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California Mental Health Planning Council
AGENDA CALIFORNIA MENTAL HEALTH PLANNING COUNCIL
October 18, 19, and 20, 2017 Four Points Sheraton 4900 Duckhorn Drive
Sacramento, CA 95834
Notice: All agenda items are subject to action by the Planning Council. The scheduled times on the agenda are estimates and subject to change.
Meeting Objectives: • Learn about issues and prevention of suicide• Attend screening of documentary, S Word • Learn about new tools and resources for mental health such as rules about
sharing health info, an app to access help, an online tool for county fiscal dataand plans to establish private-public partnerships for early intervention services.
Wednesday, October 18, 2017
COMMITTEE MEETINGS Time Event Room 9:00 a.m. Executive Committee Meeting Monarchs Room
11:00 a.m. Patients’ Rights Committee Meeting Sacramento Rm
PLANNING COUNCIL GENERAL SESSION Rivers West Room Conference Call 1-877-951-3290 Participant Code: 8936702
Time Topic Presenter or Facilitator Tab 1:30 p.m. Welcome and Introductions Susan Wilson, Chairperson 1:40 p.m. Approval of Minutes from
June 2017 meeting Susan Wilson, Chairperson I
1:50 p.m. Review and Approval of WET 5-Year Plan Budget Modification
John Madriz, Manager, Grants Management Section, Healthcare Workforce Development Division, OSHPD
2:40 p.m. Recess to Crest Theater for Screening of Documentary, The S Word
All K
California Mental Health Planning Council
Thursday, October 19, 2017
COMMITTEE MEETINGS Time Event Room
7:30 a.m. Children’s Caucus Hotel Restaurant 8:30 am-12:00pm Advocacy Committee Monarchs Room 8:30 am-12:00pm Evaluation & Quality Improvement Kings Room
8:30 am-12:00pm Health Care Integration Committee Sacramento Rm 12:00 p.m. LUNCH (on your own)
PLANNING COUNCIL GENERAL SESSION Rivers West Room Conference Call 1-877-951-3290 Participant Code: 8936702
Time Topic Presenter or Facilitator Tab 1:30 p.m. Welcome and Introductions Susan Wilson, Chairperson 1:40 p.m. Opening Remarks Julie Freitas, LMFT, Clinical
Manager, Adults & Older Adults, Yolo County
2:00 p.m. Suicide in the Aging Population
Stan P. Collins, Advocate L
2:35 p.m. My Story Council Member Carmen Lee, Survivor and Advocate
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2:55 p.m. Public Comment Susan Wilson, Chairperson 3:00 p.m. Break 3:15 p.m. Overview of Mental Health
Services Oversight and Accountability Commission Projects
Brian Sala, PhD, Deputy Director and Sharmil Shah, PsyD, Chief, Plan Review & Cmte Ops, MHSOAC
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4:00 p.m. Committee Reports – Patients’ Rights, Health Care Integration, Evaluation and Quality Improvement, Advocacy, Executive
Daphne Shaw, Robert Blackford, Walter Shwe, Barbara Mitchell, Susan Wilson
4:45 p.m. Council Member Conference Report Out
Darlene Prettyman, Arden Tucker, Robert Blackford, Susan Wilson
4:55 p.m. Public Comment Susan Wilson, Chairperson 5:00 p.m. Recess
California Mental Health Planning Council
Mentorship Forum for Council members, including Committee Chairs and Chair-Elects, will occur immediately following the recess of Thursday’s General Session.
Friday, October 20, 2017
PLANNING COUNCIL GENERAL SESSION Rivers West Room Conference Call 1-877-951-3290 Participant Code: 8936702
Time Topic Presenter or Facilitator Tab 8:30 a.m. Welcome and Introductions Susan Wilson, Chairperson 8:40 a.m. Update from the California
Association of Local Behavioral Health Boards/Commissions
Theresa Comstock, President
9:00 a.m. State Health Information Guidance (SHIG)
Elaine Scordakis, Assistant Director, and Rick Lytle, California Office of Health Information Integrity, CA Health & Human Services Agency
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9:55 am Public Comment Susan Wilson, Chairperson 10:00 a.m. BREAK 10:15 a.m. Update from County
Behavioral Health Directors Association of California
Kirsten Barlow, Executive Director, County BH Directors Assoc of CA
10:40 a.m. Update from CA Dept. of Health Care Services
Karen Baylor, PhD, LMFT, Deputy Director, MHSUDS, DHCS
11:00 a.m. 7 Cups of Tea Dr. Glen Moriarty, Founder and CEO
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11:50 a.m. Update on Council BH Integration and WET Project
Susan Wilson and Jane Adcock
11:55 a.m. Public Comment Susan Wilson, Chairperson 12:00 p.m. ADJOURN
All items on the Committee agendas posted on our website are incorporated by reference herein and are subject to action.
If Reasonable Accommodation is required, please contact Chamenique Williams at 916.552.9560 by October 4, 2017 in order to work with the venue to meet the request.
California Mental Health Planning Council
2018 MEETING SCHEDULE
January 2018 January 17, 18, 19 San Diego DoubleTree Hotel 1515 Hotel Circle South San Diego, CA 92108
April 2018 April 18, 19, 20 Redwood City Pullman Hotel 223 Twin Dolphin Drive Redwood City, CA 94065
June 2018 June 20, 21, 22 Los Angeles To Be Determined October 2018 October 17, 18, 19 Sacramento Lake Natoma Inn
702 Gold Lake Drive Folsom, CA 95630
__I___ TAB SECTION DATE OF MEETING 10/18/17
MATERIAL DATE MATERIAL PREPARED BY: Adcock PREPARED 9/19/17
AGENDA ITEM: Approval of Minutes from June 2017 Meeting
ENCLOSURES: Draft Minutes of April June Meeting
BACKGROUND/DESCRIPTION: Attached are draft minutes for the June 2017 meeting of the California Mental Health Planning Council for member review and approval.
