MediCal Focus Group at MHCAN

December 13, 2001

Summary Information

* Parents answered for their adult children on remaining items.

Note:  Information contained in this report is first-person experience.  While it does not represent the opinions of a broad population, it does highlight real experiences within our mental health system in the last year.  This anecdotal information can be used to identify problems and make recommendations for change.

Treatment Planning

Do you feel involved in your treatment planning?  What is your role in determining the specific services you receive?

3 people did not have a plan/ did not know about a plan.

6 people had a plan.

There were varying opinions on involvement in treatment planning.  One consumer reported “I play a big role in it.”  Another reported “No.  I just tell them how I feel and what I do and they write it down.”  Family members felt uninvolved though they would like to be more involved.

Some participants indicated that their treatment plans did not contain positive or clear goals other than to “stay stable.”

Were you asked to sign your treatment plan after it was completed?

All who had a plan were asked to sign it.

Not much follow-up was reported on the plans.  One consumer felt his plan was basic and easy to follow.  Another consumer feared not knowing who had access to her plan.

How did your family members and persons who help you in the community participate with you in your treatment plan?

Family members did not know about the treatment plans.  Some family members offered general support, but no one said their family was involved with their treatment plan per se.

One family member stated “If I was not actively involved pursuing the treatment I feel that I would not be consulteed.” 

Did you receive a copy of your treatment plan?

2 people received copies/ 1 didn’t know/ 1 didn’t want one/ 2 did not receive one.  One parent stated “As my son’s conservator, no, I have never seen his treatment plan.”

Sensitivity to Cultural/Ethnic/Language/Spiritual/Educational background

Are staff sensitive to your cultural/ethnic/language/spiritual/educational background?

3 people believed staff were sensitive to their background. 

Clients stated that they weren’t sure if psychiatrists stayed up-to-date on the latest research.  A concern was expressed that psychiatrists might be unaware of how medications affect ethnic groups differently.

3 felt comfortable discussing spiritual issues.

Most clients felt supported in education and career goals

Housing

How often are you asked about your housing needs/ problems?

Participants reported that they were asked about their housing as needed.  Coordinators and doctors seemed very concerned when clients were homeless.  In one case a participant stated that her psychiatrist was more concerned than she was. 

All participants knew at least one homeless, mentally ill person who had a case manager.

The two family members present had divergent experiences with the housing situation.  One parent reported that she felt her son was being pushed to move out.  The other parent reported staff seemed to expect her son to continue living in her home.  Both parents felt their sons were being encouraged to change their minds.

Service Accessibility

Is the physical facility where you receive services friendly?  Is it accessible to transportation?

Participants reported that they liked Emeline.  They liked the smoking area, the bathrooms, and the sculptures.  Also, the bus came twice an hour at Emeline.

At Encinal the bus only comes once an hour.  People do not generally take cabs or use Lift Line.  The bus at Encinal is on the hour, so clients often have to cut their appointments short to make the bus.  The lack of privacy in coordinator’s cubes has not been a problem because there are conference rooms available for meetings.  One client said she liked the colors and all the windows at Encinal.  In general, clients felt the move was smooth.

People also noted that the receptionists are very friendly.

Respect shown by staff

Do all staff treat you with respect?  What makes you say so?

The response to this question was mixed. 

One client reported “No, they joke around a lot.  They make fun of me sometimes and kid me about my illness by talking about the “P-word” (paranoia).  .

Another participant stated: “I respect them, they respect me.”

Another participant said that she felt County staff are okay, but Dominican and some of the contractors are a problem. 

“At 7^th Avenue the staff is mixed.  Some are good, but there is a lot of disrespect to clients and families.  Staff don’t want to have to deal with families.  They say it’s gotten better, but I don’t know.”

At El Dorado one family member felt overwhelmed by a social worker who she felt was bullying her.

Regarding DMHU, participants stated:

“Staff damaged my dentures so I couldn’t open my jaw.”

Another reported that she felt ER staff did not believe her because of her diagnosis.

“Dominican treated me with excessive force, lost my clothing, and restrained me so that I couldn’t breathe.”

“Families are not listened to.  They are treated like their complaints are their problem.  The family is not acknowledged. They are treated like they are in the way.”

“Though there are a few shining stars, most Dominican staff have a superiority attitude.”

