ADOPTED MINUTES
Mental Health Board
Wednesday, September 9, 2009
City Hall, Room 278
San Francisco, CA
BOARD MEMBERS PRESENT: LaVaughn Kellum King; Officer Kelly Dunn, M. Lara Siazon Arguelles; Mary Ann Jones, PhD; Susan McIntyre; Tom Purvis; Njoroge Tho-Biaz, M.A; Lisa Williams; Errol Wishom and Virginia Wright.
BOARD MEMBERS ON LEAVE:
BOARD MEMBERS ABSENT: James L. McGhee, Chair; Jagruti Shukla, MD, MPH, Vice- Chair; and James Shaye Keys, Secretary.
OTHERS PRESENT: Mitch Katz, MD., Director of Department of Public Health (DPH); Alice Gleghorn, PhD, Deputy Director of Community Behavior Health Services (CBHS); Helynna Brooke (MHB Executive Director); Loy M. Proffitt (MHB Administrator); Florence C. Fee, J.D., President of No Health Without Mental Health (NHMH); Francisca Oropeza, Southeast Mission Geriatric Services; and Ralph Fenn, MD., Family Service Agency (FSA).
CALL TO ORDER
The meeting was called to order at 6:30 PM.
ROLL CALL
Ms. Brooke called the roll.
AGENDA CHANGES
None
ITEM 1.0 PRESENTATION: INTEGRATION OF PRIMARY CARE AND BEHAVIORAL HEALTH CARE: MITCH KATZ, MD, DIRECTOR OF DPH
1.1 Presentation: Integration of primary care and behavioral health care: Mitch Katz, MD, Director, Department of Public Health
Ms. King: We welcome Dr. Mitch Katz, Director of the Department of Public Health for the City and County of San Francisco. He will be presenting his vision for integration of primary care and behavioral health.
Dr. Katz: Thank you for having me here tonight. Many people have used all of our health service system independently, but they often have multiple problems or have not known what specific problem they may have. Our services are provided in a holistic way. As a clinician myself, working many years at San Francisco General Hospital (SFGH), I have seen patients experiencing physical illness that I see as psychosomatic. I am concerned that mental health clients who are only in the mental health system are not getting needed primary prevention care.
I visited a Connecticut Federally-Funded Federally Qualified Health Center (FQHC) that was built about 20 years ago to talk about Healthy San Francisco and was very impressed with their way of handling mental health clients. At the inception of their health care infrastructure, they incorporated both primary care and mental health care together.
I realize that duplicating this model in San Francisco would be difficult, because it is impossible to rebuild our whole health care system that has been around for seventy-five years. Furthermore, many of the primary care and mental health clinics are not large enough or not located in the best places.
Health care integration in San Francisco is occurring at a bad time because, on a national level, the United State is now in a world wide recession. On the state level, I am concerned that integration would be impacted by budget cuts as California experiences the boom and bust cycle. Given the current fiscal status of economic contraction at a time when many people need help the most, I do not have control over how much money San Francisco receives from the State and the Federal government. I only have control over how to allocate the available monetary resources to maximize healthcare services. I would like to open up for questions and answers from the board.
Dr. Jones: Do you envision one system of health care where primary assessments are across all modalities?
Dr. Katz: Having a primary system would be optimum, but we are still far from achieving that. For instance, people with HIV and AIDS have been in a fifteen year old system at SFGH; these people have seen me as their primary care physician. Many patients with HIV and AIDS also have mental illnesses. There is a coordination of care at SFGH. I provide primary care; two psychiatrists provide mental health care. This coordination of care provides physicians and psychiatrists the same patients chart that shows any medical updates on symptoms as well as medications. Also at SFGH, some patients with substance abuse issues receive counseling sessions. We can make referrals for residential care as well. Everyone would benefit from seeing a primary doctor first who can then coordinate care for specialists such as a psychiatrist. Needs are met in a holistic way on one floor at SFGH.
Dr. Jones: What is the time line for full integration?
Dr. Katz: It will take awhile. There are primary care physicians who are hesitant to see patients with psychosis. 30% of my patients have active psychosis. There are mental health practitioners who fear losing their own identity due to being swallowed up or loss of independence.
But there are some who believe that a system of primary care and mental health can be together. Primary care physicians need access to medication lists and lab results from psychiatrists but do not need details of counseling. Both OMI and Tom Waddell programs now have access to mental health clinicians in their clinics. I still expect it will take years to complete the health care integration.