__J___ TAB SECTION DATE OF MEETING 10/18/17
MATERIAL DATE MATERIAL PREPARED BY: Adcock PREPARED 9/14/17
AGENDA ITEM: Review and Approval of Workforce Education and Training
Five-Year Plan Budget Modification
ENCLOSURES:
BACKGROUND/DESCRIPTION: In January 2014, the Planning Council approved the proposed Workforce Education and Training Five-Year Plan (Plan) developed and implemented by the MHSA WET team at the Office of Statewide Health Planning and Development (OSHPD). Under the current Plan, there is $1.4M in unallocated funds. OSHPD is proposing to offer an additional grant fund opportunity under the Pipeline Program for fiscal year 2017-18. This allocation of unexpended funds from prior fiscal years will not take funds away from any of the existing programs currently funded under the Plan. The proposed budget modifications will be provided during the presentation. The team at OSHPD is returning to the Planning Council with the revised budget for the Council’s review and approval. We have an ad hoc workgroup working closely and directly with the team, they include Dale Mueller, Monica Wilson, Deborah Pitts, Darlene Prettyman and Steve Leoni. The current 5-Year Plan can be found at this link: http://www.oshpd.ca.gov/HWDD/pdfs/WET/WET-Five-Year-Plan-2014-2019-FINAL.pdf
__K___ TAB SECTION DATE OF MEETING 10/18/17
MATERIAL DATE MATERIAL PREPARED BY: Adcock PREPARED 9/19/17
AGENDA ITEM: Recess to Crest Theater for Screening of Documentary, The
S Word
ENCLOSURES: Flyer for S Word
BACKGROUND/DESCRIPTION:
A suicide attempt survivor is on a mission to find fellow survivors and document their stories of unguarded courage, insight and humor. What she discovers is a national community rising to transform personal struggles into action.
From the creative team behind the award-winning Of Two Minds, comes a new film that tackles one of the most unfathomable and cloistered issues of our time... Suicide. This film documents the first-person perspectives of a number of survivors in order to understand the impacts of suicide and recognize that it's okay to talk when we're struggling emotionally and psychologically.
Join us on Wednesday, October 18th for a special screening of this powerful story of hope and recovery. Immediately following the screening will be a discussion with director Lisa Klein and one of the subjects of the film, Kelechi Ubozoh, to talk about their respective journeys tackling the issues of mental health and suicide and their experiences making this film
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___L__ TAB SECTION DATE OF MEETING 10/19/2017
MATERIAL DATE MATERIAL PREPARED BY: Wiseman PREPARED 09/08/2017
AGENDA ITEM: Suicide Prevention
Background information: Suicide in the Older Adult ENCLOSURES: Population How this presentation relates to the Council’s mission. The CMHPC evaluates the behavioral health system for accessible and effective care. It advocates for an accountable system of responsive services that are strength-based, recovery-oriented, culturally competent, and cost-effective. To achieve these ends, the Council educates the general public, the behavioral health constituency, and legislators. This presentation will lead into a discussion of how suicide can be prevented in the Older Adult and Aging Population. This information will inform the Council’s advocacy efforts and service system review for this population.
BACKGROUND/DESCRIPTION: Stan Collins is a Consultant: Resource navigator/Suicide Prevention Specialist at Each Mind Matters (EMM): California’s Mental Health Movement sin July 2015. In this role he assist counties and organizations in developing and implementaing mental health awareness and suicide prevention strategies. Prior to working with EMM, Mr. Collins has worked for Yellow Ribbon Suicide Prevention Program, the San Diego County Suicide Prevention Council and Know the Signs Suicide Prevention Campaign.
Stan Collins – Life Devoted to Suicide Prevention By Emily Sorensen, Contact Reporter August 16, 2012, 1:11 PM Stan Collins never planned that he would end up devoting his life to suicide prevention. “I wanted to teach history and coach water polo at Poway High School,” said Collins. Instead, a tragic loss lead to a drastic change in direction. Collins, who grew up in Poway and graduated from Poway High School in 1999, was inspired by the suicide of a friend in their freshman year of high school to learn about suicide prevention. He was introduced to the Yellow Ribbon Suicide Prevention program by his father, who works in law enforcement. “He introduced me to [Yellow Ribbon] to
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see if kids would approve of it,” said Collins. Instead of just watching, Collins ended up sitting on the panel as a “survivor of suicide,” after a panel member was unable to make the presentation. “It gave a lot of legitimacy in the role that a youth can play,” said Collins of his participation. Collins was so moved by the Yellow Ribbon program that, in his junior year of high school, he fought to bring it to Poway High. “I gave it to the principal [Jerry Leininger], and I bugged him about it until he agreed.” Already a member of Link Crew and Peer Counseling at Poway High, giving presentations for the Yellow Ribbon program at school came naturally to Collins. “I just jumped in with both feet,” said Collins. After graduating, Collins studied social science at San Diego State University while interning with the Yellow Ribbon program. Collins spent nearly 11 years working with the Yellow Ribbon Suicide Prevention program both locally and nationally, giving presentations and suicide prevention training to emergency services, law enforcement and high schools. Collins estimates that he has spoken to a quarter of a million people about suicide prevention since he began. In 2001, Collins testified before a U.S. Senate subcommittee about suicide with the national chapter of the Yellow Ribbon program in Colorado. Collins said that the presentations and training he gives isn’t about counseling or therapy, but more like CPR. “I want to make people more comfortable with the topic of suicide,” said Collins. “It’s OK to talk about suicide. You will not make it happen by talking about it. You need to talk about it.” Collins is currently working as a suicide prevention consultant for a few different organizations, giving presentations and working on social media campaigns. “People don’t understand that everyone should have this information,” said Collins. “But a lot of people don’t pay attention. They say, ‘this will never happen to my kid, or my friend.’ “I never would have picked it for my life career, but I find it very hard to believe that I could ever walk away from it,” said Collins. “We have a lot of work to do.” To find out more about suicide prevention and how to become involved, contact the San Diego County Access and Crisis Line at 888-724-7240, or visit www.up2sd.org. Do you know someone who should be featured here? Contact Editor Steve Dreyer at [email protected] or call him at 858-218-7207. Copyright © 2017, Pomerado News
Suicide in the Older Adult Population
Contemplating your mortality is a natural part of aging. For some, this contemplation leads to counting your blessings for a life well-lived, but for others, the blessings don’t push to the forefront. They can be crowded out by feelings of isolation, loss of mobility and independence..
