The Shasta County board of supervisors recognizes Venton Trotter, Associate Engineer, from the Department of Public Works as employee of the month.
Trotter has worked for the county for 30 years. "I've been blessed to work in our community. To give back to our community."
Next is a presentation from the Health and Human Services Agency
Director Donnell Ewert is on the podium - detailing community mental health providers in Shasta County. Medi-Cal, the Medicaid program in state, is managed through health centers. Counselors might be social workers, therapists. That's for that population. Then there are those with severe mental illness, and those are the responsibility of the county. Each county is responsible for that demographic.
We have three acute care hospitals. That's important the mental health facilities that treat folks will not accept folks without medical clearance. We have contractors - federally qualified health centers. We have board and care homes. There is one in Tehama County, along with two in Shasta County.
Ewert is detailing the services available to mental health. It's a system we put together to manage those with mental illness. One measure is the service penetration rate among Medi-Cal Beneficiaries. Those who go through the services. Shasta County has a good rate for getting people served compared to the rest of the state. That could be good or bad news - are we better at outreach or getting people services? How for us to say, Ewert said.
Funding for mental health: 36 percent, realignment. 27 percent Medi-Cal. MHSA 21 percent. Other is 9 percent, 6 percent IGT, and one percent is the general fund. This is a pie of $32 million. This is an estimate for 2015-16.
IGT is intergovernmental transfer. A small amount comes from the general fund and there are other grants, according to Ewert, like the "Block" grant.
Ewert shows a trend for Mental health and MHSA funding. The general fund is flat, the MHSA has gone up and the other sources are flat as well.
Expenditures: The county spent $29 million in 2015-16 for mental health. The biggest slice of pie is Community Services and Support at 23 percent. Then Children's Outpatient at 22 percent. Ewert said the Innovation slice will expand - it was 0 percent previously.
Ewert details the funding paid to boarding homes for people returning to the community after receiving service at a facility. They're being cared for - they don't stay there forever.
Ewert shows the board a 5-year trend for mental health spending. It is relatively flat.
HHSA mental health services includes assessment, crisis intervention, treatment planning, group and individual therapy, collateral interventions with family and caregivers, rehabilitative services, case management, medication mangement, psychological testing, wellness centers, therapeutic behavioral services - HHSA children's services branch and Housing support - HHSA adult and children's services branches.
There are two wellness centers in Shasta County - one in Redding, another in Burney.
Children’s Services Branch Director Dianna Wagner is on the podium. She's detailing pyschotropic medication for children. The trend from 2015 - 2016 shows medication required, behavioral problems, learning disorder and mood and psychotic disorder. "The steady decline does indicate there is an increase focus on the symptoms." Therapy and skill building is emphasized, said Wagner.
Foster youth and placement changes due to behaviors. The different care facilities that foster child goes through is due to their behaviors - a higher level of need. "By addressing the youth's mental health needs, throughout the life of their case, they're able to address their main symptoms and the trauma." There is a discipline team, family, social workers, care providers and others. The county has seen a decline in those placement changes, according to Wagner.
Foster Youth: Pathways to Wellbeing youth - there are three classes outlined for average count of crisis services.
Children adolescents needs and strengths (CANS) is a tool used by HHSA Children's Services Branch.
Next is the data from 274 clients from before and after the use of CANS. The categories include depression/anxiety, psychosis, attention and social functioning.
Wagner is showing the board data from a community support service.
Adult Services Branch Director Dean True is on the podium.
Behavioral Health Court: Available to those with mental illness. The results are positive and shows that the results are a need for more crisis residential services.
True: Those graduates from the behavioral health court. Results show a decrease in the need for severe mental health services. True calls the need for crisis residential a safety valve and a good indication for the community.
There are those who were admitted to the program and True has data on what happens to those who do not graduate. There are multiple reasons someone might not graduate.
The data shows there is an improvement in those people's lives in how much services they need.
True: One thing we track, we want to prevent the involuntary psychiatric hospitalization.
There are different populations detailed by this next slide - those who they never see before and the ones who are known to the county. For the new people, not engaged by services, they could be hospitalized again after getting some help.
True is reviewing the CANS tool mentioned by Wagner. This acronym is called MORS and it's for adults - It's an 8-point scale - where someone is in terms of their mental health. This tracks how someone is doing in the county's services. True shows a pie chart, with 1,044 patients. The average people they see are in the 4 or 5 categories.
Over time those scores change. An increase from a 4- 5 - 6. There are those who increased, about 20 percent. The decrease was 15.7 percent and those who stayed the same was 64 percent.
The full service partnerships: There are 248 partnerships that were active within this 5 year period. On 6/30/2016, there were 57 active partnerships. 44 adults and 13 children. Average length that people stay in those programs is about 18 months.
14 percent of people experienced homelessness ,but 58 percent with fewer days spent homeless.
Incarcerations: 33 percent experienced fewer. 60 fewer days were spent incarcerated.
This extends to ER visits and psychiatric hospitalizations.
True details field based nursing. It's when someone visits a client at least daily. It's a challenge to get that data. For those who have been engaged by this service experience fewer crisis.
The next slide shows pre and post onsite clinicians at ERs. The idea it's taking too long to evaluate someone who is having a mental health crisis. They have decreased the amount of time to do an evaluation. The medical clearance to face to face assessment by a clinician is an important category, according to True.
We are getting to the point now that the assessment is being done in 1-2 hours. We have dramatically reduced the time someone spends in the emergency room. We continue to not have enough in-patient beds - we don't have the ability to control that time frame.
Ewert is on the podium again. What's coming in 2017. Jan. 1 was the continuum of care reform. This is related to reducing children in group home placement. Children need to be raised in a family.
