Innovating Equitable Telehealth for LA County The Los Angeles County Department of Mental Health (LACDMH) is the largest county-operated mental health department in the United States, directly operating 85+ programs and contracting with close to 1,000 organizations and individual practitioners. It’s goal is to reach 1.2M of its 10M residents who are in need of mental health services.

1. Telehealth Use in
The Los Angeles County
Department of Mental Health
Marc Heiser MD, PhD
Racheal Burgess
Los Angeles County Department of Mental Health

2. LAC Department of Mental Health
Race/Ethnicity
Average
Monthly
Unduplicated
Medi-Cal
Beneficiaries
Percentage of
Medi-Cal
Beneficiaries
Unduplicated
Annual Count
of Beneficiaries
Served by the
MHP
Percentage of
Beneficiaries
Served by the
MHP
White 499,886 13.0% 34,467 15.6%
Latino/Hispanic 2,270,000 59.1% 117,531 53.1%
African-American 387,547 10.1% 40,669 18.4%
Asian/Pacific Islander 370,343 9.6% 9,430 4.3%
Native American 4,765 0.1% 581 0.3%
Other 314,957 8.2% 18,458 8.3%
Total 3,840,000 100% 221,136 100%
The total for Average Monthly Unduplicated Medi-Cal Enrollees is not a direct sum of the averages above it.
The averages are calculated independently.
Los Angeles MHP
• Largest mental health system in the country
• Covers a population of ~10 million
• Over 80 directly operated (DO) programs (~40k
clients/month)
• 700 contract providers

3. LAC DMH Telepsychiatry Prior to COVID-19
• Telemental Health and Consultation Program
• Small program providing medication support services for directly operated
DMH clinics that were short-staffed
• Clients would present to clinic in-person and see DMH psychiatrist located
remotely
• Remote psychiatric consultation also provided to DHS primary care clinics as
part of Behavioral Health Integration/DMH Collaboration Program

4. Telepsychiatry Now: Rapid Pivot To Remote
Care
• Priority: Maintain client services, check in on health, ensure housing
and food security
• All disciplines have shifted to remote service delivery
• Case management
• Peer support and community health workers: Outreach and engagement,
support groups
• Therapy: Individual and groups
• Nursing: Education, symptom screening, client management
• Medication support: New evaluations and ongoing care

5. Opportunity and Innovation
• Expand support for people residing in shelters
• Deployed field-based teams with remote psychiatric support for people
residing in emergency shelters and isolation and quarantine shelters
• Improve access to care: Redistribution of psychiatric resources
• Traditionally, psychiatrists are clustered in certain geographic areas of LA
County, leaving other areas underserved
• Using telehealth, we have been able to redeploy psychiatrists more equitably
across the county
• These psychiatrists no longer see clients in one clinic, but rather see clients
throughout the system

6. LAC DMH Outpatient Services (DO Only): Jul 2019- Sept 2021
Telehealth
Telephone
Other
COVID-19 Safer at Home
• Client services increased
during COVID-19
• Phone predominates

7. FY20-21 % Outpatient Services by Phone/TeleMH by DO vs LE
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
70.0%
2020-07 2020-08 2020-09 2020-10 2020-11 2020-12 2021-01 2021-02 2021-03 2021-04 2021-05 2021-06
DO - TeleMH LE - TeleMH DO - Phone LE - Phone

8. 0
1000
2000
3000
4000
5000
6000
7000
8000
9000
10000
2020-21 DMH DO VSee Use (# of Visits)
2020 2021

9. Challenges with Telehealth
• Access to technology: Individuals may not have smart phones and/or
data capable of supporting audiovisual conferencing. They may not
have enough minutes to use for telephone services
• Comfort with technology: Varying levels of comfort with telehealth
technology
• Privacy: Individuals may be unhoused or they may not have private
space where they reside

10. DO Clinic Efforts To Increase Video Visits
• Quality Goal: Increase use of videoconferencing for mental health care
• Video conferencing is equivalent to in-person care (Hilty et al. 2013)
• Superior to telephone visits
• To increase videoconferencing we have implemented the following:
• Increased training sessions to twice a week
• Trained “VSee Champions” to assist staff and clients
• Implemented a clinic workflow to get clients online
• Reviewing clinic VSee use at APEX meetings
• Applied for federal funding for telehealth equipment
• 6 month QI review of data

11. Result: Clinics With VSee Workflow Have More Video Appointments
No Protocol

12. Future Directions: Expand Access And
Improve Quality
• Integration of telehealth software with DMH electronic medical
record system
• Leverage cultural capacity: Clients may be matched with providers in
part based upon language and, if desired, cultural knowledge rather
than geography
• Use customer satisfaction survey and telehealth usage data to guide
further expansion, understand unmet needs and barriers
• Explore sources of funding for smart phones and data including
government and public-private partnerships