Compared to the national averages, suicide in California’s older adult population is lower, particularly in the more urban areas. In 2015, California ranked 45 out of 51 nationally in aggregate suicide rates, (i.e., for all ages, male and female), with a rate of 10.7 per 100,000, compared to the national average of 13.7 per 100,000.
Despite California’s relatively positive comparison to the rest of the United States, the Mental Health Association of California (MHAC) reports that “Suicide rates are highest in old age: 20% of the population and 40% of suicide victims are over 60. After age 75, the rate is three times higher than average, and among white men over 80, it is six times higher than average.”1 California ranked 44 out of 51 in the aggregate numbers, but it ranked 26 out of 50 for people over 65 with an average of 17.3 compared to a national average of 16.6 per 100,000. 2
The Global View
According to the World Health Organization's 2014 Health Profile, the United States was 47th in the World ranking for deaths by suicide, and suicide ranked as the 11th highest cause of death at 12.38 per 100,000, and despite its reputation to the contrary, death by violence ranked a distant 24th with 5 deaths per 100,000.3 In the United States, suicide rates steadily declined between 1986 and 1999, but began rising at approximately 1% per year between 1999 and 2006. It doubled to 2% annually between 2007 and 2015, about the time that the Great Recession and the opioid epidemic were becoming entrenched.
That 15-year span between 1999 and 2014 also began displaying a shift in the demographics in respect to gender and race. Despite strong cultural and religious beliefs and family support systems, women and
1 http://www.mhac.org/library/suicide.aspx 2 http://www.suicidology.org/Portals/14/docs/Resources/FactSheets/2015/2015StatesTOY-corrected.pdf?ver=2017-01-09-215406-197 3 http://www.worldlifeexpectancy.com/country-health-profile/united-states
The American Foundation for Suicide Prevention (AFSP) reports that in 2015 the highest rate of suicides was among adults between 45 and 64 years of age (19.6 per 100,000), and the second highest rate, (19.4 per 100,000) occurred in those 85 years or older.
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racial populations began increasing their representation in the statistics. Although white males still had the highest rates, the increase by percentage in women and racial populations has been significant.
Over the last 15 years, suicide rates have become much higher in rural areas than in urban ones.
The gap that has grown between urban and rural suicide rates over the last 15 years is substantial, and urban areas are showing a decline in rates that correlates to the increase in rural areas. In rural and micropolitan areas (i.e., populations between 10,000 and 49,999) suicide rates increased by 40% and 35% respectively, compared to a much smaller increase of 10% in major cities. More specifically, “As of 2015, the suicide rate in rural areas (22 per 100,000) is about 40% higher than in the nation as a whole (15.7 per 100,000) and 83% higher than in large cities (12 per 100,000).” 4
The link between opioid addiction and suicide is suggested in a paper released recently by the Center for Disease Prevention and Control, which theorizes that, in addition to social isolation and lack of access to mental health services and therapy, “This epidemic is known to have disproportionately affected less urban areas during the earlier part of the study period (i.e., 1999-2015) and opioid misuse is associated with increased risk for suicide.” 5
No Easy Explanations for the Increase
Several theories and potential explanations have been suggested as to why the suicide rate would increase after so many years of declining. Some speculate that the marked increase in US suicide rates between 2007 and 2015 corresponds to the Great Recession as well as the opioid epidemic, both of which have hit rural areas harder – and most of which are predominantly white. Others have suggested 4 Alex Berezow; Suicides In Rural America Increased More Than 40% In 16 Years; American Council on Science and Health; 3/16/2017; https://www.acsh.org/news/2017/03/16/suicides-rural-america-increased-more-40-16-years-11010 5 Kegler SR, Stone DM, Holland KM. Trends in Suicide by Level of Urbanization — United States, 1999–2015. MMWR Morb Mortal Wkly Rep 2017;66:270–273. DOI: http://dx.doi.org/10.15585/mmwr.mm6610a2
• Females aged 45 to 64 had the second-largest percent increase (63%) since 1999.
• The suicide rate for women aged 75 and over decreased by 11% from 1999 through 2014.
• The largest percentage increases between 1999 and 2014 were for non-Hispanic American Indian or Alaska Native (AIAN) females (89%) and non-Hispanic white females (60%).
https://www.cdc.gov/nchs/data/hestat/suicide/rates_1999_2014.htm
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that lack of health insurance and access to mental health services may also be strong contributors, as well as the relatively unfettered access to firearms.
