Patients with mental health and substance-use disorders are commonly seen in general hospitals. The behavioral health disorder may be a patient’s primary diagnosis, or it may be a co-morbid condition accompanying a physical health disorder, such as diabetes, cancer or coronary artery disease.
Mental illnesses are extremely common, affecting almost every family in California, from every background and of all ages. More than 2 million children, adults and seniors in California are affected by a potentially disabling mental illness every year. Generally speaking, a danger of suicide, harm to self, harm to others or being gravely disabled qualify an individual for acute psychiatric care.
Patients with mental health and substance-use disorders are
commonly seen in general hospitals. The behavioral health
disorder may be a patient’s primary diagnosis, or it may be a
co-morbid condition accompanying a physical health disorder, such
as diabetes, cancer or coronary artery disease.
Mental illnesses are extremely common, affecting almost every
family in California, from every background and of all ages. More
than 2 million children, adults and seniors in California are
affected by a potentially disabling mental illness every year.
Generally speaking, a danger of suicide, harm to self, harm to
others or being gravely disabled qualify an individual for acute
Statewide, there are approximately 6,000 inpatient psychiatric
beds in 140 hospitals supporting a population of more than 36
million people. Many hospitals providing inpatient acute
psychiatric care also provide intensive outpatient programs,
among other treatments.
Whether hospitals do or do not provide organized behavioral
health services, they must be prepared to address issues arising
from patients with mental health and substance-use disorders.
California hospitals providing acute psychiatric in patient care
are committed to the delivery of responsive, accountable and
clinically effective prevention, treatment and care for children,
adolescents and adults with mental and substance-use disorders.
CHA’s Center for Behavioral
Health focuses on legislation, policy and advocacy on behalf
of freestanding psychiatric and chemical-dependency hospitals, as
well as general acute-care units.
AB 1421 (Chapter 1017, Statutes of 2002) – known as “Laura’s Law” – established the Assisted Outpatient Treatment (AOT) Demonstration Project Act of 2002. This Act became effective January 1, 2003.
The Act creates an AOT program that permits court-ordered treatment for a person with a mental disorder who meets specific criteria. However, AOT programs may only be implemented in counties in which the Board of Supervisors, by resolution, makes a finding that no voluntary mental health program serving adults, and no children’s mental health program are reduced as a result of the implementation of an assisted outpatient treatment program.
AB 1421 (Chapter 1017, Statutes of 2002) – known as “Laura’s Law”
– established the Assisted Outpatient Treatment (AOT)
Demonstration Project Act of 2002. This Act became effective
January 1, 2003.
The Act creates an AOT program that permits court-ordered
treatment for a person with a mental disorder who meets specific
criteria. However, AOT programs may only be implemented in
counties in which the Board of Supervisors, by resolution, makes
a finding that no voluntary mental health program serving adults,
and no children’s mental health program are reduced as a result
of the implementation of an assisted outpatient treatment
There are 58 counties in California. Not all of them have similar protocols or relationships with our hospitals. In fact, California hospitals have reported frustration or confusion when trying to decipher county mental health and substance use disorder services. Navigating multiple funding streams across multiple counties can be confusing.
The Substance Abuse and Mental Health Services Administration
(SAMHSA) has released a series of resources intended to help
providers incorporate, in their disaster planning, strategies to
care for patients with serious mental illness.
The California Department of Public Health reminds
general acute care hospitals and acute psychiatric hospitals
that, effective Jan. 1, they may not require, as a condition of
admission, a person who voluntarily seeks care to be placed on an
involuntary hold under Section 5150 of the Welfare and
The Centers for Medicare & Medicaid Services (CMS) this week
announced a new Medicaid demonstration that will provide
opportunities for states to design innovative service delivery
systems for adults with serious mental illness and children with
serious emotional disturbance.
CHA’s latest guidebook, Discharge Planning for Homeless
Patients, explains California’s new homeless patient
discharge planning law and offers insights to help hospitals
prepare to return homeless patients to the community.
