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Adequacy of California's hospital infrastructure for treating the mentally ill

Adequacy of California's hospital infrastructure for treating the mentally ill. American Public Health Association San Diego CA - 29 Oct 2008. Presenter Disclosures.

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Adequacy of California's hospital infrastructure for treating the mentally ill

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  1. Adequacy of California's hospital infrastructure for treating the mentally ill American Public Health Association San Diego CA - 29 Oct 2008

  2. Presenter Disclosures The following personal financial relationships with commercial interests relevant to this presentation existed during the past 12 months: None to disclose. Linda Remy, MSW PhDGerry Oliva, MD MPH Family Health Outcomes Project Department of Family and Community Medicine University of California, San Francisco

  3. Background • In 1968 California led the national movement to deinstitutionalize the mentally ill with intend to establish outpatient treatment • Community programs not developed • Availability of new evidence –based treatments • Serious access and quality issues exist • Mental Health Services Act offers and opportunity

  4. Study Objectives • Describe the history of health planning in California • Describe hospital infrastructure changes • Evaluate the impact on hospital utilization for the population of reproductive age (15 to 44) diagnosed with mental illness and/or substance abuse (MISA)

  5. 1970s - Rise of Health Planning • Congress established health planning • Health Service Areas (HSA) defined nationally based on cluster analysis of MediCare utilization data • HSA to do health planning driven by local needs, with quality, accessibility, continuity, and cost containment as major goals

  6. Rise of Health Planning - California • 1976 California legislation paralleled Federal initiative and qualified State for Federal planning funds • Office of Statewide Health Planning and Development (OSHPD) created • OSHPD established review process with Certificate of Need for new programs, facilities, and expensive equipment

  7. Decline of Health Planning • 1983 - After intense hospital industry lobbying, California legislature suspended planning • 1987 - hospitals could close or consolidate without state review • 1993 - counties authorized to eliminate or consolidate HSA/HFPA boards • 1995 - Repealed all provisions addressing hospital construction and health planning

  8. Number of California Hospitals by Type

  9. Number of California Beds by Type

  10. Number of Hospitals in County with Adult Psychiatric Beds

  11. Number Of Hospitals In County With Adolescent Psychiatric Beds

  12. Adolescent Treatment Capacity2007 • California Department of Health and Welfare • 5 residential treatment facilities, 142 beds • Department of Social Services • 1,162 beds in group homes for SED children in 18 counties • California Counties • 11 counties Inpatient adolescent psychiatric beds Residential treatment settings Treatment group homes • 7 counties Treatment group homes • 40 counties No adolescent capacity

  13. Number Of Hospitals In County With Chemical Dependency Beds

  14. Chemical Dependency 2007 • Department of Alcohol and Drug Programs • 41,382 residential and day CD slots • in 28 counties • 10 counties - Full range of CD treatment • 18 counties - Residential or day treatment • 30 counties - No licensed CD treatment

  15. Admissions Age 15-44 1994 and 2005

  16. MISA admits (%) to hospitals lacking psychiatric capacity by location

  17. Summary of Findings • Structural capacity plummeted • Psychiatrists well-represented in most areas but lacking inpatient care • OOC admissions increased significantly for MISA population compared to general population • MISA admissions to hospitals lacking specialized facilities almost doubled • No relationship between structural capacity and where patients received care

  18. Results of “Voluntary Planning” • Deteriorated inpatient infrastructure • Community-based treatment not available • Resulting geographic disparities impact both access and outcome indicators • Findings provide solid evidence that "voluntary" planning failed • Literature supports that access to services is more equitable and may be less expensive in states with planning mechanisms

  19. Is dis a system? (R Crumb)

  20. Recommendations • Universal health insurance • Implement parity in insurance coverage for mental health and substance abuse services • Reinstitute mandatory health planning • Legislate standards for care of MISA in hospitals without psychiatric beds • Strengthen Health and Safety Code to address geographic disparities in structural and professional capacity

  21. For Further Information: • Linda Remy, MSW, PhD • Email: lremy@well.com • Gerry Oliva, MD, MPH • Email: olivag@fcm.ucsf.edu • Mail: Family Health Outcomes Project • 500 Parnassus Ave. Room MU-337 • San Francisco, CA 94143 • Website: http://familymedicine.medschool.ucsf.edu/fhop/

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