'A Coalition of the Willing': Revamping an Entire System of Care

'A Coalition of the Willing': Revamping an Entire System of Care

A group of dedicated public health leaders in Orange County, Calif., aren’t afraid of a challenge. In fact, this group is downright optimistic according to Marshall Moncrief, Chief Executive Officer of Mind OC.

“It’s inspiring to be part of a massive effort to transform mental health in Orange County and I believe, collectively, we can do it,” says Moncrief.

Moncrief is part of a team effort to revamp the entire mental health and substance use disorders system in Orange County. He credits a spirit of collaboration with being the fuel necessary to power an engine of change, motivating a massive and diverse network – 300 public and private community partners – to coalesce around a shared goal.

Like many regions across the country affected by substance use and mental health disorders, Orange County saw myriad organizations working to address this growing public health crisis, but instead of collaborating, they were working in silos.

In 2017, when Moncrief was serving as Regional Executive Director for the Institute for Mental Health & Wellness at Providence St. Joseph Health, a $100 million investment launched the Wellbeing Trust with the goal of transforming the way mental health is treated, diagnosed and prevented across the country.

But leaders in Orange County - including Barry Ross, Regional Director for Community Health Investment at Providence St. Joseph Health, Dr. Rick Afable, former President, St. Joseph Hoag Health;  Dr. Clayton Chau, incoming Director, Orange County Health Care Agency; Erik G. Wexler, Regional President, PSJH Southern California; and our local hospital chief executives - knew that by tackling this at the micro level first, rather than taking it on nationwide, they would be better positioned to find optimal solutions to a shared problem that no single organization could solve on its own.

“The community will be forced to continue to accept adequate care and a fragmented experience until we can bring public and private sector partners together to build a new continuum of coordinated care,” says Ross.

Community partners began gathering to discuss what an entirely revamped mental health care system could look like. More and more people started attending each meeting, and collaborative thinking began to emerge.

This, according to Moncrief, was the turning point. “Historically, we had all pointed fingers at each other. But someone dared to ask, ‘What would it look like if we held hands and worked together?’” he says. An additional modest investment from Providence funded the design of a blueprint for a robust public-private system, and soon, what Moncrief calls “a coalition of the willing” was born: Be Well Orange County.

Out of this blueprint, a neutral nonprofit organization, Mind OC, was established to manage the work and build on the group’s early momentum. Moncrief left Providence to lead Mind OC and engage hundreds of impact organizations, including Providence, through working groups and councils.

The group agreed that, unlike other health conditions like stroke or heart attack, there is not one direct way for people to access mental health services. The current system is underfunded, understaffed, difficult to navigate and largely dependent on the patients’ insurance status.

“The pathway to mental health care is not clear,” Ross says. “Those looking for help don’t know how to get into the system, and unfortunately, most people end up just calling 911.”

The shared recognition by coalition members of the complexity of accessing care led them to the idea of community wellness hubs – physical buildings where people could access care as part of the new larger, fully integrated system.

In 2019, thanks to investments from public agencies, private companies, nonprofit organizations, faith-based groups, universities and individual community members, Mind OC raised an unprecedented $40 million – including $4 million from St. Joseph Hoag Health, $2 million from St. Joseph Orange and $2 million from St. Jude Medical Center – to break ground on the first of three facilities.

The first building will include 93 beds and have the capacity to treat about 100 people each day. But based on county data, Moncrief anticipates the visitor total will actually be much higher.

“Fifty thousand people went to the emergency room for psychiatric care or substance abuse in 2018,” Moncrief says. “That means we must create an easy-to-navigate environment that informs people about where to go for the care they need, and ultimately avoid a trip to the emergency room.”

But these new buildings are only one part of a much bolder shift. Mind OC and its community partners are taking a holistic approach to mental health and substance abuse. This new system will work to reduce stigma, ramp up prevention and early intervention efforts, fill glaring gaps in treatment and improve the local crisis response system.

“This is about so much more than a new building,” Moncrief says. “We are all committed to creating a comprehensive system that provides the best care for our vulnerable neighbors and addresses not only acute challenges of mental health and substance use disorders but the upstream issues, too.”

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