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Mental health urgent care clinic to open Nov. 29

Sacramento Bee - 11/27/2017

Nov. 27--After years of mental health patients inundating Sacramento area emergency rooms, Sacramento County will open a new mental health urgent clinic to provide an intermediate level of care for people struggling to find the right treatment, county officials said.

The clinic will open Nov. 29 on Stockton Boulevard next door to the county's Mental Health Treatment Center. It will offer a variety of services from clinical and psychiatry services, to alcohol and drug screening, medication, peer support and recovery services, said Uma Zykofsky, mental health director for Sacramento County.

"It's built to handle crisis situations, but self-described crisis situations sometimes," Zykofsky said. "For instance, I might go to an emergency department because I'm running out of a refill and I'm trying to get a refill. That's not really a crisis situation but it's an urgent type of service need."

"Our community has long needed these services in the middle, between outpatient and inpatient," said Jonathan Porteus, CEO of Wellspace Health, which has a number of clinics offering outpatient mental health services to clients who are homeless or low income.

The clinic is funded by Proposition 63, the Mental Health Services Act, as a pilot program for five years. Its annual budget of $2.5 million will pay for a "multidisciplinary team" of psychiatrists, social workers and peer navigators, said Al Rowlett, CEO of Turning Point Community Programs, a mental health service provider hired by the county to run the clinic.

The clinic's staff will refer patients, depending on their need, to other services such as crisis respite, crisis residential or alcohol and drug treatment, thus avoiding expensive and sometimes unnecessary hospitalizations.

As a pilot program, Zykofsky and Rowlett said they expect to serve 400 to 450 people per month.

The opening of the urgent care facility is the newest in a series of reforms to fill in the gaps in the county's mental health care system.

In 2015, a Sacramento County grand jury report condemned the county's "shameful legacy of neglect" in its failure to provide adequate access to mental health services. In 2009, the county closed the Crisis Stabilization Unit and reduced the number of beds at its mental health treatment center by half, from 100 to 50.

The result was a flood of mental health patients into Sacramento area emergency departments. According to data from the Office of Statewide Health Planning and Development, in 2009 there were 3,798 people admitted for inpatient psychiatric care through emergency room visits in Sacramento County. By 2013, that number jumped to 7,780 people.

Local emergency departments had to make changes to handle the increase in mental health patients. At UC Davis Medical Center, they hired mental health workers, a substance abuse counselor and trained emergency department nurses in de-escalation techniques and common psychiatric medications, Dr. Lorin Scher said, director of emergency psychiatric service at UC Davis Medical Center.

"The ER is not the best place for people in mental health crisis, so we try to make it as patient centered as we can," he said.

The county's withdrawal from mental health services disproportionately affected low-income and indigent people, the grand jury report found.

A 2016 community health needs assessment by Valley Vision, a research and public policy group, shows African Americans had the highest rate of mental health-related emergency department visits -- at least 50 percent higher than the county rate -- in nine out of 15 ZIP codes. The ZIP codes with the highest rates of emergency department visits are in downtown Sacramento, Oak Park and Arden Arcade.

A white paper by Sierra Sacramento Valley Medical Society pointed out that wait times in Sacramento area emergency departments also increased from 10 hours in 2012 to 19.5 hours in 2013.

In 2015, the county partially reopened the Crisis Stabilization Unit under a new name, the Intake Stabilization Unit, that can be accessed through a referral from a local emergency room, psychiatric hospital or jail. That same year, the county also received grants that allowed it to form a triage navigator program and the mobile crisis support team, which is made up of law enforcement officers and mental health clinicians who respond to mental health crises and connect people with services. Teams can be accessed by the public only through law enforcement dispatch. In its first nine months, the teams at the Sheriff's Department and Sacramento Police Department responded to 551 calls. Of those, 194 people were connected to mental health services or admitted to an outpatient facility, according to a Sacramento County report.

The urgent care clinic will have an "open door at the front," Zykofsky said. "This facility is comparable to the front door of the Crisis Stabilization Unit, when the public was coming in."

It will be open 10 a.m. to 10 p.m. during the week and 10 a.m. to 6 p.m. on weekends.

"The (emergency departments) do currently get individuals who absolutely need to go to an ED but they also get individual who don't have another place to go. We anticipate that there will be a shift; however, I think it's going to take a few months of education of our community to understand how big that shift will be."

The county and Turning Point will publicize the clinic to potential patients through emergency department staff, law enforcement and triage navigators.

"I'm cautiously optimistic that it will decrease the burden on local emergency departments," Scher said.

The new urgent care clinic is open to children and adults, Zykofsky said. There will be bilingual staff to help patients overcome language barriers, too.

"What we're seeing with this decision is 'start small and grow it'... After a period of drought, a little rain is better than no rain," said Porteus, the CEO of Wellspace Health.

"I think in our community because we haven't had this intermediate level of service for mental health, people don't have another alternative, and we are providing that alternative level of care," Zykofsky said.

At the end of the five-year pilot program, the county will evaluate the clinic's service records and determine whether more mental health urgent care clinics should be opened in new locations.

Molly Sullivan: 916-321-1176, @SullivanMollyM

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(c)2017 The Sacramento Bee (Sacramento, Calif.)

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