According to PEW Research Foundation, the links between guns and suicide and homicide have become less pronounced over the last 15 years despite the increase in suicide rates and the over-representation of white males within that population.
Firearms have traditionally figured prominently in the suicides of older white males, and has been described as an act that links access to opportunity. Rural areas, where 46% of American households are gun owners, have much higher rates of death by suicide. The total overall death by firearms rate (i.e., suicide and homicide) has declined from a high of 15.2 per 100,000 in 1993 to 10.5 in 2014, but homicide shows a much stronger decline in gun use than suicide. The baseline rate per 100,000 for both suicide (7.3) and homicide (7.0) were very close in 1993, but by 2014 the homicides by firearms had decreased by 50% to 3.4. The suicide by firearms also decreased by 2014, but at a much more modest rate. The Pew Research Foundation reports that “gun suicides now account for six-in-ten firearms deaths, the highest share since at least 1981”6 and that 48% of white men say they own a gun, compared with about a quarter of white women and nonwhite men (24% each) and 16% of nonwhite women.
http://www.pewresearch.org/fact-tank/2013/05/24/suicides-account-for-most-gun-deaths/ The Impacts of Health Care Access and Race
Similar to assumptions about guns, theories that link lack of access to health care services and higher rates of suicide are not fully borne out by facts. It turns out that the states without expanded Medicaid access and less robust mental health services do not necessarily translate to higher suicide rates, and neither do states with a majority white population.
6 http://www.pewsocialtrends.org/2013/05/07/gun-homicide-rate-down-49-since-1993-peak-public-unaware/
More than one-half of male suicides (55.4%) in 2014 were firearm-related, although the percentage of suicides by this method was lower than in 1999 (61.7%).
https://www.cdc.gov/nchs/data/databriefs/db241.pdf
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Using the 19 states without Medicaid expansion as the baseline, and comparing them to the states with the highest suicide rates and the states with the highest white population, less than half - only seven states - appear on all three charts.
It should be noted that expansion of services under the Affordable Care Act (ACA) and the causes of suicide are two very complex phenomena. While theories are postulated, there is no proof that one is the sole cause of the other. Additionally, implementation of the ACA is still relatively recent thus, it could be too soon to draw conclusions on its impact on suicide rates nationally or in California.
How Does California Compare With The Rest of the Nation?
California has historically had lower rates of suicide death than the rest of the US. This may be due to the diversity within the state, where faith and belief systems create stronger taboos or resistance to taking one’s own life. It may also be related to the highly concentrated urban centers where social services and family support systems might be stronger, or to enhanced access to mental health services
The 19 states with the highest suicide rates in 2015 Nation – Both Sexes Combined
Rank State Rate
1 Alaska 27.2 2 Wyoming 26.8 3 Montana 26.3 4 New Mexico 24.0 5 Idaho 21.17 6 Utah 21.00 7 Oklahoma 20.2 8 South Dakota 20.2 9 Colorado 20.0 10 Arkansas 19.4 11 Nevada 19.3 12 Oregon 18.9 13 Arizona 18.7 14 West Virginia 18.4 15 Maine 17.7 16 Kentucky 17.5 17 Missouri 17.3 18 New Hampshire 17.1 19 Vermont 16.5
http://www.suicidology.org/Portals/14/docs/Resources/FactSheets/2015/2015StatesTOY-corrected.pdf?ver=2017-01-09-215406-197
The 19 States with Highest White Population in 2015
State % White
Vermont 94% West Virginia 93% Maine 91% New Hampshire 91% Montana 90% Iowa 85% Kentucky 85% North Dakota 85% Wyoming 85% Idaho 84% South Dakota 83% Minnesota 82% Utah 81% Indiana 80% Missouri 80% Nebraska 79% Ohio 79% Wisconsin 78% Michigan 76% Pennsylvania 76% http://www.kff.org/other/state-indicator/distribution-by-raceethnicity/
The 19 States without ACA (as of 1-1 17)
Idaho Wyoming Utah South Dakota Nebraska Kansas Oklahoma Texas Missouri Wisconsin Virginia Tennessee North Carolina South Carolina Georgia Florida Alabama Mississippi Maine http://www.kff.org/health-reform/slide/current-status-of-the-medicaid-expansion-decision
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due to a strong network of University and College systems and Federally Qualified Health Centers providing low cost services. More recently, the Mental Health Services Act may have contributed to the awareness, availability, and increased social acceptance of seeking mental health services as well as the suicide prevention strategies and awareness campaign.
In aggregate, California has lower rates of suicide, across all ages, than the rest of the United States.
In 2015, the overall ranking of suicide rates per 100,000
California: 10.24 United States: 13.26 Females, all ages California: 4.9 United States: 5.6 Males, all ages California: 17.0 United States: 21.00
https://www.americashealthrankings.org/explore/2015-annual-report/measure/Suicide/state/CA California also has demonstrably lower rates of suicide within its racial populations than the rest of the US.
Comparison of US and CA Suicide Rates
Race Rate per 100,000 (CA) 2015
Rate per 100,000 (US) (males) 2014
Hispanic 4.7 10.3 African American 6.2 9.7 White 12.2 25.8 Asian 5.7 8.9 American Indian/ Alaskan Native
6.4 27.4
https://www.americashealthrankings.org/explore/2015-annual-report/measure/Suicide/state/CA
2008 – 2014, California Suicide Rates per 100,000 Population All Races, All Ethnicities, Both Sexes
Ages 65 – 85+
https://wisqars.cdc.gov:8443/cdcMapFramework/mapModuleInterface.jsp
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Diversity Plays an Important Role
• Hispanic/Latinos and Whites are nearly equally represented in California’s population, but the suicide rate for Hispanic/Latinos is much lower.
