ADOPTED MINUTES

Mental Health Board

Wednesday, April 08, 2009

City Hall, Room 278

San Francisco, CA

BOARD MEMBERS PRESENT: Jagruti Shukla, MD, MPH (Vice- Chair); James Shaye Keys (Secretary); M. Lara Siazon Arguelles; Officer Kelly Dunn; Mary Ann Jones, PhD; LaVaughn Kellum King; Tom Purvis (by telephone); Njoroge Tho-Biaz, MA; Lisa Williams; Virginia Wright, and Errol Wishom.

BOARD MEMBERS ON LEAVE: John Kevin Hines.

BOARD MEMBERS ON ABSENT: James L. McGhee (Chair); and Bridgett Brown.

OTHERS PRESENT: Alice Gleghorn, PhD, Deputy Director of Community Behavior Health Services (CBHS); Helynna Brooke (MHB Executive Director); Loy M. Proffitt (MHB Administrator); Judith Mayer; Executive Director of National Alliance on Mental Illness (NAMI-SF); Gifford Boyce-Smith, MD, President, NAMI-SF; Ralph Fenn, MD, Family Service Agency (FSA); Carletta Jackson-Lane, JD, Sojourner Truth Foster Family FSA; and David Pine, MD, CBHS-Mobile Crisis.

CALL TO ORDER

The meeting was called to order at 6:43 PM.

ROLL CALL

Ms. Brooke called the roll.

AGENDA CHANGES

No agenda changes were made.

ITEM 1.0 DIRECTORS REPORT

Mr. Key:  Although Dr. Bob Cabaj, the Director of Community Behavioral Health Services (CBHS), normally gives the Director s report, he cannot attend the meeting tonight.  Dr. Alice Gleghorn, Deputy Director of Community Behavioral Health Services will give the Director s report and then follow that with the Mental Health Services Act Updates.

Dr. Gleghorn:  Several items are in the April report.

First, seniors and disabled persons needing assistance with interpreting the Medicare Part D plan can get help from the Health Insurance Counseling Advocacy Program (HICAP).  With the help of a HICAP counselor, clients receive guidance on cost-benefit analyses for their prescriptions.

Second, the Center for Multicultural Development at the California Institute for Mental Health (CIMH) has been partnering with behavior health promoters to support the Latino communities on mental health issues including mental health education and the Prevention and Early Intervention initiative.

Third, regarding the MHSA plans, the Information Technology Plan had its final meeting on April 7, 2009 at the Office of Self Help from 3:00 pm  5:00 pm.  The Advisory Committee meeting, which will be a community forum, will meet on April 16, 2009 at Institutio de la Raza from 3:00 pm  5 pm, and we are seeking new members for the committee as well.  The Innovation plan, which includes a series of planning meetings, will hold the first meeting on April 20, 2009 at Pier 1 from 12:00 pm  1:30 pm.

The Prevention and Early Intervention (PEI) Plan was submitted to the State s Department of Mental Health (DMH).  So far, we have not been asked to submit anything more to the DMH. DMH has made positive comments about our plan so far.

We are in the process of developing Requests For Proposals (RFP s). We will be seeking responses from community members, providers, agencies and any interested groups.  We urge providers to look at the PEI Plan that is posted on the DPH website.  We would welcome members of the Mental Health Board to participate on the RFP review panels provided they are not applying for money because that would be a conflict of interest.  In our last review panel, over a third of the panel members were community members, including consumers and family members.  We hope to post the RFP s in about 6-8 weeks.  Last time, we had a training orientation for potential reviewers, and we will do it again.  We also hope to have an educational forum about contracts, and the board can help facilitate the forum.

Monthly Director s Report

April 08, 2009

1.      Resource for Clients with MEDICARE D Plans

HICAP (Health Insurance Counseling Advocacy Program) is available to assist our clients with their Medicare Part D plans.  They are a program funded through a grant from the state and federal government with the focus of helping the senior and other disabled populations (including our behavior health clients).

Clients can call to set up an appointment to meet with a counselor to evaluate their Part D plan.  The HICAP counselors utilize the Medicare website and enter the client's medication list and explain the options to the clients who then chose a plan.   Clients should bring a complete list of their prescription medications for the appointment.

HICAP has offered to come out the clinic to meet with the staff and explain all the services that they offer and even mentioned that they may be able to help clients here in the clinic.

