Calmer, Quieter MH Urgent Care Clinic Offers Alternative to ED for Patients in Need

Open 24 hours a day, seven days a week, MHUCC has treatedn more than 22,000 individuals and their families since opening in 2017. “We’ll see anyone who walks through our doors,” said Rachel Robitz, M.D., the clinic’s medical director, who is board certified in psychiatry and family medicine. MHUCC sees patients regardless of type of insurance (or lack thereof), county of residence, documentation status, or age.

In many ways, the clinic is the opposite of sterile, chaotic emergency departments where alarms are blaring, long wait times for behavioral health crises are the norm, and physicians are the center of the care team. With its open floor plan and comfy couches, the clinic strives to look more like a homey living room; quiet movies are playing, and the children’s waiting room has toys.

“I oftentimes get feedback from clients about how calm and quiet it is here,” Robitz said. “We really work to be welcoming to the diverse group of patients we see, and that includes making sure we use trauma-informed approaches, focus on harm reduction, and [display] cultural humility.

“Being gender affirming is also important to us,” she said. “We see patients of diverse genders and sexual orientations.”

The staff receives ongoing coaching and reinforcement on providing services judgment-free and using recovery-oriented language.

The clinic sees patients strictly on a walk-in, voluntary basis. A patient’s visit to MHUCC starts with sitting down with a trained peer support specialist—someone with lived experience who is further along in their mental health treatment journey. “Sometimes people just need someone to talk to [about their mental health struggles],” Iffat said.

MHUCC uses a multidisciplinary care model, with psychiatrists, peers, nurses, social workers, and others working in tandem. Patients’ acuity dictates the care they receive. “We are all working together, and we all have our part to play to meet the clients’ needs,” Robitz said.

Colleagues are often surprised to hear that only about half of patients are seen by a psychiatrist, nurse practitioner, or physician’s assistant. What’s more, only about one in 10 is referred for psychiatric hospitalization.

Unlike mental health crisis stabilization units, MHUCC has no beds, so patients cannot stay overnight, Iffat said. She explained that aftercare arrangements—linkage and referrals to ongoing services to help patients manage psychosocial stressors—are a key part of what is provided. From intake to discharge, visits average just 2.5 hours.

Robitz said that patients in Sacramento wait an average of three months to land an appointment with a county outpatient psychiatrist, so MHUCC provides an important bridge to care. She frequently sees transient residents, such as college students or other newcomers, who have no local provider. Often, they need a refill for their prescription psychiatric medication.

The clinic does have structure, rules, and policies to prevent abuses of the system, Robitz added; this includes limits on the number of times refills are provided, to encourage patients to find and keep appointments with a regular clinician. The staff also avoids prescribing medication for patients who are already working with a psychiatrist.

In most cases, the clinic can verify patients’ medications and dosages using electronic medical records or by calling patients’ pharmacies. In fact, the sole medications the clinic keeps onsite are long-acting injectable antipsychotics. (Narcan and fentanyl test strips are also distributed to opioid users for them to use offsite.)

Law enforcement officers often drop off patients in need of mental health help; area schools, primary care providers, crisis navigators, and local emergency rooms funnel patients to MHUCC as well. The clinic’s location next door to the county inpatient psychiatric hospital may be one key to its success. “Patients who need to be hospitalized can be walked through a door, and hopefully avoid going through the emergency room,” Robitz said. In addition, UC Davis Medical Center is across the street for those with immediate medical needs.

Robitz said the clinic sometimes sees patients in its attached courtyard who feel too anxious or paranoid to enter the facility. However, MHUCC is not set up to treat those with violent behavior or agitation, such as children with severe behavioral disturbances, since staff cannot physically hold or medicate people.

The clinic was initially funded in part by California’s Mental Health Services Act, which is sourced by a 1% tax on personal income in excess of $1 million per year. To receive funding, services must be wellness- and recovery-oriented and put clients in the driver’s seat of their own care. They must also be innovative, culturally competent, and promote meaningful inclusion of diverse, underrepresented members of the community. The MHUCC checks all the boxes. Now the clinic typically bills Medi-Cal or private insurance for its services.

As for the family who was fleeing violence, the mother soon called back to thank the staff. “She was so happy with the services she received,” Iffat said. “We feel very proud to have been a part of their recovery.” ■