• In 2015, the suicide rate for Whites was close to double that of African American and American Indian/ Alaskan Native populations in California, and nearly three times that of Latino/Hispanic
populations.
Geography Does Too
Like the rest of the United States, the rates of death by suicide in California have increased in rural areas while urban rates have decreased. The counties with the highest suicide rates are predominantly White, while those with the lowest rates are more racially and ethnically diverse.
California Suicide Rates by Race in 2015
Race Rate per 100,000
% of pop.
Hispanic 4.7 0.0047
African American 6.2 0.0062
White 12.2 0.0122
Asian 5.7 0.005.7
American Indian/ Alaskan Native
6.4 0.006.4
https://www.americashealthrankings.org/explore/2015-annual-report/measure/Suicide/state/CA
California Racial Population Distribution Aged 65 and over, 2010 and 2016
Race July 1, 2010 % of population
July 1, 2016 % of population
All persons 65 + 11.40 13.60
African American 6.20 6.50
American Indian /Alaskan Native
1.00 1.7
Hispanic/Latino 37.60 38.90
White 40.10 37.70
Asian 13.00 14.80
https://www.census.gov/quickfacts/CA
10 Highest Rates of Suicide By County 2008 - 2014 All Races/Ethnicities,
Male and Female 65 - 85+ County Rate per
100,000 % of County White (2017) (All Ages, M/F)
Amador 43.41 87 Calaveras 38.37 88 Humboldt 37.53 81 Siskiyou 34.43 84 Lake 33.48 80 Shasta 32.35 86 Tehama 28.84 81 Mendocino 28.58 76 Sutter 28.51 60 Butte 26.54 81 https://wisqars.cdc.gov:8443/cdcMapFramework/mapModuleInterface.jsp https://suburbanstats.org/population/california/list-of-counties-and-cities-in-california
10 Lowest Rates of Suicide By County 2008 - 2015 All Races/Ethnicities,
Male and Female 65 - 85+ County Rate per
100,000 % of County White (2017) (All Ages, M/F)
Tulare 11.83 60 Fresno 12.59 55 Los Angeles 12.89 50 Santa Clara 13.10 46 San Francisco 13.81 48 San Mateo 14.72 53 Contra Costa 14.72 58 Merced 15.94 58 Alameda 16.09 51 Orange 16.97 60 https://wisqars.cdc.gov:8443/cdcMapFramework/mapModuleInterface.jsp https://suburbanstats.org/population/california/list-of-counties-and-cities-in-california
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Prevention and Hope The Mental Health Services Act (MHSA) was approved by California voters in November 2004. The MHSA created a funding source and a framework for transformation of mental health services in California. Specifically, the MHSA seeks to reduce negative outcomes of untreated mental illness including suicide. The MHSA promotes a recovery and wellness model targeted to the needs of children transition age youth, adults and older adults. This model offers wrap-around services to meet the varied needs of the individual. Additionally, counties in California joined funds to create a Joint Powers Authority called CalMHSA. To address the problem of suicide, the California Mental Health Services Authority (CalMHSA) has implemented the Suicide Prevention Initiative. This initiative is one of several Prevention and Early Intervention Initiatives funded by the MHSA. Didi Hirsch Mental Health Services established the California Suicide Prevention Network (CSPN) in collaboration with ten crisis centers and one of the goals of CSPN is to encourage widespread adoption of best practices programs, interventions, curricula and protocols. There are many prevention programs operating across California with services in formats tailored to reach the various generations including older adults. Aging does not have to be a negative, there is still a lot of life, accomplishment and contribution that can occur in this stage of life. Know The Signs is a public awareness campaign with information, materials and call to action for all Californians to actively engage individuals who may exhibit signs of isolation, depression and suicide ideology. More information on Know the Signs and other suicide prevention programs can be found at http://calmhsa.org/programs/pei-statewide-projects/2011-2015-phase-i/suicide-prevention/ .
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___M__ TAB SECTION DATE OF MEETING 10/19/2017
MATERIAL DATE MATERIAL PREPARED BY: Wiseman PREPARED 09/06/2017
AGENDA ITEM: Older Adult and Aging – Suicide Survivor
ENCLOSURES:
How this presentation relates to the Council’s mission. The CMHPC evaluates the behavioral health system for accessible and effective care. It advocates for an accountable system of responsive services that are strength-based, recovery-oriented, culturally competent, and cost-effective. To achieve these ends, the Council educates the general public, the behavioral health constituency, and legislators. This agenda item presents life experiences of Older Adults with lived experience with mental illness/substance use disorders.
The context for this agenda item is as follows: Ms. Carmen Lee is a suicide attempt survivor and advocate. She will address how her experiences in dealing with the disease has been different than someone younger. BACKGROUND/DESCRIPTION:
Ms. Carmen Lee is a person in recovery who has spent over twenty years, collectively, in institutions, including state hospitals, for major depression and suicidal acting out. Ms. Lee has personally experienced and witnessed the impact and effect of stigma and discrimination of suicide. She also saw how having mental health challenges were grave deterrents on the road to recovery. These experiences inspired Ms. Lee to begin an educational outreach program in1990, called Stamp Out Stigma (SOS). To date, SOS has delivered over 2700 public presentations and has become a well-respected, sought-after organization, both nationally and internationally. SOS has directly reached 900,000 people throughout the Greater San Francisco Bay and has traveled to China,
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Australia and Europe giving workshops on beginning anti-stigma programs. Since SOS’s early pioneering efforts, the Consumer-perspective has been the primary driver in the educational programs to address mental health needs and suicidal issues in communities around the nation and in many countries around the world. Carmen Lee is very close to her only child, Christina, who is a professor at Mount Holyoke College in Massachusetts. She also is a long-standing member of the California Writer's Club, having published numerous articles, essays and stories, along with having won several poetry and writing contests. Time permitting, she is in the process of writing Nude In Times Square, her story of struggle to attain wellness. Carmen Lee is employed with a mental health agency in San Mateo County as a mentor to other mental health clients, offering them hope and encouragement.