Mr. Purvis: Is there anybody overseeing the successes and issues of integration?
Dr. Katz: DPH has a steering committee for SFGH and Laguna Honda hospitals. Barbara Garcia oversees Community Programs and HIV. There are going to be integration challenges given the complexity of our health care system.
It can happen two ways. We want people to get treatments for both physical and mental health and substance abuse. After 75 years of separate models, I expect integration to be hard.
Mr. Wishom: Since budget cuts, services and programs have been eliminated. Are there any alternatives?
Dr. Katz: We try to get more money with fees such as fees on restaurants and on landlords. But, at the end of the day, most of the money is spent on hiring personnel, trying to assess different services and letting go of the ones that could grow back.
Ms. Argüelles: What steps have you done for both sides to bring them together?
Dr. Katz: We are planning to move part of the Southeast Children s Mental Health Center to the Silver Avenue clinic because we own the building; the move saves us on rental expenses. The Silver Ave clinic currently offers primary care services. Some Southeast people feel it is too much a burden for some patients to travel to the Silver Avenue clinic. We have talked about taxi vouchers. We want children to see a pediatrician on a regular basis for preventive care.
Ms. Wright: Is there any plan to bring in more doctors to the Silver Avenue clinic due to the shortage there?
Dr. Katz: Our hope is to expand the Silver Avenue Clinic and we hope mental health care will be a part of this expansion, where patients can get both physical and mental health.
Ms. King: Can you please clarify which part of the Southeast sector; are you talking about the Bayview and Hunters Point areas?
Dr. Katz: People in the Bayview want to have a health hub. We would like to co-locate physical and mental health services there in the same building. There are a number of behavioral health programs on 3rd street that might be interested in moving to a larger southeast health center.
Ms. King: Are you open to a proposal plan from contractors?
Dr. Katz: I am open to new ideas and proposals.
Mr. Tho-Biaz: I have heard and become sensitive to the needs of the 3rd Street corridor. What is being done for this community s seniors to soften their concerns of having to travel outside the area for services?
Dr. Katz: In spite of negative feelings due to budget cuts, there is a positive side of integration that we can look forward to in good times to build a center in communities. Some people have a limited view rather than a broader perspective of a center where everybody can get together.
Mr. Tho-Biaz: If they were to hear directly from Dr. Katz, they may feel that you have heard their needs.
Dr. Katz: That s a good suggestion.
Ms. McIntyre: What is the next step after relocation of services?
Dr. Katz: The buildings we tend to own are physical health centers. The exception is the Sunset Mental Health Clinic. Most mental health centers are in rental buildings. We make investments in buildings we own such as the Castro, Silver Avenue, Chinatown, Tom Waddell, Southeast and Curry Center.
We believe that the need of mental health consumers for preventive services can be taken care of by primary care doctors. We would like to add physical health to mental health facilities too.
Mr. Tho-Biaz: In planning integration of primary care and mental health care, is there any honor of the whole person in term of holistic care?
Dr. Katz: I am a big believer in holistic care. There is connectedness in housing quality, community connection, economic health, what is going on in the family, etc. People seem to only get help due to deficit rather than positive. We want to have more cohesiveness, health promotion and wellness.
1.2 Public Comment
Dr. Fenn: Dr. Ralph Fenn commented on cohesion and mentioned that he is in the board and care home system. His concerns are home-bound people who cannot attend clinics because getting there is very difficult for many of them. He wondered if psychiatric clinicians and nurse practitioners can come to board and care homes to deliver care to these people.
Dr. Katz: Nurse practitioners can be very helpful at handling these issues. I am not saying everyone should have to come to clinic. Board and care many need their own system.
Ms. Florence Fee: Ms. Florence Fee inquired about how the side effects of psychiatric medications are being handled. She asked for elaboration on how his clinic at SFGH coordinates the medical/psychiatric care and treatment for seriously mentally ill patients on antipsychotic medications that carry significant adverse medical side effects, e.g. a primary medication for paranoid schizophrenia, clozapine, while effective in treating psychiatric symptoms, also leads in many cases to high blood pressure, weight gain, hypertension, diabetes etc.
Dr. Katz: Psychiatrists would manage medications, and any side effects might lead to a referral to a primary care doctor.
