The document discusses mental health and recovery in California. It notes that about half of adults and two-thirds of adolescents with mental health needs do not receive treatment. Around 1 in 20 California adults suffer from a serious mental illness. Expenditures for inpatient and residential treatment have declined as outpatient care and prescription drug costs have increased. The Mental Health Services Act of 2004 provides funding for community-based mental health services in California.

1. ❧
MENTAL HEALTH
AND RECOVERY IN
CALIFORNIA
By Colleen & Devon

2. ❧❧ About half of adults
and two-thirds of
adolescents with
mental health needs
did not get treatment
❧ About 1 in 20 adults in
CA suffer from a
serious mental illness
making it difficult to
carry out major life
activities.
Prevalence

3. ❧
Mental Health Continuum in California

4. ❧
The distribution of spending on mental health care in
the US has changed dramatically over the last 20 years,
with inpatient and residential care spending decreasing,
and outpatient care and prescription drug spending
increasing
❧ From 1995-2010 acute psychiatric beds have
decreased by 40%
Mental Health Services in California

5. ❧ Expenditures for
inpatient and
residential
treatment declined
as expenditures
for prescription
drugs and
outpatient care
increased.

6. ❧
However, spending on public mental health has been increasing:
federal health reform, expansion of Medi-Cal and Mental Health
Services Act

7. ❧

8. ❧
❧ November 2004, U.S. State of California passed Prop 63
called the Mental Health Services Act (MHSA)
❧ By January 2005, it became a law representing the
movement to provide better coordinated and comprehensive
care to those with serious mental illness and underserved
populations
❧ MHSA demands that California State Department of Mental
Health contract with each county mental health departments
to develop and manage implementation of services
❧ Funding from taxing 1% of income over 1 million
Mental Health Services Act

9. ❧❧ Define serious mental illness among children, adults and seniors as a
priority
❧ Includes prevention and early intervention services and medical and
supportive care
❧ Reduce the long-term adverse impact on individuals and families
❧ Expand successful service programs for children, adults and seniors
already established in California,
❧ Including culturally and linguistically competent approaches for
underserved population
❧ Provide State and local funds to adequately meet the needs of all children
and adults
❧ Ensure all funds are spent in cost-effective manner and services are
provided according to best practices,
MHSA Requirements for
Service Delivery

10. ❧
❧5 Essential Concepts:
❧ Community collaboration
❧ Cultural competence
❧ Client/family-driven mental health system for older adults,
adults and transition age youth and family-driven system of
care for children and youth
❧ Wellness focus, which includes the concepts of recovery
and resilience
❧ Integrated service experiences for clients and their families
throughout their interactions with the mental health system
Department of Mental
Health

11. ❧❧ State Tax Revenue County County Contracted⇒ ⇒
Programs
❧ Community Planning: involve public in identifying local
funding priorities
❧ Community Services & Supports: provide integrated mental
health and other support services in the community
❧ Prevention and Early Intervention: reduce stigma and
discrimination , preventative services
❧ Innovative Programs: improve access to mental health care
❧ Capital Facilities and Technology: improve infrastructure of
CA mental health system
❧ Workforce Education and Training: develop and grow the
public mental health workforce
Service Delivery

12. ❧
ROLES IN MENTAL HEALTH SERVICES

13. ❧
OUR EXPERIENCE

14. Counseling Cove
Trauma-focused outpatient clinic

15. ❧❧ Target Population: Youth ages 12-20 experiencing homelessness
or running away
❧ Social Problems: Substance use (drugs/alcohol), Sex trafficking,
Physical/Sexual abuse, Trauma, Removed from home due to
disclosing sexual orientation (LGBTQ)
❧ Services Provided: Individual, Group, Family Counseling
❧ Treatment Models: Trauma-Focused Cognitive Behavioral Therapy,
Motivational Interviewing, Solution-Focused Therapy, Crisis
Intervention, Assertive Outreach and more.
❧ My role: Rehabilitative worker, I provide individual sessions with client
(patient), teach healthy coping skills, model and role play social skills
while in community, teach healthy communication skills such as
speaking clearly, slowly, and pronouncing words. I advocate for client
to get welfare benefits and other necessary documentation. Facilitate
groups at homeless shelter
Counseling Cove

