County of Marin Health and Human Services

2015 MHSA Innovation Question Results

Results of Public Input after the 1.9.2015 MHSA Innovation Meeting

Mental Health and Substance Use Services (MHSUS) changed its name to Behavioral Health and Recovery Services (BHRS).  As such, all references in existing departmental policies and procedures to MHSUS can be understood to reference BHRS as well.

Results from 01/09/2015 MHSA Innovation Meeting

Skip to Question #2

Question #1: When you hear "reducing disparities" regarding mental health access/outcomes, what does that mean to you?
Civil Rights Issue
Social Justice Issue
Income Level
Isolation
Services - Local, Criteria to use
Identify Gaps in services - comprehensive
On-Site in communities (board and care facilities)
Prevention in communities (early detection of absent fathers)
Check-In / reminders and personal (caring) messages to keep clients engaged in services
Extensive Outreach - e.g., Marin City - services not there
Providing informational course in communities on empowerment of their own health care options and continued support
Programs for single parents with children that are experiencing mental health problems
Positive Role Models: Peers, cultural and community
Use of New Technology
Stigma reduction directed at specific communities
Support services including Faith-based practices
Knowing where to go
Change in physical mobility
Not knowing benefits due to changes in health insurance/healthcare reform
Transportation to Services
Expanding hours for services
Language barriers
More Advocacy at schools regarding mental health
More emphasis on community best practices rather than standardized
Getting client services when needed (without the wait)
Novato huge lack of services for Severely Mentally Ill (SMI) - transportation or bringing case management to Novato
How are services informed by peoples experience of trauma
Different framework when working with trauma
Include families in work
Fear / Not understanding services and what's involved
Careful with labeling people
Access to caregivers
Integrating school districts in more fluid way
Lack of multi-cultural /multi-lingual employees
Why outcomes measure by amount of services rather than quality of services
Older Adults - stigma around mental health
Over use of Emergency Room (ER) - no one knows what to do and so they go to the ER - linkage to outpatient services after discharge
Social inequities - variables beyond control, i.e., lack of housing will impact outcomes - the need to deal with basic needs first
Services not the right fit
We make a lot of assumptions
We have predefined definition of outcomes, which is different from client driven input on needs
Listen to clients and how they are doing
Silos: institutional and at all levels (impacts non-English speaking or folks who don't have time to figure system/process)
Confusing (long) process (impacts non-English speaking or folks who don't have time to figure system/process)
Cultural norms differ re: seeking services
Service and System not connected (services may exist but system may too difficult to access)
Stigma (impacts different cultures differently)
Lack of cultural representation in services
Staff / Intern turnover (continuity of care)
Barriers to admission and retention (increase inclusiveness)
Clients are not included as leaders (lack of empowerment opportunities)
Top down and white middle class norms dictate decisions (uncomfortable)
Capacity and band-width of any single agency / organization (underlying much of disparity)
Funding requirements are limiting (cast a wide net)
Drive by funding / services - leverage one agency or organization is problematic
Objective and outcomes - who determines them (needs a cultural shift)
Communities aren't receiving service that they need
Lack of access to information
Poverty
Isolation
Stigma / discrimination
Language barriers
Transportation to Services
Space to meet
Lack of family support
Not recognizing differences
Belief system
Lack of support
Type and location of services
Lack of responsiveness
System not adequate in responding / recognizing needs
Fear
Services prior to Severe Mental Illness occurrence
Behavioral Health issue at school that are unidentified /misidentified (root of problem)
System of care should be focused on the individual
Access to health, emphasis on wellness
Care in community
Utilize community centers
Education and information / outreach to families - door to door
Go to families
Reduce stigma, embarrassment, trust issues
Effective care - what are measures, delivery, frequency, intensity? The system is case management, medication focused
What is effective care? Clinical assessment; cultural competence
Awareness of funders and system of certain populations that are marginalized (e.g., criminal justice system)
Lack of access to trusted sources of healing
West Marin - no services; isolated
Everyone gets effective care regardless of race, ethnicity, gender, sexual orientation, age, insurance coverage
Training for effective care regardless of race, ethnicity, gender, sexual orientation, age, insurance coverage
Revealing underserved populations - providing "true" services
Effective care for individual
Client determined (asking community) and offering to create solutions - holistic movement
Source of health, healing and wellness - non-traditional
Not "patients" and "treaters"
Spiritual - engage churches
Adolescents in school (middle and high school) (LGBTQ, different academia achievement)
Students not give access to services
Parent and teens have trouble accessing mental health services (lack of information, knowledge of where to get help)
Bring services to where the group is
Follow through and coordination of services
Reduce stigma
How to better bring everyone together to have a collective impact model
Access
Culturally and linguistically competent
Provide different services in different modalities
Services in non-traditional settings: school, community centers, faith-based, home, where other personal services are provided, where large groups gather, spiritual events
Lack of Latino providers and different cultural providers
Lived experience as professionals
Fold mental health and substance use services into non-mental health support groups
Mild to moderate - this group really is slipping through the cracks. How to provide intervention to this group that’s not a prevention or early intervention group.
Private insurance and all the barriers there
Youth who may want services but their parents does not agree, stigma, uncomfortable, modality. How to reduce this barrier.
Affordability


