California MHS Act: Impact on Practice & Organizational Culture in Public Clinics

描述（由申请人提供）：本项目将分析由加州精神卫生服务法案（MHSA）带来的精神卫生保健的变化，重点是实现变化的机制和对客户结果的影响。MHSA通过对超过100万美元的个人收入征收1%的额外税，大大增加了对加州精神卫生保健的支持，目前每年为公共精神卫生保健带来7亿美元的额外收入。MHSA规定各县只能将MHSA的资金用于基于“恢复”哲学的项目和干预措施，MHSA有可能从根本上改变加州的精神卫生保健系统。与洛杉矶县精神卫生部（LAC DMH）合作，我们建议评估MHSA对洛杉矶，全国人口最多的县的服务提供和客户结果的影响。我们的首要目标是了解MHSA对客户的影响以及为什么会发生观察到的影响。我们聚集了一个多学科的精神病学家，心理健康服务研究人员，一位经验丰富的公共心理健康管理人员，一位历史学家，一位社会学家和一位人类学家。我们的具体目标是：1）在县一级，评估LAC DMH如何随着时间的推移制定和实施MHSA临床政策; 2）在诊所一级，评估诊所如何实施LAC DMH对MHSA的解释，以及这种实施如何改变临床文化，结构和提供者对疾病和治疗的理解; 3）在患者层面，评估当地临床转型对患者客观结果和主观治疗体验的影响。我们采用纵向设计，以评估在MHSA实施的前三年的变化，在两个诊所接受MHSA的资金和两个没有接受资金。方法包括客户（n=480-640）和供应商（n=377）自我管理的调查;定性访谈的LAC DMH管理员（n=28），供应商（n =50），和客户（n=50）;录音临床互动（n=20 dyads）;人种学观察;文件分析;和分析的LAC DMH数据库。总结：《加州精神卫生服务法》（MHSA）通过将“康复”概念置于严重精神病患者（SMI）治疗的最前沿，代表了从根本上改变公共精神卫生保健系统的努力。该项目的目的是研究MHSA对重度精神病患者的影响及其在三年内的治疗。通过研究MHSA，我们希望提供一个全面和有启发性的例子，说明当一项可能影响数千名患者的新政策强加于公共精神卫生系统时会发生什么，其目标是改善护理。

DESCRIPTION (provided by applicant): This project will analyze the changes in mental health care brought about by the California Mental Health Services Act (MHSA), focusing on the mechanisms by which change is achieved and the impact on client outcomes. The MHSA significantly increases support for mental health care in California via an additional 1% tax on personal income above $1 million, currently generating $700 million in additional yearly revenue for public mental health care. Mandating that counties use MHSA funds only for programs and interventions based on a philosophy of "recovery," the MHSA has the potential to radically transform the mental health care system in California. In collaboration with Los Angeles County Department of Mental Health (LAC DMH), we propose to assess the impact of MHSA on service provision and client outcomes in Los Angeles, the country's most populous county. Our overarching goal is to understand both what effects the MHSA has on clients and why the observed effects occurred. We have gathered a multidisciplinary team of psychiatrists, mental health services researchers, an experienced public mental health administrator, an historian, a sociologist, and an anthropologist. Our specific aims are: 1) at the county level, to assess how LAC DMH develops and implements MHSA clinical policy over time; 2) at the clinic level, to assess how clinics implement LAC DMH's interpretation of the MHSA, and how this implementation transforms clinical culture, structure, and providers' understandings of illness and treatment; and 3) at the client level, to assess the impact of local clinical transformations on clients' objective outcomes and subjective treatment experiences. We employ a longitudinal design to assess change in the first three years of MHSA implementation in two clinics receiving MHSA funding and two not receiving funding. Methods include client (n=480-640) and provider (n=377) self-administered surveys; qualitative interviews of LAC DMH administrators (n=28), providers (n=50), and clients (n=50); audio-taped clinical interactions (n=20 dyads); ethnographic observation; document analysis; and analysis of the LAC DMH database. LAY SUMMARY: The California Mental Health Services Act (MHSA) represents an effort to radically transform the public mental health care system by putting the concept of "recovery" at the forefront of treatment for the severely mentally ill (SMI). The purpose of this project is to study the impact of the MHSA on SMI clients and their treatment over the course of three years. By studying the MHSA, we hope to provide a comprehensive and instructive example of what happens when a new policy, potentially affecting thousands of patients, is imposed upon a public mental healthcare system with the goal of improved care.