Mental Health Services

The services described below may be delivered as stand-alone outpatient mental health services or bundled as components of the Intensive Case Management or Assertive Community Treatment/Forensic Assertive Community Treatment levels of care.

• Mental Health Assessment — A process used to learn about a person’s history, current challenges, past trauma, daily functioning, and other important factors. This information helps create a full picture of the person’s needs and supports coordination of care with other providers or agencies.
• Treatment Planning — This service focuses on helping a person identify their goals and decide what support they need. It can include creating or updating goals of treatment and reviewing a person’s progress. Treatment planning may also involve meeting with caregivers or other support systems to help guide the plan and ensure it reflects the person’s current needs.
• Case Management — Support is provided to help a person access the services and resources outlined in their plan. This includes helping them access medical care, school or job programs, social support and connect with other resources. Staff may coordinate care with providers or agencies across systems, make referrals, set up services, and check to see if the support is helping. Case management also helps a person stay connected to community resources and encourages ongoing progress.
• Rehabilitation — Support offered in individual or group settings to help people build coping skills and improve daily functioning affected by serious and ongoing mental challenges. This can include skills for social situations, work, community involvement, and everyday activities. It may also involve meeting with caregivers and other support systems to provide coaching and skill development that encourages the person’s progress.
• Crisis Intervention — A phone-based service for unplanned situations that need quick attention but are not severe enough for our Mobile Crisis Response Team. The goal is to help the person cope with the challenge, regain stability, and remain safely in the community. If needed, the situation may be escalated to our Mobile Crisis Response Team.
• Therapy — Therapeutic interventions focused on helping reduce symptoms, improve daily functioning, reduce impairments, and support overall coping and adjustment. Therapy is offered in individual, group, and family formats.
• Occupational Therapy (OT)— This support helps people improve how they do everyday activities like bathing, dressing, writing, cooking, socializing, working, and other activities. Occupational therapists help individuals build, regain, or keep these daily living skills when they are affected by serious and ongoing mental challenges. Santa Cruz County Occupational Therapy provides assessments of clients to inform their treatment goals. We also offer OT skills groups for clients to improve psychosocial functioning.
• Psychiatry including Medication Management — Our Psychiatry services provide comprehensive, patient-centered mental health care for adults who qualify for specialty mental health services. We offer evidence-based evaluation, diagnosis, and medication management, including long-lasting injections, for conditions such as mood, anxiety, psychotic, trauma-related, and attention-related disorders. Each treatment plan is individualized and may integrate care for co-occurring mental health and substance use challenges to support stability, functioning, and long-term recovery.

Outpatient Mental Health Services are for adults who meet criteria for Specialty Mental Health Services but do not, or no longer, need the higher level of care provided by Full-Service Partnership Intensive Case Management or Assertive Community Treatment. These services provide lower-intensity, less-restrictive treatment, rehabilitation, and recovery support for adults living with serious and persistent mental illnesses.

The goal of outpatient services is to help people who are living with serious mental illness recover, stay well, build daily living skills, avoid setbacks, and improve their overall quality of life. These services also help people continue active engagement with their care as they step down from higher-intensity programs. Many of the interventions used here are also part of the higher-intensity service models described below.

Services provided may include:
 - Assessment
 - Treatment Planning
 - Case Management
 - Individual and Group Therapy
 - Occupational Therapy
 - Referrals to contracted providers
 - Psychiatry including Medication Management

Full-Service Partnership Intensive Case Management is a step up from standard outpatient mental health services. It is designed for individuals with moderate to significant behavioral health needs who can benefit from full-service partnership support systems. It combines core case management practices such as assessment, planning, and linkage with low staff-to-client ratios, assertive outreach, and direct service delivery.

ICM is a team-based, recovery-focused model that provides a wide range of community-based services and support based on each client’s unique needs. Its goal is to help stabilize individuals, improve health outcomes, and give them the tools they need to move from crisis toward stability and routine care. This model has shown positive effects on overall functioning, employment and housing outcomes, and reduced psychiatric hospitalization.

Service Components:
 - Assessment
 - Treatment Planning
 - Case Management
 - Psychosocial Rehabilitation
 - Therapy
 - Crisis Intervention
 - Peer Support Services
 - Referrals and Linkages
 - Psychiatry including Medication Management

Santa Cruz County Behavioral Health Division is currently planning for implementation of these services.

Assertive Community Treatment (ACT) is an evidence-based model of community-based care delivery for individuals with significant behavioral health needs. ACT provides the highest level of support for people with complex treatment histories, including psychiatric hospitalizations, emergency room visits, residential treatment, involvement with the criminal justice system, experiences of homelessness or risk of homelessness, and difficulty engaging in traditional outpatient services.

ACT uses a multidisciplinary team that includes clinicians, psychiatrists, nurses, peer support specialists, substance use specialists, and employment specialists, who work together to support each client. Services are delivered as an integrated approach that addresses mental health care along with practical needs such as housing, benefits, transportation, physical health, and substance use. Low client-to-staff ratios allow for frequent and assertive contact, often provided in the community in settings such as streets, hospitals, homes, and shelters. This model supports continuity of care across service and housing settings.

ACT has been shown to improve quality of life and functioning, reduce symptoms, increase engagement in treatment, and support better medication adherence. It also increases independent living, reduces homelessness, and decreases both the length and frequency of hospitalizations.

Forensic Assertive Community Treatment (FACT) builds on the ACT model to meet the needs of individuals with significant behavioral health challenges who are also involved in the criminal justice system. Their needs are often complex and may be made more difficult by justice system involvement. FACT adapts the ACT approach to address barriers to community reintegration, including challenges accessing treatment, employment, housing, and other support systems. FACT helps bridge the behavioral health and criminal justice systems. For more information about our services for individuals involved in the justice system, please visit our Justice Involved page.

Service Components:
 - Assessment
 - Treatment Planning
 - Case Management
 - Psychosocial Rehabilitation
 - Therapy
 - Crisis Intervention
 - Peer Support Services
 - Referrals and Linkages
 - Psychiatry including Medication Management