by Caroline Calonge, Consultant and Paulina Hatfield, Consultant

Access to behavioral health services is becoming more difficult, especially after the COVID-19 pandemic, but programs are working to increase access to services for those that need it most. Recently, RDA Consulting partnered with Merced County in evaluating the effectiveness of an innovative program that makes services more accessible. With our findings, we learned some best practices to improve service delivery and meet the needs of clients receiving intensive case management services.

Almost one in seven California adults experiences a mental illness and in 2022, nine percent of Californians met the criteria for a substance use disorder.^[1],[2]  The COVID-19 pandemic worsened mental health stress and substance use disorder rates among Californians. The pandemic negatively impacted access to services, leading to a behavioral health crisis where those who need mental health or substance use treatment cannot get the care they need. Based on the California Health Interview Survey data gathered at the time of the pandemic, 46% of nonelderly adults who reported any mental health or substance use need, did not receive treatment. Over half (57%) of these respondents did not receive care because of costs and almost a quarter (23%) reported difficulty scheduling an appointment.^[3] Other barriers that keep people from receiving care include a lack of providers, gaps in insurance coverage, transportation, long wait times, and a lack of culturally competent care. The effects of these barriers impact some groups more than others, particularly communities of color, which leads to varying, and oftentimes disproportionate, negative health outcomes.

Best practices for increasing access to care have been offered up to create a more accessible behavioral health system. Solutions to improve access include integrating behavioral health care into primary care, strengthening and expanding the behavioral health workforce (including peer navigators and community health workers), delivering behavioral health services at home and in the community, and providing case management services.^[4],[5],[6]

One program in Merced County did just that. Through the Mental Health Services Act (MHSA) Innovation (INN) funds, Merced County Behavioral Health and Recovery Services (BHRS) implemented the Innovative Strategist Network (ISN), a program aimed at reducing barriers to accessing behavioral health services by providing intensive, short-term services in the community and offering case management to connect clients to long-term care.

This innovative program served individuals of all ages, ranging from mild-to-moderate to severe mental illness, who faced significant barriers to accessing care. These barriers included unstable housing, lack of social support, lack of transportation, and health insurance issues. Many of these individuals were either accessing mental health services for the first time or had a history of not following a doctor’s medication and treatment recommendations. The ISN offered a range of services including therapy, case management, transportation, care coordination, and warm hand-offs to BHRS partners and community support.

Throughout our evaluation of Merced County’s ISN program, we found that the piece that made the biggest difference for clients was the staff’s ability to provide intensive services, sometimes meeting with clients multiple times a week. ISN clients shared experiences of staff checking in on them to bring them food and clothing and to see how they were doing. Staff brought clients to their medical appointments, assisted them in getting documentation for housing applications, and made space for clients to openly express their vulnerabilities. While connecting clients with long-term services could be challenging due to long waitlists, ISN staff kept clients enrolled until they successfully connected to services. Clients were able to build strong relationships with staff, which increased their overall satisfaction and improved clinical outcomes.

The ability to meet with clients in the community was critical to the success of the program. Staff were able to meet with them in their homes, in encampments, in parks, or wherever was most convenient for the client. Staff also extended their hours to meet with clients who were unable to meet during regular business hours. Clients were much more engaged with the program when staff literally and figuratively met them where they were.

Based on the results of our evaluation, the ISN program has been made a permanent program within the behavioral health system in Merced County. They have extended the target enrollment length and expanded eligibility criteria to continue providing intensive services in the field to those who need it most. RDA has extensive experience evaluating innovative behavioral health programs, boiling down to the key components that work.

If you are interested in consulting services with RDA, please don’t hesitate to contact Ken Lupoff, Associate Director of Business Development (klupoff@RDAconsulting.com).

Caroline Calonge & Paulina Hatfield

^[1] California Health Care Foundation. (2022, July). Mental Health in California. https://www.chcf.org/wp-content/uploads/2022/07/MentalHealthAlmanac2022.pdf

^[2] California Health Care Foundation. (2022, January). Substance Use in California: Prevalence and Treatment. https://www.chcf.org/wp-content/uploads/2022/01/SubstanceUseDisorderAlmanac2022.pdf

^[3] Panchal, N., Young, G., Cox, C., Ortaliza, J., Ramirez, G., & Garfield, R. (2022, March 17). A Snapshot of Mental Health and Access to Care Among Nonelderly Adults in California. KFF. https://www.kff.org/coronavirus-covid-19/issue-brief/a-snapshot-of-mental-health-and-access-to-care-among-nonelderly-adults-in-california/#footnote-549225-2

^[4] Alegría, M., Nakash, O., & NeMoyer, A. (2018, February). Increasing equity in access to mental health care: a critical first step in improving service quality. World psychiatry : official journal of the World Psychiatric Association (WPA), 17(1), 43–44. https://doi.org/10.1002/wps.20486

^[5] Nuzum, R., Williams, R.D., Counts, N., Federman S., & Horstman, C. (2022, May 12). Expanding Access to Equitable Behavioral Health Services. The Commonwealth Fund. https://www.commonwealthfund.org/blog/2022/expanding-access-equitable-behavioral-health-services

^[6] Martone, K., Arienti, F., Gulley, J., & Post, R. (2022, September). The role of supportive housing, case management, and employment services in reducing the risk of behavioral health crisis. Technical Assistance Collaborative Paper No. 8. Alexandria, VA: National Association of State Mental Health Program Directors.