Summer Savon, MD, PhD, James Dilley, MD, Christina Mangurian, MD, Emily Martin, BA, Jaspreet Uppal, BS, Richard Patel, MD, Richard Oliva, MD, Martha Shumway, PhD

University of California, San Francisco and San Francisco General Hospital

Research Questions

•How do WCC clients describe themselves in terms of health, well-being, and socioeconomic status?

•How do WCC clients feel about the services they receive here? Are there areas where client satisfaction is higher, and other areas where improvement is needed?

BackgroundThe goals of contemporary behavioral health treatment have expanded to include more broadly defined concepts of self-direction, respect, responsibility and hope. A successful treatment plan incorporates these concepts and moves a person toward greater and greater lasting recovery. On the other hand, a gradual loss of well-being can occur which eventually includes a cessation of medication for any of a variety of reasons. The lack of medication is an important pivot point as either an intervention that restarts medication can occur, or a further plummet of functioning takes place that often ends up with the individual going to the psychiatric emergency room. “Psychiatric urgent care” can address this crucial pivot point. However, there is limited literature describing the individuals who use these urgent care services or how the services are perceived by those who use them.

MethodsParticipants: All English-speaking WCC clients who were not cognitively impaired or being placed on a legal hold for psychiatric evaluation were eligible to participate. The current, preliminary sample includes 17 clients.

Study Procedure: When research interviewers were available, all eligible clients were asked to participate in interviews. Consenting clients completed at 67-question survey that included demographic characteristics, objective and subjective socioeconomic status, the WHO-5 Well-Being Scale, the General Self-Efficacy Scale, an adapted version of the Multidimensional Scale of Perceived Social Support, and the MHSIP Consumer Survey of satisfaction with mental health services.

Data Analysis: Descriptive statistics were used to summarize the data.

Results

Results DiscussionThese preliminary findings help delineate a segment of the chronically ill in the general population that is still functioning socially, but carries a high risk of future difficulties due to lack of medication. It is interesting that the majority of clients seen at WCC, regardless of their specific situation, are very satisfied with the services they received.

There are two themes that arise from this study which may apply to this client population in general:

1.These clients are optimistic and view themselves as problem solvers with good support systems. Yet, they realize the need for urgent psychiatric care. Once back in treatment, clients are better able to participate in on-going care.

This clinic model can be seen as analogous to the harm reduction model, in that it constitutes a way to provide critical emergent psychiatric medication without first requiring complete connection with an outpatient mental health clinic.

2.Although clinic participants feel positive about their lives in several ways, some of the initial data indicates that clients are not as satisfied with:

a. physical aspects of well-being: waking up refreshed, feeling able to handle difficulties

b. spiritual aspects of well-being: good quality of life, feeling that life is interesting

This suggests that education on practical matters of general nutritional/preventative health could be very helpful if provided in a manner that is easy to implement. Similarly, there may be ways to provide access to enriching activities either on site, or in the community.

 

SettingThe Westside Crisis Clinic (WCC), a “psychiatric urgent care” facility located in downtown San Francisco, is a program that provides re-initiation of medication to individuals who are stable enough to be in the community, but are at risk due to lack of medications. WCC was founded in 1967 and has transitioned from being a 24-hour clinic to a structured six-day, 8 am-5 pm clinic. Most clients are SF residents who are currently in rehab facilities, have recently been incarcerated, or have lost benefits due to unemployment, etc.

The Westside Crisis Clinic opens at 8 am, with a line of about 15-20 clients that began to form at 7 am. Clients sign in, are assessed for risk and appropriateness. As appropriate, clients are given an appointment time for later in the day. The appointment involves meeting with a psychiatrist or a psychiatric nurse practitioner for about 40 minutes and typically results in a prescription for a month’s supply of medication.