Ms. Fee: Ms. Fee also asked if Dr. Katz knows if California medical schools are beginning to cross-train medical students and residents in the medical/psychiatric interface, e.g. programs to exposure future primary care physicians to psychiatric training, since over 50% of people seek mental health care initially from their primary care doctor, and many will not seek out mental health professionals due to stigma.
Dr. Katz: I m not aware of any model. I would hope psychiatrists and physicians would collaborate. Ideally, if we had true integration, these doctors would work together.
I also know internists who do not feel comfortable at prescribing psychiatric medications. Many of the primary care doctors in the public health system see people needing mental health services and primary care and they may refer mental health patients to psychiatrists.
Dr. Fenn: Dr. Fenn asked if the City is going to use outcome measures in this process.
Dr. Katz: Yes.
Item 2.0 DIRECTOR S REPORT
2.1 Discussion regarding Community Behavioral Health Services Department Report, a report on the activities and operations of Community Behavioral Health Services, including budget, planning, policy, and programs and services.
Ms. King: Dr. Alice Gleghorn, Deputy Director of Community Behavioral Health Services will give the Director s report.
Dr. Gleghorn: Mental Health Services Act (MHSA) money is funding capital expenditures.
Ms. Dunn: Is the Redwood Center still for men only?
Dr. Gleghorn: Yes, we have providers developing services for women only. There are substance abuse programs focusing on women only. We also have mixed centers being transformed to women only.
Letters went out last week to the organizations that had their proposals approved. We are in protest period right now.
Ms. Brooke: The Drumming Circle for Girls was cut but for boys it is still there.
Mr. Purvis: Do you know how the Drumming Circle rates on evidence based practices?
Dr. Gleghorn: The National Registry of Evidence-based Programs and Practices (NREPP) is a service of the Substance Abuse and Mental Health Services Administration (SAMHSA). The website is www.nrepp.samhsa.gov
Mr. Tho-Biaz: In light of the success of the drumming program, what innovative programs that may not have been validated by the top administrators but nevertheless that program works for certain communities?
Dr. Gleghorn: MHSA has funding called Innovation that funds innovative projects. Pilots are possible to try out new things. We selected about 13 of them. But going forward we have on-going ways to pick similar projects. In terms of RFP s, we encourage programs to summit evidence-base practices.
Ms. King: Is there a list showing primary care sites that provide mental health services that could be given out to people?
Dr. Gleghorn: We have the Access program that people can call for behavioral health services. On the DPH web site there is a list community oriented primary care clinics. We have about fourteen such sites. Also there is a consortium of eight-to-ten clinics who participate in Healthy San Francisco.
2.2 Public Comment
No public comments
Monthly Director s Report
September 9, 2009
1. Health Professions Education Foundation
The Health Professions Education Foundation is pleased to announce the March 2009 award recipients for the Mental Health Loan Assumption Program (MHLAP). Pursuant to the Mental Health Services Act (MHSA), MHLAP was created to increase the supply of hard to retain professionals practicing in California s public mental health system by providing a financial incentive to repay educational debt.
MHLAP s inaugural application cycle- March 24, 2009- demonstrates the overwhelming need for this program with 1,222 applicants statewide. Applicants incurred an educational debt burden of $57,594,700, requested more than $15 million in loan repayments and more than half (55%) were employed in a hard-to-fill/retain position within the state s public mental health system. Overall, MHLAP was able to reward $2,246,874.31 to 283 individuals employed in 41 counties across the state.
Out of 38 applications received in San Francisco, 8 recipients were chosen. They are: 1) Terese Allen, Edgewood Center for Children & Families; 2) Margaret Amaral, UCSF, Trauma Recovery Center; 3) Caroline Cangelosi, San Francisco General Hospital; 4) Brenda Meskan, City & County of San Francisco Department of Public Health, San Francisco FIRST Program; 5) Ivania Molina, Homeless Prenatal Program; 6) Michelle Vidal, Instituto Familiar de la Raza; 7) Ellen Zhou, Department of Public Health; 8) Ingrid Zimmermann, Instituto Familiar de la Raza.
Congratulations to all of the award recipients!
2. Instituto Familiar De La Raza Therapeutic Drumming Practice Accepted into SAMHSA
The Therapeutic Drumming Practice at Instituto Familiar De La Raza (IFR) has been accepted into the SAMHSA National Database of Community Driven Evidence Based Practices. The official acknowledgement and acceptance of Community Defined Evidence Practices by National Institutes is a shift in policy that resonates with the vision of San Francisco, DPH, IFR, and our Communities at large; and empowers the voices of our diverse people. SFDPH supports their efforts for being visionaries and leaders in promoting culturally appropriate practices throughout San Francisco.
