Mental Health and Primary Care Integration

1. Mental Health and Primary Care Integration County of San Mateo Mental Health Cheryl Walker M.S., M.F.T. Unit Chief Primary Care Interface Team Unit Chief Family Self Sufficiency Interface Team

2. Primary Care & Mental Health Integration Points Primary care Interface Team (embedded in primary care clinics) Primary care nurse practitioner (embedded in mental health clinics)

3. Primary Care Interface Team2006 • Primary care interface team. 3 Spanish speaking mental health clinicians in 4 primary care clinics. One .5 Adult Psychiatric in 2 primary care clinics 1.5 Youth Spanish speaking clinicians in 4 primary care clinics 1 Youth Chinese clinician fluent in two or more languages in 3 primary care clinics One .60 Child and Adolescent Psychiatrist in 3 primary care clinics 1 Unit Chief. One .5 field based clerk

4. Primary Care Interface Service • Assess, consult, treat or refer. • Identify SMI and link to the intake team. • Brief treatment Solution Focus Therapy, case management or linkage (1-8 interventions). • Refer patients to alcohol and drug services, consult with those services and add to treatment plan. • Facilitate communication between primary care, regional mental health.

5. Psychiatrist Role • Assessment • Medication evaluation • Brief medication management for complex symptoms that have not responded to primary care treatment. • Consultation

6. Psychiatrist Role: Continued • Liaison • Education • Training

7. Primary Care Interface Criteria for Mental Health Treatment Mental or emotional illness negatively impacting medical care Crisis intervention/5150 Serious mental illness /linkage to ACCESS team

8. Breakdown of Services 2001-2002 • Received 877 written referrals • Opened 691 charts • Charted over 6000 contacts • Team productivity is 70% • Average 172 open charts per clinician annually • 71% of the charts were closed within 60 days • Average 10 interventions per client

9. Breakdown of Funding Sources • Medi-cal • Medicare • Insurance • M.O.U. Other departments • Fees

10. Communication • Intra-agency referral form • E-mail • Voice mail • Dictation of MH report into medical data base • Computer access to MH, medical, Data

11. Interface Team Funding 02-03 • Medi-cal $388,000.00 • Hospital & clinics $ 97,000.00 • Human service agency $120,000.00

12. Primary Care Nurse Practitioners 1994-Current • 1.3 nurse practitioners in three regional mental health clinics

13. Criteria for Referral to N.P. • Treatment for mental illness by regional mental health team • Client unable to use primary care clinic service due to impairing mental health symptoms

14. Nurse Practitioner: Treatment • Primary medical care • Referral to specialist Discharge criteria • Referral to primary care clinic when discharged from mental health services

15. N.P. Outcome • Diabetic education groups • Nutrition weight loss study • Monitoring for known medical side-effects of atypicial • Lipid abnormality • Diabetes • Weight gain

16. Continued: • Women’s health study found • Majority over 40 • Non smokers • Increased weight gain • Not sexually active

17. Communication • Mental heath team referral form • Attends weekly mental health clinical meeting • Consultation with mental health staff • Voice mail • Dictation of medical report into medical data base • Computer access to mental health data base • E-mail

18. Nurse Practitioner Funding Approximately $175,000.00 Completely funded by primary Care Funding resources Medi-Cal Medicare Well Program Fees Indigent program

19. Work in Progress Improving communication between primary care & regional mental health Developing new computer system for electronic record Developing discharge strategies to primary care Start up of psychiatrists Start up of Youth therapists

20. Thank You Celia Moreno-Medical Director Mental Health (650)573-2043 Cmoreno@co.sanmateo.ca.us Cheryl Walker-Unit Chief, Interface Teams (650)573-2630 Cwalker@co.sanmateo.ca.us