The Centers for Medicare & Medicaid Services (CMS) has announced
the Maternal Opioid Misuse (MOM) model, intended to better align
and coordinate care of pregnant and postpartum Medicaid
beneficiaries with opioid use disorder. Under the model, state
Medicaid agencies will be required to design a comprehensive set
of services that includes care management and coordination,
health promotion, individual and family support, and referral to
community and social services.
CHA and Our Health California (OHC) — a digital community of nearly 1 million supporters — have published two new data-focused videos in support of Behavioral Health Action. Co-founded by CHA this year, Behavioral Health Action is a coalition of more than 50 organizations working to engage candidates and raise awareness about the importance of addressing behavioral health issues statewide.
The videos are the first phase of a three-pronged OHC advocacy campaign to support Behavioral Health Action’s objectives between now and Election Day on Nov. 6. Titled Healthy Minds, each video “datagram” includes key facts about the behavioral health crisis — for example, that it affects millions of Americans, including 6 million Californians, and that many of those affected don’t seek the help they need. The OHC web page also includes information on signs to watch for, available resources and the need to destigmatize mental health issues.
Next week, OHC will launch an advocacy petition urging the 330 congressional and state legislative candidates to prioritize behavioral health issues and provide a written/video response for the Behavioral Health Action website. Between mid-October and Nov. 6, OHC will promote a “get out the vote” campaign urging its community and others to vote for candidates who have clearly prioritized health care issues, including behavioral health.
new study funded by the Bill and Melinda Gates
Foundation and released in The Lancet finds that alcohol
use is the leading risk factor for global disease burden and
causes substantial health loss. According to researchers, the
risk of all-cause mortality — specifically of cancers — rises
with increasing levels of consumption, and the level of
consumption that minimizes health loss is zero. The analysis
relied on 694 data sources of individual and population-level
alcohol consumption, along with 592 prospective and retrospective
studies on the risk of alcohol use. The data were used to
estimate the prevalence of current drinking, abstention, the
number of drinks consumed daily among current drinkers,
alcohol-attributable deaths and disability-adjusted years of
life. Globally, alcohol was the seventh leading risk factor for
both death and disability, accounting for 2.2 percent of female
deaths and 6.8 percent of male deaths.
new toolkit from Mental Health America (MHA) aims to help
raise awareness of the importance of proactively addressing
student mental health. Noting that half of all mental health
disorders begin by age 14, the toolkit includes information about
how traumatic events can trigger mental health issues and
encourages parents, caregivers and school personnel to recognize
the signs of a person struggling with mental health. Fact sheets
address understanding trauma, recognizing anxiety, recognizing
psychosis, recognizing depression and preventing suicide.
MHA also emphasizes the importance of mental health screening to
identify symptoms of a behavioral, emotional or cognitive
disorder. Free, confidential and anonymous screening tools are
available at www.MHAScreening.org.
The Center for Medicare & Medicaid Innovation has
announced the Integrated Care for Kids Model, a child-focused
model to “increase behavioral health access, respond to the
opioid epidemic and positively impact the health of the next
generation.” The new model aims to reduce expenses and
improve quality of care for children eligible for Medicaid and
the Children’s Health Insurance Program – through
prevention, early identification, and treatment of priority
health concerns such as behavioral health challenges and physical
health needs. The Centers for Medicare & Medicaid Services will
select up to eight participants for the model; participants
will be either a state Medicaid agency or a local entity called a
“lead organization.” More information is
New resources from the Substance Abuse and Mental Health Services
Administration (SAMHSA) seek to provide greater support for first
responders’ mental health. According to a recent national study,
19 percent of first responders reported having had thoughts of
suicide, while 27 percent reported having struggled with
substance use issues, and 81 percent said they feared being
seen as weak or unfit for duty if they asked for help. With input
from first responders, SAMHSA developed a
new, online training course that addresses occupational
stressors; mental health and substance use issues, including
depression, post traumatic stress disorder, suicidality and
alcohol use; resilience; and healthy coping mechanisms, including
demonstrations of stress management techniques. It is accredited
by the Commission on Accreditation for Pre-Hospital Continuing
Education for continuing education credit.
