Regional Meeting Resource Staff:The community feedback period for this idea began on 6/5/2019 and ended on 8/4/2019

What is the problem that needs to be addressed? Please describe how it is related to mental health.
Regional governments in Orange County, including cities and county agencies, have public comment periods during meetings. It is observed that meetings do attract people who are homeless and may have a mental illness. These venues are not equipped to provide needed services thus the individual makes a public comment, many times with significant emotion, without any mechanism for post-comment intervention/follow up.

 

Why is this a concern for Orange County? What can Orange County and other counties learn from this project?
County Supervisors, City Councilmembers and other elected/non-elected officials should not be expected to provide human services to individuals that appear during government meetings. Humans do not always walk into the “right door” to obtain services.

 

What is currently being done to resolve this problem in our county and throughout the United States? If applicable: Is it working; why or why not?
What is currently being done is providing an open comment period, giving people approximately three minutes during the open comment period with the option to provide written comment to the clerk, and moving on to the next person when time is up.

 

What is new or different about this project idea? Please describe how this differs from what is already being done (Question 6). Please list any research that was done on this topic.
The open questions this project can answer include: 1) Are people utilizing government meetings as a first attempt to cope/ask for help or is it their last? 2) Are people utilizing government meetings asking for help aware of how to get help through established processes? 3) Do people utilizing government meetings qualify for help currently available? 4) Do people utilizing government meetings experience excessive barriers to obtaining help?

 

What is the project idea? Please describe how this project will operate.
Provide licensed, trained and resource knowledgeable staff available at regional government meetings – County Supervisors, City Councils, etc – to provide resources or intervention to people who may not have help nor know how to get help. If a person needs help, then providing Just-In-Time help to include: 1) HTS/HTO/GD risk assessment 2) Immediate needs assessment: food, water, shelter, clothing, security, healthcare, sanitation, transportation, reversing social isolation 3) Bridging care plan to resources available with follow up appointment with a specific provider (care continuity) who has access to the information already provided (health record continuity) 4) Easy to understand educational materials that explain the inclusion/exclusion criteria for the many many choices available. 5) If available, informed consent information about the outcomes associated with the many, many choices available. 6) Is the underlying concern about an issue immediately impacting the individual or is the underlying concern about a future issue/trend that makes the individual feel unsafe in their community (i.e. criminalizing sleeping in a parked car, carrying a sleeping bag, eviction, priced out of rental housing, etc) 7) VI-SPDAT filing, if needed and not previously filed. Regional government bodies that allow this service into their meetings may be provided access to de-identified reports that may explain why a person is showing up to a government meeting and what deficiencies may exist in the community.

 

Additional Information:
Respondent skipped this question

 

May 21, 2019

2 comments

Thank you for your submission. The Innovation team needs additional information, please elaborate on your responses as best as possible so that we may work through our review process.

•The idea as proposed sounds like an outreach program that would have staff available at public meetings to provide needs and risk based assessments along with linkage to a mental health provider. The outreach staff and the mental health provider would have a system that would be able to share information. Is this correct?

•How would the success of this program be measured?

The questions asked by the Innovations Team are a bit too specific at this time. In the Scientific Process of Observation, Formulation of a Question, Hypothesis, Prediction, Testing, Analysis, Conclusion, Replication and Peer Review – I am at Observation mostly and hypothesis somewhat. I am not quite at experimental design/intervention. It is unfair to place the burden of thought on one individual with impaired, delayed access to a two-way conversation on a particular innovations proposal. Due to the lag time in the process I feel going through the process and refining the proposal during the process as the best choice of the currently provided choices.

What I observe are three ways that Orange County engages people for mental health resources: 1) People come to a clinic; 2) People are court ordered to come to a clinic or 3) Outreach comes to a homeless person in the streets.

