Mono County’s behavioral health department has made a radical change in how it conducts business over the past year or so.
The department has focused on treating every individual who walks through its doors for both physical health and mental health issues.
Once linked to specific services, the department made sure those individuals seeking help did not fall through the cracks, even if it meant escorting them to doctor and/or counseling appointments.
The results gained the department a prestigious award last month from the California State Association of Counties. The department received a “Challenge Award” for innovation in county government—one of 11 awarded out of 200 applicants.
On the ground, the paradigm shift has “exceeded our wildest dreams,” said the county’s behavioral health director, Robin Roberts.
“We decided to address the effects of chronic diseases on clients,” she said, “with the premise that many of the clients seeking mental health help had underlying physical issues that were adding to their mental health issues.
“The task seemed almost insurmountable, certainly overwhelming,” she said.
“Statistics show us that consumers of county mental health systems, people with ‘severe mental illness,’ have a life expectancy that is 25 years less than an average American. Twenty-five years! We had seen the death of six clients over a two-year period and felt the impact of those statistics in a deeply personal way.”
From there, the department launched the first of many changes, Roberts said: to take and record the blood pressure of individuals who walked into the office, ask them if they have a primary care provider, whether they use tobacco products, and how much they exercise each day.
“Simple data collection, right?” she said. “Turns out, this prompted many important questions from consumers and staff.”
Questions like, “I thought mental health was separate from physical health?” “What do high BP numbers mean?” and “Can you help me access primary care?” Roberts said.
“What looked like a simple act of putting the blood pressure cuff on a client’s arm and writing a few numbers down was in fact an information exchange that created a learning curve for both the consumer and the staff,” she said.
“Suddenly there was talk about how blood pressure relates to stress and how depression is decreased by daily activity. But more importantly, we saw from our survey that our client satisfaction and the client’s perceived wellness increased tenfold.”
The department didn’t stop there. While some see the Affordable Care Act as a problem, Roberts said in a recent statement describing her new program that she saw a unique opportunity to both tap the resources made available by the new law, and to do a better job of meeting the needs of every county resident who came to her office seeking help.
“We knew we had an opportunity to create a unique, very small county response,” she said.
“As an organization, we had just taken on new leadership and were eager to find our identity. We wanted to create partnerships with county and other agencies. We believed that collaborative efforts would benefit staff and clients greatly.”
Roberts and the behavioral health staff used their combined knowledge of what worked—and what did not—to adopt what she calls the “warm hand off” policy.
“First we made sure everyone who came to us was fitted with some kind of service, rather than having them wait to be seen,” she said. “We found what they qualified for. Then, we worked with them to make sure they actually took advantage of the services we offer. We have lost some people because of lag time between intake and the first appointment.
“Maybe they have childcare issues, or can’t drive, or don’t have the money for transportation, so we have focused on getting them to the services they are eligible for, including escorting them to a primary care doctor, if that’s what is needed.”
The results of this warm hand off approach combined with the focus on connecting mental and physical health has been “fantastic,” she said.
“We believe the increased contact and connection along with weekly engagement about the body and how physical health influences mental health (and vice versa) is the key.”