3. Nonprofits Join Forces on 990 Polk
Affordable Housing Finance magazine has named 990 Polk Street as one of two finalists in its senior housing category for its Reader's Choice Award for the Nation's Best Affordable Housing Developments. This is a national competition, with entries from 140 projects in 20 states, with selection based among other things on community impact and overall role in community revitalization.
Below is the article that appeared in the Affordable Housing Finance Magazine July/August issue:
SAN FRANCISCO. Formerly homeless and low-income seniors are integrated under one roof at 990 Polk Street.
"It's an example of a mixed-population approach to supportive housing for the homeless," says James Buckley, president of Citizens Housing Corp. " With the city's assistance, we are able to provide 50 of the 110 units for people coming from the streets or shelters and surround them with services to stay in housing long term."
Citizens and Tenderloin Neighborhood Development Corp. (TNDC), both San Francisco-based nonprofit developers, had looked at the site separately before opting to work together to build 990 Polk. The new housing replaces a gritty parking lot and a laundry business. The development was first conceived to house all low-income seniors, but formerly homeless seniors were added to the mix as part of a city push to move the chronically homeless into permanent housing.
The result is a more diverse community, which the developers have strived for in their work, says Don Falk, TNDC executive director.
The $35.1 million development utilizes two new funding programs from the city and state. First, it uses a new local operating subsidy that helps to keep rents low. The development is also one of the first funded under the state Mental Health Services Act housing program that helps provide permanent housing to people with mental-health issues.
The apartments are reserved for seniors earning no more than 45 percent and 50 percent of the area median income. On-site programs and case management are provided, and a nurse from the city Department of Public Health works at the property.
The development is designed to bring in natural light and features green-building strategies and products. More than 3,500 seniors applied to live at 990 Polk. - Donna Kimura"
For more information on the background on the competition: http://www.housingfinance.com/ahf/index.html
4. Mental Health Service Act (MHSA) Update
COMMUNITY SERVICES AND SUPPORT
The fourth quarter unduplicated counts were finalized for Fiscal Year 2008-2009. There were 582 clients served by the full service partnerships, 76 of whom were housed in stabilization and permanent housing situations. These numbers represent a 68% increase from FY07-08 fourth quarter unduplicated client count of 346. Overall, the full service partnerships served a total of 608 individuals for the fiscal year ended June 30, 2009.
The general system development agencies served 4,105 clients, providing a variety of services: peer based centers (n=2,104), school-based Wellness Center at School of the Arts (n=48), residential treatment for dually diagnosed individuals (n=9), children exposed to trauma and violence (274), increasing capacity for culturally and linguistically appropriate services (n=57); behavioral health services in primary care settings (n=151); supportive services for housing (n=322); vocational rehabilitation (n=39); transitional housing for youth (n=10); and centralized access to mental health and substance abuse services (n=1,066); and services to seriously emotionally disturbed children (n=25). In addition, 3,415 individuals were reached through outreach and engagement activities performed by all MHSA funded agencies and 2 clients in the supportive services for housing were approved for stabilization room housing. Overall, the general system development agencies served 7,176 individuals for the fiscal year ended June 30, 2009.
MHSA PREVENTION AND EARLY INTERVENTION/WORKFORCE DEVELOPMENT,EDUCATION AND TRAINING RFP PROPOSAL REVIEW PROCESS CONCLUDES
In June of this year, CBHS released a Request for Proposals (RFP) to develop and implement projects included within the City and County of San Francisco s Mental Health Services Act (MHSA) Workforce Development, Education and Training (WDET) and Prevention and Early Intervention (PEI) Three-Year Program and Expenditure Plans.
CBHS received 52 proposals in response to the PEI/WDET RFP. The proposal review process included seven Technical Review Panels held from Wednesday August 19, 2009 to Friday August 21, 2009. Special thanks to the 39 reviewers who contributed their time and expertise to inform the review and selection process. The diverse panels included 8 representatives from various sections of DPH, 11 representatives from other city/non-SF government agencies and 20 representatives from community-based organizations. A total of 8 reviewers identified themselves as consumers and/or family members of consumers.