We have a Mission Clinic client who recently used the resource, and had a good experience with them.  Here is their information:

Link for HICAP website: http://www.cahealthadvocates.org/HICAP/sanfrancisco.html

2.      Mental Health Service Act (MHSA) Update

CIMH TO PARTNER WITH PROMOTORES IN ADDRESSING MENTAL HEALTH NEEDS OF LATINO COMMUNITIES

The Center for Multicultural Development at the California Institute for Mental Health has recently released a policy paper on partnering with promotores in advancing the mental health of Latino communities in California and advancing the opportunities for partnering with promotores in Prevention and Early Intervention to address the wellness needs of all communities. Promotores de Salud (health promoters) are individuals who provide health education and support to community members, provide their services in the community, and are generally from the community that they serve.  Although more widely engaged in the field of physical health, promotores increasingly address mental health concerns as well.  For more information regarding the expansion of these services to promote wellness for underserved and unserved ethnic and cultural communities in California, please contact William Rhett-Mariscal, Ph.D., Associate, CIMH, at (916) 379-5347, e-mail: wrhettmariscal@cimh.org

INNOVATION COMPONENT SET TO BEGIN COMMUNITY PLANNING MEETINGS

The Innovation component of the MHSA has announced a series of upcoming community planning meetings on Monday, April 20, 2009, at Pier 1 (next to Ferry Building) 12:00 pm  1:30 pm; Wednesday, April 22, 12:00 pm  1:30 pm, Location: TBD; Tuesday April 28,       11:30 pm  1 :00 pm, Location: TBD; and Thursday April 30, at Community Vocational Enterprises, 1425 Folsom Street, 12:00 pm  1:30 pm.  The public is invited to come and share ideas regarding access to services, promoting interagency collaboration, and increasing the quality of mental health services, including better outcomes, among other things.  Box lunches will be provided.  For more information, contact Kevin Ledbetter at (415) 255-3 513 or e-mail kevin.ledbetter@sfdph.org

INFORMATION TECHNOLOGY PLANNING COMMITTEE TO HOLD ITS FINAL MEETING

The final Information Technology Planning Committee meeting is scheduled for April 7, 2009, from 3:00 pm  5:00 pm, at the Office of Self Help, 1095 Market Street, on the 6th floor.  Interested individuals and parties, including providers, clinicians, consumers, family members, and members of the public are invited and encouraged to attend.  For more information, please contact  Frank Isidro at (415) 255-3572 or e-mail: frank.isidro@sfdph.org

MHSA ADVISORY COMMITTEE MEETINGS

The next meeting of the MHSA Advisory Committee will be a Community Forum, taking place at Instituto de la Raza, 2919 Mission Street, on April 16, 2009, from 3:00 pm  5:00 pm.  The public is invited and encouraged to attend this meeting, at which time all the most recent updates and developments regarding MHSA-related components, topics, and meetings will be under discussion.  Light refreshments will be served and copies of all relevant documents will be made available.

We recently sent e-mails to current MHSA Advisory Committee members, in an effort to solicit their interest in continuing to serve on this committee.  Thank you to those who responded.  However, it would be greatly appreciated if we could hear back from everyone.  If you haven t responded, please e-mail Kevin Ledbetter at kevin.ledbetter@sfdph.org, so that we may update the Committee roster.

The Mental Health Services Act Advisory Committee meets bi-monthly from 3-5 pm, alternating between advisory meetings and community forums.  The next scheduled meetings are:

3.      Upcoming Training

LIVING and THRIVING IN SAN FRANCISCO WOMEN S HEALTH CONFERENCE:
Thursday, May 14 and Friday, May 15, 2009, 8:45am-4:00pm, St. Mary s Cathedral Conference Center.  This two-day conference promises to be a great learning experience for clinicians and providers in our System of Care.  The conference will address issues such as the balancing act often required of women involved in the justice system; how to effectively communicate with clients about sexual health and behaviors; STDs and HIV; Women, health, behaviors, and body image; and the conflict and impact of trauma across the life course of women.

Guest speakers include: Susan Salasin and Dr. Westley Clark  from SAMHSA,  Peggy Bean from the California State Department of Alcohol and Drug Programs, Lisa Najavits, Ph.D., and several of our local DPH staff experts.

Registration begins Thursday, April 9^th.