16. ❧❧ Clinician (Therapist):
❧ Provide psycho-education regarding diagnosis
❧ Teach healthy coping and relaxation skills to cope effectively with
trauma, diagnosis, and symptoms of clients
❧ Monitor treatment goal progress and modify client treatment plan if
necessary
❧ Utilize treatment models to provide therapy to clients
Support Partner (Rehabilitative Workers):
❧ Practice healthy coping and relaxation skills to cope effectively with
trauma, diagnosis, and symptoms of clients
❧ Provide referrals and connections to further services (case
management)
❧ Teach client about healthy boundaries, communication skills, and
social skills
❧ Psychiatrist:
❧ Medication Evaluation
❧ Psychiatric Evaluation to request more sessions
Treatment Teams at
Counseling Cove

17. ❧
❧ Emergency Psychiatric Hospital (72 hour hold)
❧ Placed on 72 hour hold when danger to self, others, or greatly
disabled
❧ Coordinate discharge planning with Doctor and hospital staff
❧ Client may be visited by Therapist or Rehab worker in order to
create safety plan
❧ Parents/Guardians and other caregivers of Clients
❧ Teach healthy boundaries
❧ Teach relaxation techniques and coping skills to help the client
practice to address symptoms
❧ Teach about triggers and warning signs
❧ Help caregivers manage own emotional and behavioral responses
towards client
Coordination of Care

18. ❧
TELECARE: GATEWAY
TO RECOVERY
ASSERTIVE
COMMUNITY
TREATMENT

19. ❧
❧ Target Population: Adults 18-65 years old
❧ Social Problems: mental health, substance use
(dual diagnosis), homelessness, recidivism (criminal
justice systems, re- hospitalizations)
❧ Goal: Establish stability in the community
❧ Referral: Psychiatric Hospitals + Highest users of
psychiatric services
❧ Assertive Community Treatment (ACT)
Model: multi disciplinary team (5 teams, 7-8 per
team)
TELECARE: GATEWAY
TO RECOVERY

20. ❧❧Role of Social Worker (4): Intensive Case Management (Full Service
Partnership), Weekly individual sessions, psychosocial rehabilitation,
representative payee, supported housing, medication support, crisis
intervention (24 hour hotline), individual, family, and group therapy, advocacy
❧ Example of tasks: coordinate discharge and treatment plan with
hospital, assist with Primary Care Physician Appointments, apply for
Medi-Cal/ ID Card/ Social Security, conflict resolution with landlord,
❧ Typically each case manager is a specialist (housing, substance use,
vocational skills, clinician (therapy).
❧Role of Nurse (1): Medication Management, Insurance, Provide
antipsychotic shots
❧Role of Psychiatrist: Assess and prescribe medication
❧ 2 psychiatrists for all teams
❧Role of Peer Mentor(1): Lived experience of recovery, knowledge of
additional resources, different perspective
❧Intern (1): Similar to Social Worker Duties
ROLES

21. ❧❧ MENTAL STATUS EXAM
❧ Appearance: appropriate, hygiene, falls, apprent age, state of
health
❧ Behavior: eye contact, motor movement, alertness
❧ Cooperation: accept/refuse services
❧ Speech & Language: fluency, rate, volume
❧ Affect /Mood: self reported vs observed, congruence
❧ Thought Process: logical, illogical, flight of ideas, tangential
❧ Thought Content: delusions, Suicidal/Homicidal Ideation
❧ Perception: hallucinations
❧ Orientation: time, place, person, and current situation
❧ Cognitive Functioning: Judgment, Insight, Memory, Intelligence
Assessment:

22. ❧
❧ Medical model vs recovery model
❧ Ex. Alcohol Anonymous
❧ staying in control of their life despite experiencing a
mental health problem
❧ Strength Based: focusing care on supporting
recovery and building the resilience of people with
mental health problems, not just on treating or
managing their symptoms.
❧ Recovery as a process of self discovery, personal
growth, and discovery of values skills and interests
RECOVERY ORIENTED SERVICES