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Question #2: In Marin, which populations do you think are most in need of “Innovative” efforts to reduce disparities in MH access/outcomes? (ie Which populations seem hardest to effectively reach with existing mental health services? Race/ethnicity • Age • Geographic • Other)
Isolated Seniors (age discrimination)
Marin City & African Americans in other parts if Marin
Canal Area: Hispanic Population Immigrants (and throughout County)
Transitional Aged Youth
Unemployed & Under employed
Homeless
Foster Children
Dual Diagnosis including MH Sub Abuse and Disabled
Buckelew (SMI) Population
Recently released from Prison/Jail - Stigma (in-out jail and prison)
Mental Health Services for Family Home Caregivers
Obesity and Mental Health Issues
Chronic Disease
Relationship
Single moms under poverty level
Public Housing Population all over Marin
People who need public housing: can't get it get kicked out
West Marin Population (Farmers, etc.)
Victims of Abuse
Integration of Substance Use and Mental Health
Children of Incarcerated Parents (0-18yrs)
People with intellectual disabilities - hard to find services / caregivers
Residents of Novato (no county services)
Novato - undocumented Latino community (Adults and Children)
Uninsured
Hoarders - fall through cracks
Homeless Adults
Clients with eating Disorders for uninsured or Medi-Cal
Homebound Older Adults
Young Women (Single, un-married, no kids) have hard time accessing services due to long history of Domestic Violence
Transitional Aged Youth (Public Housing) (Precariously Housed)
Senior LGBTQ
1st Generation Immigrants with Cultural Norms Prohibitive of Seeking Services (Adults, Youth, Families, Seniors)
Homeless / Mentally ill
Undocumented
Those in Criminal Justice system & their children
Folks living in geographically segregated areas (Marin City)
Low income youth (people of color outside systems of opportunity, alienated, not engaged, substance abuse)
55 yrs. + (Latino, unemployed, physical disabilities)
Children / Youth (of incarcerated parents)
Foster Children
Single Parents
Children with stressors at home, parents who are incarcerated
Unsupervised, unstructured, youth (African American in Marin City) (No rec in Marin City)
Transitional Aged Youth with first episode resulting in arrest
Re-entry from prison / jail without services or supervision (probation)
Undiagnosed (MH,SA) 45 and older
Low income older adults, suffer loss, isolation, depression
Low income 60-70+ with substance abuse issues
Children and Families / Caregivers (parents incarcerated, probation, parole, low income, SA, domestic violence)
Non-Spanish speaking Latino pop (Indigenous People)
Immigrant families, acculturation, separation issues - they don’t talk about the separation
OA (underserved, isolated, non-English speaking, immigrant, lack resources in general
Asian
African American
Youth (new comers, Spanish speaking, lack of Latino providers)
LBBTQ
Youth (who have the most stressors stacked against them - high risk)

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