To register for this training, please contact Norman Aleman, CBHS Training Coordinator

at 415-255-3553 or email norman.aleman@sfdph.org

_____________________________________________________________________________

Past issues of the CBHS Monthly Director s Report are available at:http://www.sfdph.org/dph/comupg/oservices/mentalHlth/CBHS/CBHSdirRpts.asp

To receive this Monthly Report via e-mail, please e-mail richelle-lynn.mojica@sfdph.org

ITEM 2.0 Mental Health Services Act (MHSA) updates and Public Hearings

2.1 Public Hearing: Three-Year Program and Expenditures Plan for the Capital Facilities Component Proposal

Dr. Gleghorn:  I will give an overview of the Three-Year Program and Expenditure Plan for the Capital Facilities Component Proposal.  The 30-day period of posting the plan for the public on San Francisco s Capital Facility just ended.  I would like to clarify that the proposed distribution of $4,148,350 is for public buildings owned by San Francisco City and County where we have jurisdiction to improve and renovate them.  We are considering 1-2 wellness centers, 1-2 residential treatment buildings, and 1-3 integrated outpatient facilities.

Mr. Keys:  Why is there no capital funding for program buildings in the Southeast sector?

Dr. Gleghorn:  The following health centers are owned by San Francisco county:  Tom Waddell, Silver Avenue, and Castro-Mission Health centers.  Sunset Mental Health Services is also a county building and is being converted to provide mental health recovery-oriented services.

Ms. King:  I would like to encourage CBHS to take a look at the work of Dr. Nadine Burke who did the Impact of Trauma and Stress on Physical Health presentation at the March 11, 2009 meeting.  She also runs the Bayview Child Health Center in the Southeast sector and has done a lot of outreach to the area.

Dr. Gleghorn:  Thank you Ms. King.  I will forward that information to CBHS.

Dr. Jones:  Are wellness centers replacing traditional mental health services?

Dr. Gleghorn:  The Recovery Model is core to MHSA, and traditional health centers will need to work with this model as well.

Dr. Jones:  The states of Arizona and Georgia have Wellness Models in conjunction with other types of care.  With a Wellness Model only, it precludes many vulnerable people from participating in care because there would be less access to other services.

Dr. Gleghorn:  MHSA offers the opportunity for providers to learn new models of care and incorporate these into their existing practices.  For example, MHSA emphasizes peer employment as key in recovery, and CBHS has hired lots of peers to set a model of successful peer employment.

2.2 Public comment

Ms. Jackson: She is a lawyer and pointed out that the level of crisis is highest in the Southeast sector and what is going on there has a huge impact on all aspects of the City.  She wondered if there are other monies available for this area of the City.

Dr. Gleghorn:  Thank you for your comment.

There are other funding opportunities such as the MHSA Prevention and Early Intervention (PEI) and Workforce Education Training (WET) Plans, which have no strings attached such as owning buildings.

But the MHSA Capital Facilities funding is essentially only applicable to City or County owned buildings.

Item 3.0 PRESENTATIONS

1. COMMUNITY BEHAVIORAL HEALTH SERVICES BUDGET PROCESS: Barbara Garcia, Director, Community Programs, Deputy Director of Health

2. NATIONAL ALLIANCE ON MENTAL ILLNESS, SAN FRANCISCO (NAMI): Gifford Boyce-Smith, MD, President

3.1 Presentations:

Mr. Keys:  Barbara Garcia is the Director of Community Programs and Deputy Director of Health for the Department of Public Health. She is going to give us an overview of the budget process and the ways in which advocates can participate.

Following her presentation we will hear from Dr. Gifford Boyce-Smith, President of the National Alliance on Mental Illness in San Francisco.

1. Community Behavioral Health Services Budget Process, Barbara Garcia

Ms. Garcia:  Thank you for giving me the opportunity to talk about the CBHS budget process.  I m both the Director of Community Programs and the Deputy Director of Health at CBHS.

20% of the $1 billion operating budget is general fund money for public health in the City and County of San Francisco to operate San Francisco General Hospital (SFGH) and Laguna Honda Hospital, according to regulations and mandates, and supports about 125 non-profit community based organizations (CBO s) that provide Primary Care, HIV/AIDS programs, Maternal and Child Health, Behavior Health services, Housing and Urban Health, Indigent Health and Prevention and Health Promotion.  As I mentioned earlier, the general fund makes up 20% of the budget.  Or it can be inferred that to be $200 million.  But in this coming fiscal year we are anticipating a $100 million short fall for the Department of Public Health (DPH).

We must carefully evaluate different CBO s where some provide multiple programs and consider various permutations to keep essential functions to meet the demand.  We need to maintain core services at SFGH and Laguna Honda Hospital.

However, I believe mental health services are essential on an ongoing basis to the recovery process for many people.  A hospital takes care of emergencies and stabilizes a patient.  But for persons with mental illnesses like PTSD, schizophrenia, bi-polar or substance abuse problems when he is discharged from a hospital that person often needs comprehensive continuum care.  That may mean a full wrap-around service, housing arrangements for homelessness, medication management, behavior therapies, assisted living and legal assistance.  For example, 70% of the clients at Tom Waddell have mental health services needs.

