NR2-212
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
Background

The 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.
Setting

The 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.

Research Questions
•
•
How do WCC clients describe themselves in terms of health,
well-being, and socioeconomic status?
0%

Participants: 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.
10%
Very Good
12%
Good
12%
25%
30%
35%
40%
45%
50%
0
1
2
3
4
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.
Poor
Thanks to my resourcefulness, I know how to handle unforeseen situations.
29%
5%
There are two themes that arise from this study which may apply to this client
population in general:
I can solve most problems if I invest the necessary effort.
12%
10%
Very Good
15%
I can remain calm when facing difficulties because I can rely on my coping…
20%
25%
40%
45%
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 ongoing care.
If I am in trouble, I can usually think of a solution.
I can usually handle whatever comes my way.
50%
Is there someone:
23%
Poor
Very Poor
Mean All Items--US Adults
Social Support
(1=low, 6=high)
29%
Fair
69%
31%
35%
12%
Good
31%
69%
30%
29%
1
2
3
4
5
6
… who is around when you are in need?
6%
… with whom you can share your joys and sorrows?
Race
Caucasian
African American
Asian / Pacific Islander
Other
Education
Less than High School
High School
Post High School Education
College
Postgraduate Degree
13%
0%
69%
13%
6%
13%
5%
10%
15%
Very Good
Good
25%
30%
35%
40%
45%
50%
Income (Annual)
Less than $25,000
$25,000 - $50,000
More than $50,000
71%
12%
18%
88%
6%
6%
a. physical aspects of well-being: waking up refreshed, feeling able to
handle difficulties
… you can count on when things go wrong?
… who cares about your feelings?
b. spiritual aspects of well-being: good quality of life, feeling that life is
interesting
… is willing to help you make decisions?
24%
29%
MHSIP Consumer Survey: Satisfacton with Mental Health Care
(lower=less satisfied, higher=more satisfied)
12%
1
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.
Marital Status
Single, Never Married
Married / Partnered
Divorced
… is a real source of comfort to you?
… you can talk to about your problems?
12%
Fair
Minimal
20%
24%
Poor
6%
24%
59%
6%
6%
… gives you the emotional help and support you need?
Quality of Life: Overall Quality of Life - WHO-5 Total Score
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
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:
… who really tries to help you?
Hispanic / Latino
These 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.
I am confident that I could deal efficiently with unexpected events.
When I am confronted with a problem, I can usually find several solutions.
0%

Discussion
I can always manage to solve difficult problems if I try hard enough.
35%
Very Poor

Mean All Items: WCC Sample
n = 17
Gender
Male
Female
20%
Physical Health: How would you rate your physical health in the last 12 months?
Sample Characteristics
Age
Under 30 years
30+ years
15%
Fair

Results
5%

Results
Self-Efficacy: General Self-Efficacy Scale
(1=low, 4=high)
Mental Health: How would you rate your mental health in the last 12 months?
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?
Methods

Results
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
2
3
4
5
6
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.
In Ten Years
For additional information, contact:
Summer Savon, MD, PhD
summer.savon@ucsf.edu
This work was supported by Westside
Community Services.