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Santa Cruz County mental health report sparks change at Telecare
Santa Cruz Sentinel - 10/16/2017
Oct. 16--SANTA CRUZ -- For years, people in severe mental health crises have been denied care or received inadequate treatment in Santa Cruz County. Poor clinic staffing and stringent guidelines on what constitutes hospitalization were to blame, according to a recent report.
But that practice is changing. The report by Santa Cruz County NAMI has sparked developments at Telecare Corp., a psychiatric services company.
Telecare Corp., the company contracted by Santa Cruz County Mental Health to provide services for mental health crises, had a series of leadership roles vacated last year, leaving the organization's local operation in disarray, according to the report.
NAMI, the National Alliance on Mental Illness, is an advocacy group with state and county chapters designed to improve the lives of people with mental health conditions, particularly severe conditions.
The NAMI report committee formed to address concerns by families saying their loved ones were being turned away during crises and others saying their relatives were being released without receiving adequate treatment.
The 20-page report will be presented Monday to Santa Cruz County leaders, the anniversary of the police shooting that killed 32-year-old Sean Arlt on Oct. 16, 2016, on Santa Cruz's Westside. Police officers were dispatched after Arlt, who was reported to have suffered from a mental illness, was creating a disturbance at a Chace Street home of an acquaintance by pounding on the door and making threats. Arlt threatened officers with a metal bow rake when he was shot, police said.
The Santa Cruz County District Attorney's Office declined to file charges in the shooting.
The alliance found problems with Telecare Corp.'s methods of patient evaluation. Those concerns also spurred questions about Telecare's psychiatric treatment and release of Arlt before his death.
Alliance President Carol Williamson compiled the report.
"(Arlt) had a nearly identical episode of psychosis only five days previous, where multiple police officers were required to contain him, at the same location," Williamson wrote. "He was placed on a (mental health watch) at that time. Yet he was released after a stay of only eight hours."
Michael Fitzgerald, a Ben Lomond mental health professional and advisor for the alliance investigation, said Telecare's manual used for involuntary commitments was more restrictive than others used in California. He said that high threshold should have been lowered some time ago.
"Someone should have known there were problems," Fitzgerald said, referring to Arlt's health.
Fitzgerald said the task force found that Arlt wasn't an isolated case.
"It seemed to be fitting a pattern," Fitzgerald said.
Since 2013, Telecare has operated the 16-bed Santa Cruz Behavioral Health Center for inpatient treatment and the Crisis-Stabilization Program for outpatient treatment.
Despite prevalent thinking that hospital stays should be avoided, many mental health cases require evaluations beyond the typical 24-hour evaluation period, according to the report.
Arlt was placed with the Crisis-Stabilization Program five days before he was shot.
"Some individuals need hospitalization to manage and stabilize their serious mental health condition when it is in an acute phase," Williamson wrote. "The patient may even seemingly be improved while in the Crisis Stabilization Program 24-hour evaluation period. However, a patient admitted to a crisis stabilization unit does not mean that the condition can be resolved within 24 hours. This was especially concerning because of the Sean Arlt case."
WAVE OF COMPLAINTS
The Santa Cruz County NAMI Acute Crisis Services Task Force, which created the report this month, formed after a flood of comments to the alliance hot line, known as the warm line, were complaints about people being turned away by Telecare. The anecdotes helped spur discussions between the task force and the corporate provider.
"More and more concerns were made through the NAMI warm line from families distressed about getting treatment and stability for their family members. We felt urgency for action," Williamson wrote.
The task force contacted Telecare CEO Anne Bakar in May and months of meetings ensued between the company and alliance advocates.
The results have driven drastic changes at Telecare's operations in Santa Cruz County.
The collaboration has resulted in Telecare boosting its staff with registry and traveling nurses to provide full coverage in Santa Cruz County. The company agreed to participate in training by the alliance this month and in November and plans to review methods to improve behavioral health customer service, Telecare Chief Medical Officer Kent Eller told the Sentinel.
Arlt's death is a reminder that people enduring mental health crises deserve access to compassionate care in welcoming settings, Eller said.
Telecare spokeswoman Daphne Phillips created a list of corrections and improvements underway in Santa Cruz County.
"Telecare has filled key leadership positions locally at the Psychiatric Health Facility and Crisis Stabilization Unit, including program administrator, clinical director, and director of nursing, and has also implemented new regional leadership over these programs," Phillips said. "NAMI has been invited to meet all potential leadership candidates before they are hired."
The company also has started to consult with doctors before any patient is released from the Crisis Stabilization Program, Phillips said. Another change: Doctors are making morning and evening rounds to visit patients and staff at Telecare facilities in Santa Cruz County.
Telecare is conducting a comprehensive review of standards, policies and procedures to improve "our services, staffing and environment," Phillips said.
Even food is being improved at the Santa Cruz Behavioral Health Center with "heartier, nutritious options for youth and adults," Phillips said.
A shower also has been added for youth at the Crisis Stabilization Program.
"The culture change was almost immediate," Fitzgerald said.
For information about mental health services, visit namiscc.org or telecarecorp.com.
(c)2017 the Santa Cruz Sentinel (Scotts Valley, Calif.)
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