California mental-health services best practices

How do you know if something is working? Study the data.

But often the data is not so clear. Collecting data is expensive. And sometimes what matters cannot be counted, and what can be counted does not matter. Nevertheless, we want to understand the impact of programs such as the Mental Health Services Act (or Proposition 63), which will raise $1.7 billion this year.

Because California is a pioneer in significantly increasing funding for mental-health services, we cannot look to other states. We have to come up with our own criteria for evaluating programs.

And data often seems to generate more heat than light. Hearing the call for data to understand mental-health outcomes, I was skeptical at first that we’d be able to get good information. But now I am more optimistic.

A recent Steinberg Institute and County Behavioral Health Directors Association of California study showed convincingly the impact of mental-health programs on 35,000 Californians who received “Whatever-It-Takes” intensive services. These services dramatically reduced hospitalizations, jail time and out-of-home placements for children. Implementing this program clearly saved lives as well as dollars.

The costs of these preventative programs were small, compared to the benefits to the recipients as well as the reduced costs of other services such as jail or hospitalization that would have had to be provided otherwise.

Last month, at a Cap-to-Cap event in Washington, D.C., Darrell Steinberg proposed the creative approach of using data to provide direction. He suggested asking questions that would help to establish a clear path for the counties to implement best-practices mental-health plans.

Here are the questions that he would like to learn the answers to:

(1) In our six-county region, how many mental-health outreach and assessment workers are stationed at emergency rooms, jails and social service facilities to identify those with severe mental illness in need of crisis intervention?

(2) How many mobile outreach units are available to intervene with children or adults having a mental-health crisis in their own residences?

(3) How many crisis beds are available county-by-county and within our region to help stabilize people triaged out of the settings described in the first question?

(4) How many longer term treatment slots of various intensity and supportive housing units exist in our region for people who transition out of crisis housing?

(5) How quickly do people move through the steps described above?

(6) What are the medium- and long-term outcomes of reduced hospitalizations, arrests, psychiatric interventions and other reduced consequences for people who get help through the continuum of care described above?

The answers to these questions could provide clarity and a direction for the county staff to follow. A better understanding of best practices would likely result in significantly less people suffering from untreated mental health problems. And hopefully, it would also result in lower overall costs, if factors such as the costs of incarceration, institutionalization, hospitalization and loss of productivity due to mental illness are taken into account. That is data that is worthy of being counted.