Description of Target Population and Geographic Region
Carson City Community Counseling Center (CCC) intends to collaborate with a number of Designated Collaborative Organizations (DCO) to provide social model detoxification and follow up out-patient mental health services in a timely way. This is intended to remove this burden from the medical services providers in Carson City as well as address a rapidly developing need.
Currently, Rural Clinics and CCC are working together to attempt care for these clients, but because of inadequate resources, the needs of the client population are not being adequately met. The current state agency, Rural Clinics in Carson City, has a delay of at least 30 days before clients can be seen by a therapist or for medication. The clinic is able to complete paperwork very quickly, but the appointments for treatment are less timely. The CCC has always attempted to fill the gap by providing a marriage and family technician, a licensed counselor, and substance abuse counselor as appropriate and always using evidence based practices. Unfortunately, the waiting list at CCC for mental health support has also extended from 3-5 days in 2016 to 10 days for an individual mental health appointment because of a staff shortage and lack of space to accommodate more counselors.The CCC promotes improved access to high quality care. With this funding, CCC would assist with overflow from Rural Clinics Carson so that clients would not have to wait for a month to be seen. Additionally, the clients could begin their medication sooner by having CCC’s psychotropic medication provider on staff evaluate them within the first hours of discharge/release.
Mallory Crisis Center, Nevada’s first psychiatric ER 10 bed unit, opened in January 2017 because the need for mental health treatment was overwhelming the Emergency Room at Carson Tahoe Hospital. The Center is available to individuals in crisis as identified by law enforcement, EMS/Fire, family or self-referral. ( 36% of the referrals to Mallory come from the Carson Tahoe Emergency Room; 28% come from law enforcement; and 53 % are walk ins. The number of repeat clients is 399, 17.25% of all visits.) Of the Mallory admissions this year, the percentage is 60% psychiatric and 39% substance abuse. Although this new facility has alleviated the crisis at the hospital’s Emergency Room, it does not solve the critical and essential need for follow up mental health care and substance abuse treatment upon discharge from the Center.
There are approximately 6 new clients admitted each day to Mallory and/or Behavioral Health Services (BHS). Of the admissions to Mallory, 55% were then admitted to BHS for ongoing inpatient care, 35% were discharged home, and 8 % were discharged to another facility. These 35% discharged to their homes would comprise another portion of the target group. They could be helped by immediate follow up with CCC for supportive services for mental health or substance abuse therapy and medication. With additional staff funding, follow up visits can be quickly scheduled to seamlessly continue the medication and support these clients need. In addition, this rapid outpatient follow-up may reduce the current 3 visits to 2 for approximately 1/3 of the clients.
At least one client a month is unable to access prescriptions for their mental health issues in less then 48 hours. CCC would like to see this difficulty eliminated whenever possible. The referral process would be to accept clients directly from the jail, or rural clinics when they are unable to be quickly responsive by having them referred directly to CCC for interview with the prescribing nurse.
43% of the above clients were covered by Medicaid, 21% by Medicare, 22% by private insurance and only 12% had no insurance. The bulk of clients with Medicaid are low income along with the uninsured and are the target population for services required. The ability to pay is not an issue; the underserved must be targeted regardless of whether they have insurance. The intended target group is also local to the Carson City area which usually encompasses the citizens of Douglas County who find it relatively convenient to travel the twenty minutes to Carson.
It is the intention of CCC to provide the following, most of which are currently available and ongoing:
- medication by prescriptions by a qualified professional on staff
- medically assisted treatment for opioid addicts prescribed by a licensed suboxone provider on staff
- crisis mental health services
- screening, assessment and diagnosis
- patient centered treatment planning
- outpatient mental health and substance use services
- primary care screening and monitoring,
- targeted case management
- psychiatric rehabilitation services
- peer support, counseling and family support services
- active duty military and veterans’ services provided by a military specialist is on the staff
- Establish referral site for CPC/ Social Model Detox
In order to reach the target population, CCC will continue to work and collaborate with the Carson Tahoe Hospital, Mallory Crisis Center, and Rural Clinics Carson, to relieve them of the clients who do not need medical or residential services. Flyers and brochures will be prepared and distributed to all the local mental health agencies, law enforcement, emergency service locations, hospital and doctors waiting rooms, and various public sources that might provide referrals for services. CCC intends to expand all collaborations in the Carson City area with other health care providers, veterans’ services, social services at the Ron Wood Center, the City of Carson, the Sheriff’s Department, the Probation and Parole office, the Department of Alternative Sentencing, each judicial court, and local indigenous tribal leaders. The support of the families will also be critical. The intention is to provide immediate access to services which will reduce the need for hospitalization.
The CCC will continue to participate in the community meetings which address the needs of the local consumers, and providers and community members and enlist advice and comment from other participants in the mental health/substance abuse field. Exit interviews may be developed to collect the clients’ thoughts on the process.
The Common Themes and Next Steps as reported by the 2017 Carson Needs Assessment identifies Access to health care and Behavioral Health and Substance Abuse as two of the top four issues in Carson based on the report. There are difficulties in accessing preventative and specialty care largely relating to insurance coverage and difficulties physically accessing care due to issues relating to personal transportation. It was also discovered in this report that a need for improved and formalized referral systems and communication among health providers may improve access to health care for community members.
“Both mental health and behavioral health remain issues in the community with specific concern relating to behavioral health in the context of the abuse of illicit substances and prescription drugs. The need for these services in the community remains high.”
In summary, through collaboration with the psychiatric services in Carson, CCC will support the follow up treatment of those clients needing mental health and behavioral help in an efficient manner with no delay. The cross sector work will include the Sheriff’s Department emergency response team (MOST). Medication management will be available immediately with the provision of a prescribing nurse on staff or on call at all times. Through the use of a DCO, CPC/social model detox will be available for up to 3 persons a day. At a minimum up to 10 people will have availability to crisis management on a daily basis. Screening, assessment and treatment will be available to all clients in an easily accessible manner.