California’s behavioral health delivery system is in crisis, with
a deficiency of in- and out-patient providers for the growing
population. The attached report provides data on hospital
inpatient services available for individuals needing this level
of care. This is a preliminary report. The final report will
include additional data points related to the delivery system.
New research indicates that the Medicaid program can play a key
role in helping mothers and babies affected by the opioid crisis.
According to a
new report from Health Affairs, Medicaid covers
roughly half of all births — and more than 80 percent of babies
born with neonatal opioid withdrawal. The report identifies
opportunities for further research, including evaluation of the
causes of opioid use in pregnant and postpartum women as well as
the evidence-based interventions designed to reduce that use. The
report also identifies policy opportunities specific to pregnant
and postpartum women, including:
Replacing criminal penalties, prosecution and
incarceration with opioid treatment programs
Streamlining Medicaid enrollment processes to facilitate
expedited access to routine prenatal care
Expanding workforce development to increase the number of
clinicians trained to prescribe and provide medication assisted
treatment, including nurse-midwives
The Centers for Medicare & Medicaid Services (CMS) has issued the
attached final rule updating the inpatient psychiatric facility
(IPF) prospective payment system for federal fiscal year
(FFY) 2019. CMS finalized a 2.9 percent market basket update,
offset by a productivity adjustment of 0.8 percent and an
Affordable Care Act-mandated cut of 0.75 percent, as well as a
decrease of 0.24 percent due to updating the high-cost outlier
threshold. Overall, CMS estimates IPF payments will increase
by 1.1 percent, or approximately $50 million, compared to FFY
CMS also finalized the removal of five measures from the IPF
Quality Reporting Program beginning with the FFY 2020 payment
determination, in support of its Meaningful Measures Initiative.
CMS did not finalize the removal of three measures: Physical
Restraint Use, Seclusion Use and Tobacco Use Treatment at
Discharge. In addition, CMS finalized its proposal to no longer
require facilities to submit sample size counts for measures for
which sampling is performed, beginning with the FFY 2020 payment
determination. CHA will provide a detailed summary of the final
rule in the coming weeks. More information is available in CMS’
According to a
new report from the California HealthCare Foundation, many
Californians who experience mental illness do not get treatment.
Despite federal and state laws that mandate parity in coverage of
mental and physical illness, approximately two-thirds of adults
with a mental illness and two-thirds of adolescents with major
depressive episodes do not get treatment. However, the number of
adults receiving specialty mental health services through
Medi-Cal has increased by nearly 50 percent from 2012 to 2015 —
coinciding with expansion of Medi-Cal eligibility.
Other key findings include:
The prevalence of serious mental illness varied by income,
with much higher rates of mental illness at lower income levels
for both children and adults.
Compared to the US, California had a lower rate of suicide,
although it varied considerably within the state by gender, age,
race/ethnicity and region.
Emergency department visits resulting in an inpatient
psychiatric admission increased by 30 percent between 2010 and
2015. More robust community services might decrease emergency
In 2015, 38 percent of female prison inmates and 23 percent
of the male prison population received mental health treatment
New reports from the University of California, San
Francisco address ongoing community paramedicine pilot
programs across the state. In November 2014, the California
Office of Statewide Health Planning and Development approved an
application from the California Emergency Medical Services
Authority to establish a Health Workforce Pilot Project that has
encompassed 17 projects in 13 communities across California to
test seven different community paramedicine concepts.
The latest reports evaluating California’s Community Paramedicine
Pilot Program reaffirm that the projects have improved
coordination among providers of medical, behavioral health and
social services and reduced preventable ambulance transports,
emergency department visits and hospital readmissions. As shared
in earlier reports, the pilot projects have not resulted in any
adverse patient outcomes. The types of community paramedicine
projects being tested are post-discharge, short-term follow
up; frequent emergency medical services users; directly observed
therapy for tuberculosis; hospice; alternate destination – mental
health; alternate destination – urgent care; and alternate
destination – sobering center.