Students review delivery of county mental health care

Anne Pinckard

First-year medical students Asya Agulnik, James Colbert, Eugene Yim, Louis Saddic and Melissa Horoschak attended an April 28 conference in Santa Clara, during which they discussed the benefits of integrating operations of primary care and mental health clinics.

Santa Clara County resident Delores Lloyd panicked when her psychiatric drugs ran out. She felt her depression returning, and the last time that happened, she was hauled off to spend 72 hours in a psychiatric ward. This time, she couldn't get help from mental health clinics because she wasn't eligible for care there, and her primary care physician didn't know her diagnosis and couldn't renew her prescriptions.

Lloyd's dilemma is emblematic of the snafus faced by psychiatric patients, said Eugene Yim, a first-year medical school student. Up to 30 percent of visits to Santa Clara County primary care clinics involve a mental health issue, but such facilities are not necessarily funded or equipped to treat them. When referred to mental health clinics, patients do not receive follow-up care or can't afford to pay for treatment, he said.

Speaking at the April 28 legislative breakfast in Santa Clara hosted by the nonprofit Community Health Partnership, Yim and four other students in Stanford's Practice of Medicine class presented the results of their course project: a survey of how the county clinics coordinate mental health treatment. Their talk was one of several, including Lloyd's, commenting on the challenges of providing health care in California.

The Stanford results are part of a larger study conducted by the Santa Clara County Mental Health Department to identify the system's failures. The information will help the department guide its use of an estimated $13.4 million expected from the Mental Health Services Act, which was approved by state voters in 2004. Currently, 27 mental health clinics in Santa Clara County serve about 106,000 patients a year. About 66 percent of the patients lack insurance to cover their treatment.

The students interviewed personnel at five clinics representing different links in the mental health-care chain. One clinic provided primary care only, referring patients to mental health clinics; two provided only mental health care; the final two, one a mental health clinic, the other a primary care clinic, worked together in an integrated system of care.

Yim said that the integrated system was optimal. He noted that primary care physicians are often the first to encounter mental health disorders, but that such clinics lack the trained personnel or funding necessary to treat mental health disorders. "Often they just administer psychotropics, without following up with counseling," he said.

Yim added that referring patients to other clinics for follow up is problematic. A patient may be physically unable to go elsewhere. And Medi-Cal does not reimburse two different clinics for services administered in the same day.

The students said that an integrated system would solve those problems, allowing patients to seek care through their primary care physician, who can then arrange a mental-health consultation with a trained, on-staff provider.

Most clinics were supportive of an integrated system, according to the survey. For Frances Killebrew, MD, medical director at MayView Community Health Center, the answer was obvious. "Patients are going to come to us no matter what," she said. "We need the funding to take care of them."

The other students on the project are Asya Agulnik, James Colbert, Louis Saddic and Melissa Horoschak.

Anne Pinckard is an intern in the Office of Communication & Public Affairs.