Tompkins County mental-health committee reviews incident trends, expands naloxone access and care coordination

At a May meeting of the Tompkins County Community Services Board, the county's quality‑assurance lead summarized findings from the 2024 Office of Mental Health (OMH) incident review committee and described corrective actions the county has taken to reduce client risk and improve care coordination.

The presentation, given by Jana, the county's quality assurance and improvement coordinator, said the committee reviewed 42 reportable incidents from Jan. 1 through Dec. 31, 2024, and that the committee's work focuses on identifying system failures and recommending process changes rather than assigning blame. Jana said the committee recorded fewer deaths in 2024 than in 2023, reported two fatal overdoses in 2024 compared with seven the prior year, and recorded two suicides; she also said many of the nonfatal overdose cases involved either illegal drugs or overdoses on prescription or over‑the‑counter medications.

Jana summarized corrective actions and organizational priorities that grew from incident reviews: improved screening for co‑occurring substance use disorders, expanded access to medication‑assisted treatment (MAT), broader naloxone distribution, enhanced risk assessments and safety planning, staff training and retention efforts, caseload‑management improvements, and updated policies and procedures. "We really do try to emphasize that when clinicians are presenting their case, that we're not here to blame them," Jana said. "It's more looking for where the process is breaking down so that in the future clients can get the support they need when they need it."

On substance use and MAT, Jana said the county aims to screen clients for substance use by their second intake appointment and has improved assessment rates since 2023. She cautioned that electronic health record data are incomplete: the county's ePrescribe data capture is poor and Jana estimated the system records are undercounting actual MAT usage. From the available ePrescribe records, she said 28 clients were documented as receiving MAT for opioid use but noted this is likely an underestimate. She credited an on‑site pharmacy, identified in presentations as Genoa Pharmacy, for supporting initiation of MAT, language access and prior‑authorization assistance.

Jana also described the county's naloxone (Narcan) distribution program. The county participates in OMH's Opioid Overdose Prevention Program and began storing naloxone kits on clinic floors rather than only in medical rooms, so clinicians and members of the public can access kits without requesting a nurse. "We updated our policy also to offer them to the public, not just to clients," Jana said. She reported the clinic distributed 244 naloxone kits in 2024 (providing 488 doses) and said the kits are available in lobby areas and listed on the clinic website; trainings are offered but not required for community members who simply want a kit.

The presentation stressed improved internal and external coordination of care. Internally, the county added peer specialists and community health workers, instituted an interdepartmental referral committee to reduce dropped referrals, introduced annual appointments to update risk assessments for long‑term clients, and began providing clinicians with monthly caseload data and weekly high‑risk lists. Externally, the county has worked with local hospitals to get discharge summaries more reliably, created protocols for long‑acting injectable medication boosters after hospital stays, and is participating in OMH/Department of Health guidance to improve transitions from hospital to community services. Jana flagged a technical problem with hospital EMR integration: the county still needs HL7 connections to restore automated lab and referral exchanges and currently relies on fax for some information.

Board members pressed for additional demographic detail on suicide attempts and other incidents; Jana said the committee can supply more disaggregated data but must balance that against HIPAA and confidentiality rules for small numbers. Mary Roberts, who identified herself as a Community Services Board member and chair of the Mental Health Subcommittee, and Larry Roberts, who presented the subcommittee's update later in the meeting, both emphasized the importance of continued oversight of hospital discharge processes and community supports.

The meeting also covered systemwide planning that affects implementation. Harmony Carmody, deputy commissioner, and board members discussed recent state and federal developments: proposals to revise involuntary‑treatment transport language, concerns about federal funding cuts to behavioral‑health programs, and OMH solicitations for mobile crisis services. Board members were told Tompkins County has applied to be a designated mobile crisis provider and that a local withdrawal/stabilization contractor (Kiva Addiction Recovery Services) has finalized its contract and is preparing to reopen services. The county is planning an intensive crisis stabilization center that would provide voluntary walk‑in stabilization and immediate medical care when indicated; that project requires OMH and OASAS licensure and some facility renovation.

Workforce and retention initiatives were highlighted as necessary to sustain services: the county offers HRSA and National Health Service Corps loan‑repayment participation (Jana said 14 staff participate), recently added clinical positions and peer specialists, and used a temporary hiring waiver to reduce civil‑service barriers. Jana also noted training in suicide prevention (safeTALK), counseling and liaison models (CALM), and completion of National CLAS Standards training for staff.

Board members discussed assisted outpatient treatment (AOT) care management for non‑Medicaid individuals and the need for an RFP to ensure a provider is available when court‑ordered services are required; Harmony said the state permitted the county to use funds for non‑Medicaid AOT care management in at least one recent case. The board also discussed ongoing work on a local services plan, school‑based and satellite clinic expansions, and a college partnership that places occupational and speech therapy students with clients who have traumatic brain injury.

Formal board actions at the meeting were limited: the board approved the minutes from the prior meeting and later voted to enter an executive session. No board vote on programmatic items was recorded in the meeting transcript.

The county's presentation and discussion described near‑term, operational changes (naloxone availability on clinic floors, peer specialist expansion, updated policies) that are already in place and longer‑term initiatives (intensive crisis stabilization center, mobile crisis designation, AOT RFPs) that remain contingent on state licensure, RFP processes and funding decisions.

If board members want the committee to provide more detail, Jana offered to supply demographic breakdowns where HIPAA allows and to circulate the meeting PowerPoint to members who requested it.