Tuesday, November 22, 2016
Open Board of Directors Meeting
San Bernardino Community College District
114 S. Del Rosa Drive
San Bernardino, CA 92408
Present: Deborah Barmack, Peter Barmack, Carole Beswick, Tom Brickley, Mike Burrows, Rachelle Bussell, Scott Hofferber, Mark Kaenel, Lowell King, Bill Lemann, Dan Murphy, Roman Nava, Cid Pinedo, Steve PonTell, Jan Remm, Elizabeth Romero, Kristine Scott, and Steve von Rajcs.
Guests: David Colwell and Sharon Pudlow
Announcements: 1) The public memorial service for Jack Brown, Executive Chairman, Stater Brothers Market, will be held on Saturday, December 3, at 9:00 a.m. at the Citizens Business Bank Arena.
M/S/P: Minutes from November 15, 2016.
Rachelle Bussell introduced the panel of speakers to discuss the Behavioral Health Crisis in San Bernardino County. The four person panel consisted of Dr. William Murdoch, Jr., Chair, Dept. of Psychiatry, Loma Linda School of Medicine; Lyndon Edwards, Loma Linda University Health, Sr. Vice-President; Edward Field, MBA, Vice President/Administrator, Loma Linda University Behavioral Medicine Center and Jan Remm, MPA, PT, Regional V. P. for the Hospital Association of Southern California.
The panel presentation provided a historical perspective on behavioral health in the United States and San Bernardino County, gave a current overview of the system of care for patients with behavioral health diagnoses, discussed the challenges with the current behavioral health system and reviewed opportunities to advocate and improve the system of care for patients with behavioral health diagnoses.
The Institutes for Mental Disease (IMD) are licensed/accredited psychiatric facilities. The IMD exclusion prohibits the use of federal monies through Medicaid for any care provided to patients from 21 to 65 years old, in mental health or substance abuse residential treatment facilities with more than 16 beds. As a result, many individuals suffering from mental illness and substance use disorders are unable to access care. Individuals with private insurance or Medicaid managed care plans may even find that though their plans cover mental health care, there may not be any mental health professionals available to provide it. Nationally, less than one in five general hospitals has separate psychiatric wards. These facilities are subject to the IMD exclusion and, therefore, are incentivized to keep their bed count below 16 to preserve their Medicaid payment eligibility. These restrictions create significant barriers to patients attempting to access care.
The statistics are sobering with 1 in 5 adults experiencing some form of mental illness and 1 in 25 experiencing serious mental illness annually. Less than 60% of those with serious mental illness receive treatment. It is recommended that there should be 50 public psychiatric beds per 100,000 population. Currently Riverside County has 8.85 beds/100,000 and San Bernardino has 18.2 beds/100,000. From 1995 to 2014 there has been a 29.6% reduction in psychiatric beds as funding continues to diminish at both federal and state levels. Loma Linda Behavioral Medical Center spends some $2M (unreimbursed) annually but remains committed to continue this important service to the community.
Our Hospital Emergency Departments (ED) have experienced a 47% increase in behavioral health problems with depression listed as the number one chronic medical condition. Those who are unable to find appropriate treatment before a mental health crisis occurs may face any number of negative outcomes including job loss, homelessness, imprisonment, emergency room boarding, substance abuse, or vulnerability to violence. There is still a stigma about mental health, and our society wrongly keeps physical health separate from mental health. A parity law is needed so medical and mental health are treated equally. Typically ED staff and general practitioners are focused on physical health and not adept at handling behavioral health issues. The situation is worsened by the severe shortage of mental health professionals.
The existing system is divided and complex. Often medical care and behavioral health care are not provided at the same location. There are different payors and providers based on severity of mental illness. Designation of mild/moderate mental illness can be processed through Managed Care Medi-Cal but the severely mentally ill must go to the County Department of Behavioral Health. A 5150 hold refers to the LPS Act of the California Welfare and Institutions Code. It is a state law governing the involuntary civil commitment of individuals who, due to mental illness, pose a danger to self, a danger to others, or who are gravely disabled and require inpatient psychiatric care. Individuals are held for evaluation and treatment for 72 hours. There is little consistency from county to county on who is authorized to place and/or remove such a hold and clarification is needed.
Suggestions for advocacy are as follows:
- Removal of the IMD exclusion
- True parity for the funding and treatment of behavioral health conditions
- Audit/clarify funding streams for treatment of patients with behavioral health conditions
- Statewide guidance regarding who can place/remove 5150 holds
- Liability protections for ED Physicians to place and remove 5150 holds
- Full parity for the funding and treatment of behavioral health conditions
- Clearly allow telehealth for treatment and the placement/removal of 5150 holds
- Authorize ED physicians in non-LPS designated hospitals to place and remove 5150 holds
A Q & A period followed.
Meeting was adjourned at 8:31 a.m.