23. ❧❧ WRAP (Wellness Recovery Action Planning)
WRAP is a self-management and recovery system developed in the
US by people with mental health difficulties. People are supported to
create their own wellness recovery action plan, setting out their goals,
what help they need to get there, what helps keep them well, and what
puts their mental health at risk. WRAP aims to:
❧ increase the person's sense of control over their mental health
problems
❧ increase personal empowerment
❧ improve quality of life
❧ assist people in achieving their own life goals and dreams.
❧ A WRAP will also state how the person wants others to respond when
symptoms have made it impossible for them to continue to make
decisions safely for themselves and take care of themselves.
RECOVERY MODEL
IMPLEMENTATION

24. ❧❧ 1. Daily Maintenance Plan
❧ Vision of yourself in full recovery, what you need to do to maintain wellness, daily to do list
❧ 2. Identify Triggers
❧ Events that make you feel worse
❧ Ex. where you used to meet your drug dealer
❧ 3. Early Warning Signs
❧ Signs that you are feeling worse
❧ Ex. Can’t sleep, isolation
❧ 4. When Things are Breaking Down
❧ list those signs that let you know you are feeling much worse and need to ask for help
❧ Ex. Hearing voices
❧ 5. Crisis Plan / Advanced Directive
❧ Identify who to contact to help you make decisions and take care of you, what do you want
people to do to help, leave health care information
❧ 6. Post Crisis Plan
❧ Identify what you need to restabalize
WRAP

25. ❧
❧ Also recovery oriented
❧ Gives hope to people with severe mental illness that
they can lead normal productive lives
❧ Gives a sense of belonging
❧ build long-term relationships that, in turn, support
them in obtaining employment, education and
housing
❧ Terminology: member vs patient, client, disabled
❧ Values: Meaningful relationships, recovery,
engagement (not treatment or therapy)
CLUBHOUSE

26. ❧❧ A Work-Ordered Day
❧ 8 hour day, members work with staff to run the clubhouse ( no therapies
or treatment oriented activities)
❧ Employment Programs
❧ Transitional Employment: vocational rehabilitation, on site and offsite
clubhouse staff support, regain confidence and skills, 6-9 months
❧ Independent Employment: help seek and obtain a job of their own,
offsite support
❧ Evening, Weekend and Holiday Activities
❧ Recreational activities outside 8 hour day, social activities
❧ Community Support
❧ Access to community support: housing and medical services
Basic Components

27. ❧❧ Reach-Out
❧ Keep in contact with all active members, encourages participation,
no obligation
❧ Education
❧ offers educational opportunities for members to complete or start
certificate and degree programs at academic institutions and adult
education providers
❧ Focus on Literacy (staff and members)
❧ Housing
❧ gives members access to stable housing, linkage to housing
programs or creates own housing program
❧ Decision-Making and Governance
❧ Members and staff have an open discussion about clubhouse
policies and future plans for the clubhouse
Basic Components

28. ❧
❧ Clubhouse located in San Diego
❧ Clubhouse units (8 hour work day)
❧ units as “home base”, check in everytime, members choose their
preference
❧ Unit one: Kitchen, Cafe, and Fitness center
❧ inventory, planning and shopping for menu items, recycling,
preparing meals, maintaining fitness equipment, selling and
stocking cafe items
❧ Unit two: Business, Administration, and Communication
❧ receptionist, data entry, producing newsletter. social media,
creating of outreach and greeting cards, tracking and
managing clubhouse statistics
THE MEETING PLACE

29. ❧
❧ Employment
❧ Supported Employment:
❧ job coach, resume, interviewing skills, individualized job
search, employment workshop, job placement services, on
the job training/ support, ongoing follow up and support
❧ Transitional Employment:
❧ Partners with HomeGoods, TJ Maxx, Ultrastar Cinemas
❧ Independent Employment
❧ Education
❧ create education goals, collaboration with community colleges,
universities, and adult learning facilities for accommodations
❧ Assistance with application for enrollment and financial aid
❧ Tutoring in some areas
THE MEETING PLACE