There are some people with special needs.  Some mental illnesses like PTSD, schizophrenia or bi-polar disorder do not discriminate people by social-status, gender, or age per se.  Many elderly people living alone often feel isolated by the confinement of their own homes where they may need outreach services to go see doctors or to get groceries.  Children in the Southeast sector are living with the daily stress of violence and many are showing early signs of mental illnesses.  So we need to have early intervention and prevention programs.

We are looking for ways to get through this financially difficult period because of the budget cuts, and every section had to do both administrative and service cuts.  A $6.6 million administrative cut or 50 positions were eliminated.  A hiring freeze is another way to contain budgets, and we already have been under a position freeze for the past eighteen months.

Sometimes we substitute grant funds for general funds.  For example, Westside clinic was cut by $1 million in general fund, but grant funds reinstated the cut.  When possible, we transfer civil service staff to grant funds to save the general fund.

Many behavioral health services can be addressed by primary care under the Healthy San Francisco plan.  Many people have different perspectives on substance abuse and mental health.  MediCal only provides funds for mental health.

Managers running substance abuse residential services are in the process of developing standards for entry and discharge.  After nine months, for example, in recovery, patients with substance abuse should not be sent to the streets but should receive priority for the next level of care.  SFGH only has acute care services for mentally ill people.

I have heard that the general fund provides about 60% - 90% of the operating budgets for many non-profit organizations.  As the Director of Community Programs, I have assembled a group of 125 people from stakeholders, providers, and community leaders to help me navigate through these difficult times, and we meet monthly.  We have tried to ask CBOs to consider options like program mergers, collaborations and consolidations as ways to reduce costs.

In summary, the $100 million cut in the general fund requires us to consider many different options.  We have saved $6.6 million from administrative cuts.  In lieu of general fund, the Westside clinic received grant funds and we hope to substitute grant funds for the general fund.  We expect to get $37 million.  Under the Healthy San Francisco plan, more mental health clinics can be operated in conjunction with primary care clinics.

Mr. Keys:  We are fortunate to have Ms. Garcia here.  The Mental Health Board has worked hard to increase services in the Southeast sector.

Ms. Garcia:  Healthy San Francisco provides both primary care and mental health services for all people in San Francisco.

Dr. Jones:  Is there a way to bill peer-support services to MediCal like other states in the union?

Ms. Garcia:  California is on the bottom of the totem pole in getting MediCal reimbursements from the Federal government.  We need to develop strategies to increase reimbursement permanently in term of reimbursement dollars and time.  Substance abuse is totally dependent on general fund.

Dr. Jones:  Why is the reimbursement so low for California?

Ms. Garcia:  California has sent the following powerful women to Congress like Congresswomen Ms. Nancy Pelosi, the Speaker of the House of Representatives, Senator Barbara Boxer and Senator Diane Feinstein. We are hopeful that we can increase the reimbursement amount.

Ms. King:  There seems to be some turbulence in the Family Mosaic Program.

Ms. Garcia:  Turbulence happens every time we make changes.  We want to integrate Family Mosaic with other children s programs.  Also Family Mosaic is a hybridization of civil service and contract staff where labor union issues affect the whole dynamics.

Dr. Jones:  Times are changing, and maybe it will help shift to better services.

Ms. Garcia:  This is an opportunity to make good changes to become better at what we are doing to improve the quality of services.  We want people to go to the same place for primary care and mental health.

Ms. King:  Does the cut in the budget include housing for people when they get out of a program?

Ms. Garcia:  No, we still have housing as a priority.  We have places such as Baker Places as housing bridges for these people.

Ms Wright:  Is Silver Avenue going to have a big primary care?

Ms. Garcia:  I would like to move the Southeast sector s children s program to Silver Avenue.  But I try to do things that are important to the community.

Dr. Jones:  How are the needs of mentally ill people met through primary care?

Ms. Garcia:  There are a number of clients who do not have a primary care doctor and we like them to be part of Healthy San Francisco where primary care will be provided.

Public comment relevant to Presentation 1

Dr. Boyce-Smith: He asked if we are in a new day with the integration of primary care and mental health and wondered if the psycho-social model is waning.

Ms. Garcia:  We have a general fund of $100M short fall.  MediCal generates revenues because we get reimbursement for mental health care.  But substance abuse is supported by general fund only; therefore cutting will be the greatest in substance abuse.