ER and unit staff members have been overheard making derogatory names for diagnoses within earshot of clients and family members. 

One client believed that DMHU staff are “thin-skinned” because they are so preoccupied with outside issues that they cannot focus on clients.  Staff express themselves in disabling ways to clients.

Does mental health staff return your phone calls quickly and answer your questions?  Do doctors answer your questions about medications?

Most felt their phone calls were responded to quickly by County staff, but not by Community Support Services staff.  The group felt that calls should be returned within 2 days. 

Most felt they did not have sufficient time to discuss medications with their doctors.  They said they should have longer than 15 minutes with the doctor.  “The psychiatrist is just a pill pusher.”  There are not enough appointments, and the doctors don’t have time to fully answer.  “They (doctors) have to switch gears quickly between appointments.”  People feel they can’t ask doctors for longer appointments even when they need it.

Clients expressed frustration that doctors didn’t take time to fully disclose side effects.  One person complained that when she reported a 60 pound weight gain while taking Zyprexa, her psychiatrist told her to exercise more.

“They (staff) ask more questions than give answers.”

Special Needs

Do you have any special needs that you feel are not addressed by MediCal services?

Medi-Cal and Medicare letters are confusing.  Social Security and Medi-Cal have no coordination and often contradict each other.  Clients do not know where to get help or clarification.

Do you receive services as often as you feel is necessary to meet your needs?

I didn’t get the help I needed early enough so I wound up in the hospital.

Ease of changing providers

Is it easy to arrange a change of service provider (physician, psychiatrist, care coordinator)?

One individual had experience changing coordinators.  She reported it was not easy to change providers.  She felt she had to justify her request, and feared retribution and developing a bad reputation in a small county like Santa Cruz.  She said it would be nice if you didn’t have to explain.  “It’s like having to tell a relative you don’t love them.”  After she was changed her old coordinator said “You really hurt me.”

Another participant had some difficulty changing psychiatrists, mainly because it involved changing clinics as well. 

No one else in the group had tried to change providers.

Other MediCal Services

Do you receive MediCal services outside Encinal/ Emeline?  Where?

Central Coast Alliance for Health (Med-Cal managed care provider)

Health Clinic at 1080 Emeline

Does the county mental health program ever arrange or connect you with pharmacy, physical health, vision and/or dental care services?

It is frustrating that psychiatrists never want to discuss physical health issues.  One woman has had problems working with both a psychiatrist and a neurologist.

Many participants have found that dentists are reluctant to treat psychiatric patients if they’ve been on lithium or antipsychotics, due to bone fragility, dry mouth, problems with anesthetics, and stigma.  “Denti-Cal constant refusal of request for cap or crown.”

Physical health needs make getting mental health placement difficult (i.e. seizure disorder)

“I could not get my glasses on MediCal as often as services say.”

Obtaining mental health services

Have you had problems getting or keeping mental health services you think you need?

Some had difficulty getting therapy appointments, while others said it was no problem.

When requesting services, one woman has been told there are not funds.  One person said we need a “mid-way” crisis support, rather than Dominican or nothing.

Most helpful services

Which services do you find to be the most helpful to you in your life?

Food

Shelter

All mental health services

Services not particularly helpful

Which services are not particularly helpful to you?

None- All are helpful

Other Suggestions

If you could change one thing about County Mental Health services, what would it be?

Lower caseloads by increasing the number of coordinators.  (Note:  Participants estimated that coordinators had 70-100 clients on their caseloads.)

Shred the progress notes.

Find medications with fewer side effects.

Help people make the transition from Dominican easier and faster- need a better place where you could be not locked, but not all on your own

“If a medicine is not working, producing serious side effects and the client is not a danger to himself or others allow for a drug free period.”

“The mental health system needs to ad services specific to the 18-25 year olds.  Treatment of the whole person that includes exercie dental physical, nutrition.  The county mental health system needs to include services for those clients with P.T.S.D.”

“More Godly miracle healings and find real cures with no side effects.”

Concern was expressed about AB1421- Participants wished to let county and state leaders know they oppose involuntary outpatient commitment.

Barriers to Receiving Services

Transportation

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Copyright 2005 National Alliance for the Mentally Ill Santa Cruz County, All Rights Reserved.

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