30. ❧
❧ Recreation
❧ Summer: monthly barbeques, bonfire at the beach, field trips to
parks and other attractions
❧ Dinner, movies, shopping, holiday celebration, dancing, karaoke,
art projects
❧ Social activities created monthly in staff and member meetings
❧ Health and Wellness
❧ health= physical + mental
❧ weight loss program, nutrition and health education, organic
meals and snacks, exercise equipment, daily walking, boot camp
❧ Other
❧ assistance with applying for social security and disability benefits,
budgeting, daily living skills, advocacy
❧
THE MEETING PLACE

31. ❧
❧Employment: Longer job employment is correlated with clubhouse
attendance
❧Significant Decrease in Hospitalization
❧Significant Decrease in Incarceration: Decreased criminal justice
involvement
❧Improved Wellbeing: Members are more likely to report have close
and reliable friendships
❧Cost Effectiveness: reduced hospitalization/incarceration + cost less to
run clubhouse than other community treatment models
❧A Recent study has suggested that service systems should prioritize
services that offer ongoing social supports like Clubhouses because they
enhance mental and physical health by reducing disconnectedness
Evidenced Based Model

32. ❧
❧ Solution Focused Therapy is a short term
intervention in which client and social worker focus
on solutions and resources rather than problems.
❧ SFBT is a synthesis of other interventions including:
systems theory; crisis theory; brief therapy models,
family systems; communications theory
Solution Focused Brief
Therapy (SFBT)

33. ❧
❧ Language is powerful in shaping one’s sense of their life
❧ Words used to define patients or situations influence the conclusions
we make
❧ Social Worker (SW) should listen to how clients use language to
define their challenges and functioning
❧ SW must be cautious of professional language that can stigmatize
clients
❧ SW must de-emphasize problem talk to change focus from
looking for causes of clients problems
❧ Emphasize solution talk to help clients focus on solutions to
problems
❧ Cultivate an atmosphere of strengths and resources
Major Components of
SFBT

34. ❧
❧ Processes of assessment for SW comes from Elliott & Metcalf
(2009), DeJong & Berg(2008), Quick (2008), De Shazer (1994,
1985)
❧ Assessment:
❧ Problem articulation: includes client beliefs about the source
of the problem and how client defines problem
❧ Developing goals within the client’s view
❧ Then during the session, Social Worker does the following:
❧ explores for exceptions
❧ participates in task development
❧ Provides end-of session feedback
❧ evaluates client progress
SFBT: Assessment

35. ❧
❧ Scaling exercises --1-10 motivation to resolve the problem
❧ If motivation is low, SW ask client about how the problem situation can improve in
that context or reduces the problem
❧ Reframing comments
❧ SW give the client credit for positive aspect of his or her behavior related to the
presenting problem
❧ Strengths reinforcing coping questions:
❧ SW Ask:
❧ How have you been able to manage the problem so far?
❧ What have you done recently that has been helpful?
❧ Pre-session change question:
❧ SW ask: Has anything changed about the problem since you made the appt?
SFBT: Intervention
Strategies

36. ❧❧ Externalize the client’s problem
❧ Make it something outside of rather than within the client
❧ Explore Exceptions
❧ These questions bring ideas for solutions to the client’s attention
❧ SW ask: What was different in the past when the problem wasn’t a problem?
❧ exploring for RECENT exceptions is recommended
❧ Client is encouraged to explore goals
❧ Client works with SW to acheive them
❧ The Miracle Question (Dejong & Berg, 2008)
❧ Client asked to imagine that during the night while sleeping the presenting problem
went away, but client didn’t know it did.
❧ SW asks: What would client notice the next day that would provide evidence of
problem disappearing?
SFBT: Intervention
Strategies

37. ❧❧ http://www.chcf.org/~/media/MEDIA%20LIBRARY%20Files/PDF/M/PDF
%20MentalHealthPaintingPicture.pdf
❧ http://en.wikipedia.org/wiki/California_Mental_Health_Services_Act
❧ http://www.themeetingplaceinc.org/index.php
❧ http://www.iccd.org/whatis.html
REFERENCES