The contract negotiation process will begin as soon as the formal protest period concludes on September 10th. The final list of awards will be available on the DPH MHSA web page on or before September 15th. Projects are scheduled to begin October 1, 2009.
CAPITAL FACILITIES
The Redwood Center Project proposal s public comment period ended on June 16, 2009. There were no comments received and the Project Proposal was approved by the Department of Mental Health on September 2, 2009. This project will convert the Redwood Center into a dual diagnosis residential treatment facility, providing rehabilitative services as well as mental health and substance abuse treatment. The last project proposal to be funded by capital facilities component is the renovation of the Sunset Mental Health Services building. Purposes include making the building accessible for persons with physical disabilities and creating a space for a health and wellness recovery center. The proposal is currently posted for a 30-day public comment and review period at the MHSA website : http://www.sfdph.org/dph/comupg/oservices/mentalHlth/MHSA/mnu30-DayNotice.asp
MHSA ADVISORY COMMITTEE MEETINGS:
The last meeting for the Innovations component was held on August 27, 2009. Prior to this meeting, the Committee members and members of the public who attended either of the four special sessions were asked to vote for their top ten project/ideas for funding consideration. Thirteen projects received the most votes and six other projects received the same number of votes. At the last meeting, the Committee voted prioritized the six projects that received the same number of votes and approved projects that would be included in the SF County Innovation Plan.
The regular MHSA Advisory Committee meetings will reconvene on the third Wednesdays every other month beginning on October 21, 2009. Location is still to be determined.
5. Upcoming Conference
October 28, 2009
"Don't Worry Be Happy": Anxiety Disorders in Primary Care
10:00am-4:00pm, Mission Bay Conference Center at UCSF, 1675 Owens Street, San Francisco
The San Francisco Department of Public Health, Community Behavioral Health Services division, is sponsoring a conference targeting Primary Care Physicians and Nurses, Psychiatrists, Psychologists, Mental Health and Substance Abuse Counselors, Social Workers, LCSW's, MFT's, and Community Based Organizations. This conference will focus on integrating treatment of anxiety disorders and other behavioral health conditions in Primary Care Settings. Due to popular demand, registration space is LIMITED.
For questions or additional information, please contact the conference event planner at kathleen.minioza@sfdph.org.
COST: FREE
Continuing Education: 6 Hours (Free)
This is an activity offered by Community Behavioral Health Services (CBHS), a CMA accredited provider. Physicians attending this course may report up to 6 hours of Category credits toward the California Medical Association s Certification in Continuing Medical Education and the American Medical Association s Physician s Recognition Award.
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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 3.0 MENTAL HEALTH SERVICE ACT UPDATES AND PUBLIC HEARINGS
2.1 Updates
Dr. Gleghorn: There is no update to report this month
3.2 Public comment
No public comments.
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 July 08, 2009 be approved as submitted.
Resolution unanimously approved.
ITEM 5.0 REPORTS
5.1 Report from the Executive Director of the Mental Health Board.
Ms. Brooke: The next PCIT Training is from September 21 to September 24, 2009
5.2 Report of the Chair of the Board and the Executive Committee:
Ms. King: On behalf of the Chair, I would like to announce the appointment of Susan McIntyre, Lara Arguelles and Dr. Mary Ann Jones to the Executive Committee. In addition to the officers, there are seats on the Committee for any areas not represented such as family member, consumer and mental health professional. The Chair in consultation with the Executive Committee makes the selection.
5.3 Report by Members of the Board on Their Activities on Behalf of the Board.
Ms. King: I will give a brief report of the Southeast Group Meeting. The group has formed a community wellness partnership. We are looking forward to branching out. The Healing Circle event on September 19, 2009 is from 11 AM to 3 PM.
Ms. Arguelles: I just attended a conference in Daly City in San Mateo County. This is the first time they focus on the Asian community.
5.4 New business - Suggestions for future agenda items to be referred to the Executive Committee.
No new business.
5.5 Public comment
ITEM 6.0 PUBLIC COMMENT
Ms. Francisca Oropeza: Ms. Francesca Oropeza submitted her proposed resolution to be forwarded to the Executive Committee to be considered at the next Board meeting. She thanked the Mental Health Board for its supporting letter to the Board of Supervisors to keep the Southeast Mission Geriatric Services in its present location.
Adjournment
Meeting adjourned at 8:06 PM.