MS. CARMEN LEEMy Story: An Older Adult Survivor of Suicide and a Suicide Advocate
INSPIRATION…MY ‘EGO CORNER’
THE VOICE AWARDS
SUPPORT AND RECOGNITION COMES IN MANY FORMS
Congresswoman Anna Eshoo
2012 SPIRIT OF MATER AWARD RECIPIENT
SURVIVAL, EVEN IN THE MIDST OF THE STORM
My companion, “Ceely”
__N___ TAB SECTION DATE OF MEETING 10/19/17
MATERIAL DATE MATERIAL PREPARED BY: Adcock PREPARED 9/14/17
AGENDA ITEM: Overview of Mental Health Services Oversight and
Accountability Commission Projects
ENCLOSURES:
BACKGROUND/DESCRIPTION: The Mental Health Services Oversight and Accountability Commission has some new projects on the horizon including a new Fiscal Transparency tool that will provide MHSA fiscal information county by county. Additionally, the Commission is embarking on a new public-private partnership to achieve Innovation in meeting the needs of Californians with serious mental illness. Brian Sala, PhD., Deputy Director will present about the new Fiscal Transparency tool and Sharmil Shah, PsyD, Chief of Plan Review and Committee Operations will present about the plans for an Innovations Summit to be sponsored by the Commission and Verily (formerly Google Life Sciences).
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___O__ TAB SECTION DATE OF MEETING 10/20/2017
MATERIAL DATE MATERIAL PREPARED BY: Wiseman PREPARED 09/08/2017
AGENDA ITEM: State Health Information Guidance (SHIG)
ENCLOSURES:
How this presentation relates to the Council’s mission. The CMHPC evaluates the behavioral health system for accessible and effective care. It advocates for an accountable system of responsive services that are strength-based, recovery-oriented, culturally competent, and cost-effective. To achieve these ends, the Council educates the general public, the behavioral health constituency, and legislators. This presentation item presents information on how information sharing can potentially save lives.
The context for this presentation is as follows: The State Health Information Guidance (SHIG) is an authoritative but non-binding guidance from the State of California written in lay language for a general audience. The SHIG explains when, where, and why mental health and substance use disorder information can be exchanged. It provides clarification of state and federal laws for non-state entities. The SHIG is needed because there is confusion about the law that creates barriers to sharing patient information. California Health and Human Services Agency California Office of Health Information Integrity (CalOHII) Access the State Health Information Guidance online. BACKGROUND/DESCRIPTION:
Elaine Scordakis, CalOHII Assistant Director
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Rick Lytle is a consulting executive with more than 25 years of leadership experience in healthcare, government and technology. He has wide-ranging management experience that includes healthcare operations, privacy compliance, strategic planning, solution development, project management and organizational effectiveness. Rick’s passion is to collaborate with clients to design and implement measurable and sustainable improvements in business performance. Rick is Chief Operating Officer and Senior Vice President for Business Advantage Consulting. He earned an MBA from the University of Redlands and a BA in Journalism from Humboldt State University.
STATE HEALTH INFORMATION GUIDANCE
ELAINE SCORDAKIS, M.S.CALIFORNIA OFFICE OF HEALTH INFORMATION INTEGRITY
RICK LYTLE
BUSINESS ADVANTAGE CONSULTING
What is the SHIG?State Health Information Guidance
GuidingState Health Information
Guidance for California
AuthoritativeAuthoritative but non-binding guidance from the State of California
ClarifyingClarification of state and federal
law for non-state entities
ExplanatoryWhen, where and why mental health and substance use disorder information can be exchanged
GeneralizedWidely-applicable document in plain
language for a general audience
AssistiveThe Known Path to YES
2/19
CONFUSIONConfusion about the law is a major barrier to sharing
patient information
DEFAULT TO NEGATIVEProviders often default to not
sharing information even when it is legal to share
RISK AVOIDANCEThe primary reasons are
uncertainty, risk avoidance and liability concerns
GETTING TO YESThe SHIG helps highlight the
known path to legally and securely sharing patient information
Why Is the SHIG Needed?
3/19
Facilitating Coordination & SharingGoal & Vision
ExchangeIncrease appropriate exchange of patient information between health care providers
01
CoordinateEncourage greater coordination and integration of care through information sharing
02DevelopPromote dialogue for further applications of responsible health information sharing
03
To better articulate what California providers can do without consent today to share patient information, including who can share it, who can receive it, what can be done with it, and for what purpose. To accelerate the responsible and appropriate sharing of health information in California by facilitating a dialog among care providers of what can be done within current State and Federal laws.
