really excited about the public weighing in on Friday,” Bartlett told Voice of OC, adding that it’s part of “an ongoing dialogue” about the mental health system.
The two supervisors formed an ad-hoc committee last year to examine the issue in depth and have found several areas of concern.
One of the biggest things that’s struck Do is what he calls the “silo effect,” in which county programs are looked at as separate components, with little follow-up with those who are served.
“There is little coordination between the different things that we do,” Do said, with that approach taking a toll on costs – both to patients and taxpayers.
For example, he said, the county’s emergency services programs don’t do follow-up that could help patients remain stable and prevent them from having to return.
“By being more preventative and treating the whole person holistically, we can prevent those major flare-ups, [and] reduce the incidents of those major flare-ups,” Do said.
Another issue is the complexity of the county’s 200 programs.
Do said he took a tour of UC Irvine Medical Center, where staff there “told me the horror stories of having to keep mental health patients in the ER for hours if not days, tying up emergency beds for regular patients.”
One staffer made an off-hand comment that even if they know a person qualifies, they still don’t know which of the county’s 200 programs to put them in, Do said.
Do said he thought they were exaggerating about the number of programs, so he went to county Health Care Agency officials to ask if there really were 200 programs.
“When they said yes, my jaw dropped,” he said. But his jaw was about to drop even more, he said, when he asked for a list of the programs.
“It took them a month to put it together,” Do said. “That means they didn’t have it. And so I am thinking to myself, how do you run anything if you don’t have an inventory of what you have? How do you track performance? How do you evaluate things?”
When he did get the list, Do made it public, along with a bigger-picture breakdown of the county’s mental health spending.
“What I want to do is to bring everybody up to the same level of knowledge, so then we can truly give meaningful input,” Do said.
Meanwhile, Bartlett has pointed to another key gap in services locally: Orange County has only 80 hospital beds for mental health patients, despite the need being at least in the hundreds, she said.
“I just find that astounding,” Bartlett said in an interview.
What that means, she added, is that people going through mental health emergencies instead end up in general emergency rooms, which is not the most best place for them.
She supports creating crisis stabilization centers in the north, central and southern parts of the county.
“I think that we could probably get individuals stabilized within a short period of time instead of being hospitalized for a week,” Bartlett said.
She also noted that the county doesn’t have any psychiatric beds at hospitals for children under age 12. Supervisors have approved funding for Children’s Hospital of Orange County to help create the first 18 beds, which are slated to open by the end of next year.
As for crisis stabilization centers, Do said that would be an important step, but that it’s important to also look closely at where patients go after they’re out of emergency treatment.
“It’s up to us to follow up with these people. It isn’t enough” to prescribe medication and then wait for them to come back when they have a crisis.
The best mental health systems are ones that go far beyond simply reacting to crises, but actually prevent them, said Ogunseitan.
“An effective mental health system has the same elements as the best run hospital care system that adopts the ecological model of public health, where cures are embedded in a system of prevention and social support,” he said.
Ogunseitan said the biggest area in need of improvement in Orange County is “investment in resources for early detection, particularly among young adults.”
He noted that there’s been a “a reversal of gains in life expectancy” nationwide among caucasians, which has been linked to to drug abuse and other behavioral health problems.
Nick Gerda covers county government for Voice of OC. He can be reached at ngerda@voiceofoc.org.