Clients understand that this is an interim arrangement and that they are expected to establish on-going treatment at one of several area mental health clinics. The client leaves the visit with a list of locations and directions to area follow-up clinics and handouts with information about area shelters, free food and other resources. Additionally, the clinic offers several visits with a staff psychotherapist.

NR2-212

n = 17

Age Under 30 years 31% 30+ years 69%

GenderMale 69%Female 31%

Hispanic / Latino 13%

RaceCaucasian 69%

African American 13%Asian / Pacific Islander 6%Other 13%

EducationLess than High School 6%High School 24%Post High School Education 59%College 6%Postgraduate Degree 6%

Marital Status Single, Never Married 71%Married / Partnered 12%Divorced 18%

Income (Annual)Less than $25,000 88%$25,000 - $50,000 6%More than $50,000 6%

Sample Characteristics

12%

12%

35%

29%

12%

0% 5% 10% 15% 20% 25% 30% 35% 40% 45% 50%

Mental Health: How would you rate your mental health in the last 12 months?

Very Good

Good

Fair

Poor

Very Poor

12%

29%

23%

29%

6%

0% 5% 10% 15% 20% 25% 30% 35% 40% 45% 50%

Physical Health: How would you rate your physical health in the last 12 months?

Very Good

Good

Fair

Poor

Very Poor

24%

12%

24%

29%

12%

0% 5% 10% 15% 20% 25% 30% 35% 40% 45% 50%

Quality of Life: Overall Quality of Life - WHO-5 Total Score

Very Good

Good

Fair

Poor

Minimal

Quality of Life: WHO-5 Items - 0=At No Time to 5=All Of The Time Subjective Socio-economic Status (SES):

This ladder represents where people stand in the United States.

At the top of the ladder (where 10 is) are the people who are the best off--those who have the most money, the most education, and the most respected jobs.

At the bottom (where the 1 is) are the people who are worst off---who have the least money, the least education, and the least respected jobs or no job.

Where would you place yourself?

Now In Ten Years

Results

0 1 2 3 4

I can always manage to solve difficult problems if I try hard enough.

If someone opposes me, I can find the means and ways to get what I want.

It is easy for me to stick to my aims and accomplish my goals.

I am confident that I could deal efficiently with unexpected events.

Thanks to my resourcefulness, I know how to handle unforeseen situations.

I can solve most problems if I invest the necessary effort.

I can remain calm when facing difficulties because I can rely on my coping…

When I am confronted with a problem, I can usually find several solutions.

If I am in trouble, I can usually think of a solution.

I can usually handle whatever comes my way.

Mean All Items: WCC Sample

Mean All Items--US Adults

Self-Efficacy: General Self-Efficacy Scale(1=low, 4=high)

1 2 3 4 5 6

… who is around when you are in need?… with whom you can share your joys and sorrows?

… who really tries to help you?… gives you the emotional help and support you need?

… is a real source of comfort to you?… you can count on when things go wrong?

… you can talk to about your problems?… who cares about your feelings?

… is willing to help you make decisions?

Social Support(1=low, 6=high)

Is there someone:

1 2 3 4 5 6

I like the services I receive here.If I had other choices, I would still get services from this agency.I would recommend this agency to a friend or a family member.

The location of services was convenient (parking,..., distance, etc.)Services were available at times that were good for me.

I was able to get all the services I thought I needed.Staff here believe that I can grow, change, and recover.I felt comfortable asking questions about my treatment.

I felt free to complain.I was given information about my rights.

Staff encouraged me to take responsibility for how I live my life.Staff told me what side effects to watch out for.

Staff were sensitive to my cultural background (race, religion, language, etc.)Staff helped me obtain the information I needed [to]take charge of my illness.

I was encouraged to use consumer-run programs

MHSIP Consumer Survey: Satisfacton with Mental Health Care (lower=less satisfied, higher=more satisfied)

For additional information, contact:

Summer Savon, MD, PhD summer.savon@ucsf.edu

This work was supported by Westside Community Services.