Ralph Bend: He asked what Ms. Garcia s thoughts were on having primary care going to boarding care facilities to follow patients.

Ms. Garcia:  We have implemented such service.

Ms. Mayer: She stated that it would be helpful to know which programs will be eliminated in their entirety.

Ms. Garcia:  We try to avoid closing a program.

2. National Alliance on Mental Illness, San Francisco, Gifford Boyce-Smith, MD

Dr. Boyce-Smith:  I am here with Ms. Judith Mayer who is the Executive Director of NAMI-SF.  I would like to give a brief history of NAMI which started in the 1970 s by mothers who wanted to bring hope and comfort to families of people affected with mental illnesses because those people often feel stigmatized and socially isolated.  NAMI provides connections to other families and social services such as education, advocacy and outreach, often at no cost.

Family-to-Family is a 12 week educational program about schizophrenia, bipolar disorder, panic disorder, borderline personality disorder, major depression and obsessive compulsive disorder, medications, side effects and adherence issues.

Peer-to-Peer is a 9 week program and has 18 consumers with three mentors to help people receiving mental health services to become more involved in their treatments and mentor them.  The peer service is very popular because people with mental illness have talked about how they feel that a peer counselor can relate to their conditions more than people who have not experienced mental illnesses.

In Our Own Voice offers formal training with statewide NAMI to consumers who want to teach about mental health to behavior health court advocates and others.  Public speaking puts a human face on mental conditions.  San Diego, for instance, has a large number of people in partnership in the program.  NAMI-SF would like to have more candidates and venues for speaking engagements.

NAMI meets on the 3^rd Wednesday of each month at 1010 Gough St.  Our next meeting will be on April 15, 2009.  On May 3^rd at the Golden Gate Park there will be the annual NAMI walk.  Please spread the word and join us in the walk

NAMI is very concerned about the impact of the City budget because the Family-to-Family program is starting at the Veteran s Hospital.  The hope is that the Board of Supervisors would oppose the cuts.  Meanwhile, other funding sources are being sought to keep the program running.  For example, the Police Crisis Intervention Training (PCIT) would be a good source for us to collaborate with.

Ms. Mayer:  I would like to acknowledge board member Ms. LaVaugh King for her dedication to Family-to-Family and the Healing Circle.

Mr. Wishom:  I did the NAMI Walk and have participated in In Your Own Voice.

Dr. Jones:  I am interested in the movement of using peer services for outreach and counseling because often people with mental illnesses need someone who can understand their feelings.  Are peer counselors being compensated well enough because some peer-counselor models have low fees?

Dr. Boyce-Smith:  Peer counselors are compensated for their services.

Dr. Jones:  In some states, peer programs can bill $42 per hour because Medical does not pay for peer services.  Are we using the service to reduce costs and why are we not using NAMI?

Ms. Mayer:  We need more of a central clearing house for these ideas.

Public comment relevant to Presentation 2

Ms. Jackson-Lane: She is a lawyer, works with foster care children and has just started the NAMI training.  She finds that counties do not know mental health services are available.  She suggested that maybe the MHB and NAMI could collaborate together to get information out about services.

Ms. Mayer:  Our Family-to-Family and In Your Own Voice are peer models.

ITEM 4.0 ACTION ITEMS

4.1. Public comment

No public comments.

4.2. Resolutions

4.2. a PROPOSED RESOLUTION: Be it resolved that the minutes of the Mental Health Board meeting of March 11, 2009 be approved as submitted.

Resolution unanimously approved.

ITEM 5.0 REPORTS

5.1 Report from the Executive Director of the Mental Health Board.

The next Police Crisis Intervention Training (PCIT) will be April 20 to April 23.

5.2 Report of the Chair of the Board and the Executive Committee:

5.3 Report by Members of the Board on Their Activities on Behalf of the Board.

Ms. King:  Meetings in the Southeast sector are on community wellness.  We are looking for mergers and collaborators in Visitacion and Bayview.

5.4 New business - Suggestions for future agenda items to be referred to the Executive Committee.

Officer Dunn:  I am a little bit concerned that the system would move people with mental illnesses through primary care doctors who then make referrals for mental health care

Mr. Njoroge:  As a holistic health practitioner, I have heard the term  Wellness being used a lot.  I would like focus on the definition of wellness as a part of wellbeing or as a whole wellbeing.

5.5 Public comment relevant to Item 3.0

No public comments.

ITEM 6.0 PUBLIC COMMENT

No public comments.

Adjournment

Meeting adjourned at 8:35 PM.