We're trying to reduce that number. Resource approval process will be called Resource families.
The resource care center - the care center - will be managed by Hill Country.
Restpadd will be opening a new facility in Tehama County this year.
Whole Person Care Pilot - mobile crisis team. Will give federal funding to Shasta County - focused on homeless individuals with mental health issues. The mobile crisis team will be contracted out. They can be diverted from the ER. That 65 percent that don't need to be hospitalized could be kept out of there.
The crisis stabilization unit is a question mark now, due to no tax funding. The county will be meeting with hospitals to see about financing.
The Woodlands - it's almost finished. Planned for the Spring. 19 units for people with severe mental illness. There will be a case manager on site.
Eastern Shasta County: Housing options are also on the horizon.
Supervisor Les Baugh: The number one observation, the general public does not believe there are not mental health services in Shasta County. I think this puts that rumor to rest. I would say the observation that there will never be enough money is an accurate statement.
Baugh: We do have challenges in Shasta County, as all areas with mental health areas. We have ER beds regardless if we are answering them quickly... we still have stacking. Like airplanes circling - ER beds are filling up. Out of 32 available beds, most of the time, they are mental health cases. Some of them wait a long time. The obvious observation, there are a lot of homeless folks, and they are struggling with mental health issues. It gets down to, yes we didn't get a positive vote from the community, but it still falls on our shoulders. Can you give us more insight on how we might move forward?
Ewert: When the chief nursing official from Mercy said, there are reasons why mental health patients can't be moved out of the ER. They said 10 and they always say 10. It is not a majority of their beds. My first slide, I was trying to address, mental health is a community issue. Shasta Co. has a role and there are other providers who have a role. It isn't Shasta Co. incumbent to solve those ER issues. We would like a partnership with the hospitals. Shasta Regional Med. Center does have a 20 bed facility - we are having a conversation about working with them on that. They can treat people with co-occuring problems.
Ewert: We don't have enough places to transfer people to and those private facilities can say no in accepting those patients. We also believe the real solution is more inpatient beds.
Wagner is on the podium at a question from Baugh on foster care overhaul in the state.
how does that relate to mental health?
Wagner: Foster youth have suffered some mental trauma at some point in their life. The new paths includes bringing other options, including a resource family that will be assessed. It could be temporary or permanent.
Baugh: Is there difficulty for those foster youth who have mental health issues to finding them homes?
Wagner: At first. But we're learning more and more about trauma.
Wagner said the sooner someone can get into the home, it will decrease the likelihood of mental illness down the line.
Supervisor Mary Rickert: I appreciate the strides you made in progress. As far as those who are institutionalized, what does the picture look like when they're released?
True is on the podium to answer.
True: It's unusual someone would come out and not be placed into a lower level of care. There are people who consent their conservetorship. They literally are free to go and not be engaged by mental health services. Ewert mentioned Ridgeview. We coordinate and those patients are on conservator ship. That is lower level of care and the county engages them with those services. The statistics for those who are hospitalized again is not available just right now.
It takes 26-40 hours to find someone an inpatient bed, said True. Hospitals might not agree, because it takes days.
Restpadd is taking half of the people that the county needs to hospitalize. The rate vary, said True. There are $900-$950 a day. That's an average of over a week, said True.
Rickert thanks Wagner for her work on getting more foster homes in the Intermountain Area. I just want to thank her publicly.
Supervisor David Kehoe says last Thursday Wagner gave a great presentation to the Redding Rotary Club. The difficulties in foster care was conveyed. Kehoe thanks her as well. The audience applauds.
Next item: Public comment time.
Kehoe says this is the most important time to the agenda. There are several requests. Dr. Ray John - It's on the Shasta County Veterans Office.
Ray John is on the podium. I served in the marine corps in the Korean War. A year ago I got into my car and got physically ill and went into the veteran's service office. I felt loved and cared for. I let it all out. Incredible people there got me the help I needed. Under Tommy Key, his new personnel, they are wonderful. At one point, I said I'm not homeless. I'm not the picture of the Vietnam vet. Anyway, I'm proud of that agency. Because of that agency, my brother who has four purple hearts, has gone back to the VA in San Mateo.
You see me crippled before you - this is not from the war. Don't wear flip flops in your back yard in the mud.
Next up is Chris D.
I'm speaking on public safety. This is in regard to marijuana. The problem is when I speak about the harm marijuana has caused me as a teenager, I was flagged. I've been attacked by pitbulls.
Steele details a road rage incident he experienced in Redding. He was targeted for speaking out on one issue. We need to be able to speak freely.
William Gilbert: Congratulates Mary Rickert on becoming a supervisor and Steve Morgan. I have a list of the cases between Shasta Co. and myself.
He has a problem with the county and a county employee.
Next is Roy Vincent on the podium. He wants a survey done on his community, Jones Valley. If we get this grant, we can probably get a grant money for our repairs.
This is related to the Community Service Area management - how the residents of Jones Valley receive their water.
Kehoe says he can't discuss on the matter during a public comment, but Rickert will followup.
We're on to the consent calendar. Item 9 is being pulled. It passes. Item 9 is related to appointing owners to two-year terms on their Community Advisory Boards.
Supervisor Leonard Moty moves that the CSA - Keswick has a different appointments than what is listed. It's approved.
Next, the board convenes as the Shasta County Water Agency.
The item is related to CSA-Sugarloaf. Funding for repairs, improvements. That passes as well.
We're on to supervisor reports.
First, Larry Lees updates the board: The board directed the filing for applicants for the District Attorney's Office. We have continued that application process. They will be extending it for 10 days. This is to avoid ambiguity from the holiday that was there during the last opening.