4/19
Why CalOHII?Authority and Expertise
AuthorityCalifornia Office of Health Information Integrity has
statutory authority to interpret and clarify state law
ExperienceCreated similar
guidance for California State departments
RelationshipsStrong working
relationships with stakeholders across healthcare industry
5/19
How Was the SHIG Created?A Collaborative Product
SolicitationStakeholders solicited about
existing obstacles
AdvisementAdvisory group formed from more than 20 organizations
ResearchUser stories generated by
Advisory Group reflect cross-industry insights and experience
ConsultationPatient and privacy advocacy
organizations consulted
ClarificationClarification built around
scenario-based illustrations along with general guidance
6/19
Supporting the Triple Aim
Benefits of Whole Person Coordinated Care
Improved Overall Patient Satisfaction
Improved Efficiency and Reduced Costs
Improved Patient Outcomes
7/19
Who Can Use the SHIG?Broad in Scope
Key Users
Mental Health Care Providers
Substance Use Disorder Providers
Emergency Service Providers
Physical Health Care Providers
Caregivers and Care Coordinators
Social Services
Law Enforcement
Payers
8/19
The Problem of Complexity
Disparate regulations spread across multiple sources
Overlapping and conflicting Federal and State laws
9/19
03
01
02
Reducing ComplexityEase of Comprehension
01
02
03
ClarificationThe SHIG clarifies relevant law.
GeneralizationThe SHIG provides general
principles and guidance.
SummarizationThe SHIG summarizes
applicable legal citations.
10/19
The Problem of Ambiguity
Statutes written in dense legal language
Unclear how to apply rules to current situations
11/19
Increasing Clarity
Clear Examples
Creating a common understanding
Illustrating simple scenarios and applying rules practically
Offering an authoritative interpretation and guidance
Presenting relevant law and regulation in plain language
Reducing uncertainty and ambiguity
Clarifying what can and cannot be shared
12/19
Primary Regulation SourcesAnd Conflict Resolution
Authoritative but non-binding guidance
Final Guidance
42 C.F.R. Part 2 (Substance Use Disorder)45 C.F.R. Parts 160-164 (HIPAA)
Federal
CA Civil Code § 56 (CMIA)CA WIC LPS § 5328 (LPS)
CA HSC § 11845, § 123100, § 123125
State
In case of conflict the SHIG errs on the side of the more
restrictive law or regulation
Conflict Resolution
13/19
Authoritative Scenario-Based GuidanceHow It Works
SIMPLE, STRAIGHT-FORWARD, & ILLUSTRATED
22 SCENARIOS
RELEVANT TO A WIDE RANGE OF PROVIDER SECTORS
PLAIN LANGUAGE FOR A LAY AUDIENCE
ALL GUIDANCE TIED TO RELEVANT STATUTES, REGULATIONS AND LAWS
14/19
Scenario ExampleIn the Event of an Emergency
Description: An individual with mental health or substance use disorder (SUD) issues is being treated by an Emergency Medical Services (EMS) provider, emergency room physician, hospital emergency department or a triage team member.
What patient information can be shared in a medical emergency?
Scenario Assumptions: • Must be a medical emergency as determined
by qualified healthcare professional• Patient is unable to provide health
information to healthcare professionals• No patient or Patient Representative
Authorization
Is the information from a 42 CFR Part 2 provider/
program
May be disclosed to Emergency
Personnel:
• Patient Demographics
• Diagnosis• Prognosis• Treatment
YesQualified medical personnel deem
health situation an emergency
No
Is the information from a LPS regulated facility?
Yes
Document as required by LPS
Start
Emergency Personnel Requests Patient Info
Behavioral Health Provider
ER Physician/Triage Team Member
Emergency Dept
Document as required by
HIPAANo
Document as required by 42 C.F.R. Part 2
15/19
Scenario Example (Continued)In the Event of an Emergency
Behavioral health providers including providers subject to 42 C.F. R. Part 2 (Substance Use Disorder regulations), health care service plans, contractors and other health care professionals and facilities can share the following only to the extent necessary to meet a bona fide medical emergency for the purpose of diagnosis or treatment of the patient:o Patient demographics o Diagnosis o Prognosis o Treatment
[42 C.F.R.§ 2.1 § 290ee-3 (b)(2)(A); CA Health and Safety Code § 11845(c)(1)]
Patient information may be communicated by radio transmissions or other means necessary between emergency medical personnel at the scene of an emergency, or in an emergency medical transport vehicle, and emergency medical personnel at the licensed health facility.
[Civil Code Section 56.10(c)(1)]
The condition being treated must pose an immediate threat to the health of the individual and require immediate medical attention.
[42 C.F.R. § 2.51(a)]
Documentation Requirements When Provider is Regulated by 42 C.F.R. Part 2Immediately following disclosure of substance use disorder information the entity providing the information must document the following in the patient’s records:o Name and affiliation with any health care facility of the medical personnel to whom disclosure was madeo Name of the individual making the disclosureo The date and time of the disclosureo The nature of the emergency
[42 C.F.R. § 2.51(c)]
Scenario Guidance Narrative
[42 C.F.R. § 2.1 § 290ee-3 (b)(2)(A); 42 C.F.R. § 2.51(a); 42 C.F.R. § 2.51(c); 45 C.F.R. § 164.502(b), and § 164.514(d); 45 C.F.R. § 164.510(b)(3); CA Civil Code Section 56.10(c)(1); CA Health and Safety Code § 11845(c)(2); CA Welfare and Institutions Code § 5328(a).][Guidance on Behavioral Health Authorization Requirements – Appendix 2; Guidance on Court Orders (future).]
Citations & Related Guidance
16/19
A Great Beginning
Possible future additions include HIV/AIDs, foster children, minors, criminal justice, and more.
The SHIG is a first step.
Ongoing dialogue will continue to improve appropriate sharing of health information.
17/19
19/19
1
___P__ TAB SECTION DATE OF MEETING 10/20/2017
MATERIAL DATE MATERIAL PREPARED BY: Wiseman PREPARED 09/08/2017
AGENDA ITEM: 7 Cups of Tea
ENCLOSURES:
How this presentation relates to the Council’s mission. The CMHPC evaluates the behavioral health system for accessible and effective care. It advocates for an accountable system of responsive services that are strength-based, recovery-oriented, culturally competent, and cost-effective. To achieve these ends, the Council educates the general public, the behavioral health constituency, and legislators. This presentation item presents an innovative way to connect and provide services.
