System Transformation Under the California Mental Health Services Act: Implementation of Full-Service Partnerships in L.A. County

• Published in: Psychiatric services (Washington, D.C.) Vol. 68; no. 6; pp. 587 - 595
• Main Authors: Starks, Sarah L, Arns, Paul G, Padwa, Howard, Friedman, Jack R, Marrow, Jocelyn, Meldrum, Marcia L, Bromley, Elizabeth, Kelly, Erin L, Brekke, John S, Braslow, Joel T
• Format: Journal Article
• Language: English
• Published: United States American Psychiatric Association 01-06-2017; American Psychiatric Publishing, Inc
• Subjects: Accountability; California; Community Mental Health Services - economics; Community Mental Health Services - organization & administration; Cooperative Behavior; Health Care Reform - legislation & jurisprudence; Health Care Reform - organization & administration; Health Services Research; Humans; Mental disorders; Mental Disorders - rehabilitation; Mental health care; Models, Organizational; Prospective Studies; Regression analysis; Los Angeles County California; United States > US; Systems issues in CMI; Staff relationships/roles; Homeless mentally ill; Recovery; Community mental health services
• ISSN: 1075-2730; 1557-9700; 1557-9700
• DOI: 10.1176/appi.ps.201500390

Objective:The study evaluated the effect of California’s Mental Health Services Act (MHSA) on the structure, volume, location, and patient centeredness of Los Angeles County public mental health services.Methods:This prospective mixed-methods study (2006–2013) was based in five Los Angeles County public mental health clinics, all with usual care and three with full-service partnerships (FSPs). FSPs are MHSA-funded programs designed to “do whatever it takes” to provide intensive, recovery-oriented, team-based, integrated services for clients with severe mental illness. FSPs were compared with usual care on outpatient services received (claims data) and on organizational climate, recovery orientation, and provider-client working alliance (surveys and semistructured interviews), with regression adjustment for client and provider characteristics.Results:In the first year after admission, FSP clients (N=174) received significantly more outpatient services than did usual care clients (N=298) (5,238 versus 1,643 minutes, p<.001), and a larger proportion of these services were field based (22% versus 2%, p<.001). Compared with usual care clients, FSP clients reported more recovery-oriented services (p<.001) and a better provider-client working alliance (p=.01). Compared with usual care providers (N=130), FSP providers (N=42) reported more stress (p<.001) and lower morale (p<.001).Conclusions:Los Angeles County’s public mental health system was able to transform service delivery in response to well-funded policy mandates. For providers, a structure emphasizing accountability and patient centeredness was associated with greater stress, despite smaller caseloads. For clients, service structure and volume created opportunities to build stronger provider-client relationships and address their needs and goals.