What I observe are five different mental health payors: 1) Medicaid/SSI/County Behavioral Health (Advantages of institutional memory, recovery model, continuity of care and responsiveness/flexibility); 2) SSDI or Medicare Advantage Plans that I am not that familiar with; 3) Employer Plans that I am not that familiar with; and 4) Private Health Insurance Plans that I am not that familiar with; and 5) Private Cash Pay. My impression is that 2, 3, 4 and 5 have reduced access to psych/resource services due to “plan management,” general disincentive for mental health providers to bill insurance, situational access (if you keep this job, keep paying on the insurance or stay disabled/sick enough then you get to keep services).

What I observe is a shortage of Medical Doctors/Psychiatrists (https://news.aamc.org/press-releases/article/2019-workforce-projections-update/ https://news.aamc.org/for-the-media/article/gme-funding-doctor-shortage/ https://news.aamc.org/medical-education/article/new-aamc-research-reaffirms-looming-physician-shor/ https://www.npr.org/sections/health-shots/2019/05/31/728334635/whats-doctor-burnout-costing-america https://www.medscape.com/slideshow/2019-lifestyle-burnout-depression-6011056) and this issue hasn’t made it to the Orange County Indicators annual report. But it will, eventually.

What I observe is the concentration of wealth/cash glut for the few (the few cash rich people want a return on their investment, but look around at not many ways to find sufficient return at historically unrealistic double digit rates), the ability to make money but inflation on several key market basket items (education, housing and healthcare/mental healthcare, lending/credit rate for the typical individual) makes that money unusable/insufficient , and emergent sudden events that put large groups of people into crisis, visiting their local representativie government meetings (most recently moble home residents who face steep rent hikes, water rate increases, land use). What I observe is local representative government making decisions without much public input from socail services employees/mental health.

Money isn’t the limiting resource – there has been a cash glut 2011-2017 (https://www.bankrate.com/banking/cds/historical-cd-interest-rates-1984-2016/ https://www.firstrepublic.com/finmkts/historical-interest-rates). Supply is the limiting resource (housing, water, space allocation, Physicians). The cost of increasing supply of housing, water, space/land (fly to the moon/Mars?) and Physicians is quite high.

What I hypothesize is that the ways Orange County engages people for mental health resources doesn’t provide enough options for the treatment naive individuals in crisis who may be experincing changes in healthcare payor or healthcare provider concurrently with crisis. I observe that treatment naive individuals in crisis are less likely to understand mental health symptoms/reponses and less likely to make healthy choices like avoiding suicide (https://www.psychiatryadvisor.com/home/topics/schizophrenia-and-psychoses/first-episode-drug-naive-patients-with-schizophrenia-more-likely-to-attempt-suicide/ https://www.who.int/mental_health/media/en/56.pdf , specifically “However, a substantial proportion of people who commit suicide die without having seen a mental health professional. Improved detection, referral and management of psychiatric disorders in primary care is an important step in suicide prevention.”). Since we are short on non-burnt out Physicians, it will likely be a non-physician doing an intervention for the above described individuals.

I hypothesize that individual people will start to face more significant stresses to staying on their current healthcare payor and in their current healthcare system. I hypothesize that market failures will increase and the current public policy of growth will fail to provide for basic needs (food, water, shelter, healthcare). I hypothesize that self-care isn’t going to be a priority in this environment.

The motivation for this project is not to understand the baseline functioning/baseline interventions in mental health. Baseline functioning would not need this project as people would make an orderly path to the current choices for mental health resources. The motivation for this project is an intervention to anticipated emgergent functioning.

With this thought process, the measure of success wouldn’t be that exciting. Maintaining the status quo suicide rate would be a measure of success – the null hypothesis. Identifying Orange County equivalent communities for a case-paired study of sucidie rates during the study period could be interesting. Measuring anxiety/stress surrounding community meetings for people in representative government could be interesting. Measuring currently unidentified metrics associated with “healthy communities” could be interesting. This submitter is still unclear about what outcome measures would be “interesting enough” to proceed and isn’t well versed in accepted metricis/successful metrics for measuring public policy interventions for mental health projects.

So, yes, this is throwing the project over the fence to a yet identified person. But this is the current, best choice of the choices presented.

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