The context for this presentation is as follows: 7 Cups is an innovative and interactive mobile application that has potential to reach individuals – ‘where they are.’ One of the home page descriptors advises, “Stay emotionally fit and grow with us…Make emotional wellness a daily habit by following your growth path. Reminders and progress along your path can help you get support from trained volunteer listeners and do simple activities on your own to relax, on a regular basis, giving you more control over your own well-being.” https://www.7cups.com/ BACKGROUND/DESCRIPTION:
Glen Moriarty is the founder and CEO of 7 Cups, a web and mobile Peer-to-Peer emotional support platform. He is a psychologist passionate about the Internet’s power to help people lead better lives. He has been involved in a number of services and organizations that support people in need. 7 Cups is his most recent endeavor, marrying his background in psychology with his love for technology.
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About Us 7 Cups of Tea is an on-demand emotional health and well-being service. Our bridging technology anonymously and securely connects real people to real listeners in one-on-one chat. Anyone who wants to talk about whatever is on their mind can quickly reach out to a trained, compassionate listener through our network. We have hundreds of listeners who come from all walks of life and have diverse experiences. People connect with listeners on 7 Cups of Tea for all kinds of reasons, from big existential thoughts to small, day-to-day things that we all experience. Unlike talking to family or friends, a 7 Cups of Tea listener doesn’t judge or try to solve problems and say what to do. Our listeners just listen. They understand. They give you the space you need to help you clear your head.
Our Key Values Key Values for the 7 Cups of Tea Community We hold the following values. If you would like to join our team as an employee or listener, then we want you to also hold these same values. We treat one another with honor and respect. How we treat one another will impact how we treat people seeking help on 7 Cups of Tea. Our culture sets the cornerstone by which the rest of our “building” will be set. We believe that people are inherently valuable. We do not measure people based on where they are from or what position they hold. We do not judge or look down on people. We recognize that people make sense in the larger context or story of their lives. Sometimes it can seem like people are making choices that do not make sense, but this is likely because we do not have all of the details. We understand that people are complicated and that life is not simple or easy. We provide high support and have high expectations. We want everyone on our team to succeed. We provide training, tools, and consultation. We, in turn, expect a lot from you. You are joining a world class team that provides care for people who are struggling. This requires that you have the ability to be strong and empathic. We will invest in you to help you succeed. We need to see you invest in your work to help others succeed. If that doesn’t happen, then there is no shame in moving on. It is much better to fail fast and find a better fit in another position, than it is to stay in a role that is not a good match for your strengths.
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We are building something that is greater than ourselves. We think long-term, not short-term. We are not interested in piling up more money or putting another notch on our accomplishment belt. We are interested in creating a safe haven where people can come to feel heard, valued, and understood. We want to do this at global scale. We want our parents, friends, children, and mentors to be proud – really proud – of what we do. We are building something that we want to be remembered by. We recognize that life is messy, unpredictable, hard, and surprising. We understand we all will make mistakes. Mistakes are a key part of every worthy endeavor. They are inevitable and often valuable. We don’t have to hide our mistakes from one another. The important thing is that we learn from them individually and collectively. Listening to members, or people calling for support, is very important. They may complain or suggest that we do things differently. Please listen to them and share what you learn with us directly. They will often tell us what we need to do make the service better. We do not have the ability to predict the future. What we are doing is complex, interesting and challenging. Our job is to make sure that we continuously learn, adapt, and grow. We don’t give up. We recognize that hard work, perseverance, and grit are key ingredients for success. We take care of ourselves so we can be strong. We take care of one another through our ups and downs. We have each other’s backs. It is better to give than receive. Listening empathically to another person helps the person being listened to and it helps the listener. Listening helps the listener grow. It is a privilege to help another person through a challenging time in their life. The person seeking help gives the listener a gift without realizing it. The listener, often only indirectly, realizes that they were given a gift.
Our Mission I started this section and called it “Glen’s nook.” I plan on hanging out here more often. I’ll listen, share my thinking with you, and hope to get to know many of you as we continue to grow our community. We wanted to share our mission with you before publishing it. We believe that every voice is important and every voice matters. Please share your thoughts on our mission below.
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Our Mission: 7 Cups of Tea is for anyone who wants to live in a world where the human experience is free from stigma and stereotypes and rich with love and support. A world where all 7 billion of us can grow and feel like we truly belong. We believe that each one of us is inherently valuable. We do not measure people based on where they are from, what they look like, or what position they hold. We recognize that people make sense in the larger story of their lives. We understand that people are complicated and that life is not simple or easy. We are all on the same path. Some of us are just starting out. Others are further down the road. No matter where we are, being kind, compassionate, and accepting of one another enables us all to grow. We do not tolerate people being mean, harmful, or rejecting of others. We do not judge or look down on people. Although there are forces that tend to disempower and create division, we stand together as we compassionately care for and champion one another. We see our differences as a strength. We are united in our shared goal of creating a place where all can find acceptance and be welcomed to a home where we all belong. Our Goal: We are living in a world with an immense love deficit, which means that none of us is receiving the love we need to reach our true potential, to truly thrive. Our goal is to build a support system, a web that can hold every member of our world. We believe that we can fill that love-gap for every person in the world, either because they are an active member of our community or because they are touched personally by someone who has been empowered by 7 Cups of Tea. We will reach this goal when we provide 100 million positive and supportive conversations each and every week.