Getting services to those needing them is focus for county behavioral health director

As clinical director of San Diego County Behavioral Health Services, Michael Krelstein, M.D., often finds himself frustrated and challenged. But he also finds rewards in coming to the aid of people desperately in need of good help.

The Carmel Valley resident shared his knowledge as a clinical and administrative psychiatrist at a Jan. 21 panel titled “Putting the Puzzle Together: Mental Health Policy and Community Options.” Presented by the Behavioral Health Committee of Jewish Family Services of San Diego, the panel also featured Jim Fix, Psy.D., executive director of the Psychiatric Emergency Response Team (PERT), and Jeff G. Elias, an attorney and consultant in criminal and mental health law.

In an interview before the program, Krelstein said it would be a chance to “have a real discussion about the opportunities and challenges” in the mental health care system.

While it is the “bad outcomes that make the news,” he said the emphasis should be on what is being done to gain the upper hand and identify who the stakeholders are.

Acknowledging that the system may have failed those who make the news by allowing them to fall through the cracks, he focused on the challenge of developing resources statewide for those who are struggling.

At every level, there are policies that need to be examined, and we need to figure out how to mobilize the resources for those most in need, said Krelstein, who previously served as medical director at San Diego County Psychiatric Hospital. Before coming to San Diego nine years ago, he worked at a mental health center in Las Vegas and was an assistant clinical professor at the University of Nevada School of Medicine. He has also been a consultant for the Las Vegas Metro Police Department and the California Medical Board.

Krelstein’s father was a psychiatrist in Davis, where he grew up, and in the Bay area.

“One thing led to another,” he said, explaining that his college biology major at UC Davis included an emphasis on neuroscience.

With his growing interest in the brain, he spent an extra year in an honors program, publishing his first research paper. Then it was on to UC Irvine for medical school.

“I tried to experience everything, but I wanted to pursue the brain,” he said, so he focused on psychiatry and psychology. “It’s kind of in my blood.”

His interests led him to work in community mental health, with jail populations and the mentally ill. He has lectured on the medical-legal issues of violence and mental illness, sexually violent predators, workplace violence and malpractice.

In his line of work, clients frequently include the uninsured, the indigent and the homeless. Mental illness, he noted, leads to a higher possibility of becoming homeless.

“These are people who are individually disenfranchised and struggle with access to care,” said Krelstein. “There are social deterrents to seeking care, from challenging backgrounds to economic and developmental and mental challenges.”

The county’s Behavioral Health Services department “provides direct and indirect service to over 70,000 adults and youth with a host of mental health and substance abuse conditions,” he said via email. “Our approach is a rich public-private collaborative, guided by community stakeholder input, with access to the County’s educational and academic centers.”

Getting people to seek care often means overcoming the challenges of the perceived stigma and denial that you need help, he said.

“In our darkest moments, we feel all is lost, but there is always hope for recovery and stabilization. … It is a very personal, intimate decision on how to interface with the system.”

For people faced with a decision to seek care, he said, there are “many good providers working desperately hard to connect people with care.”

From primary care providers, to educators and faith-based resources, the broader the reach, the more hope for success.

One of the keys to care is honesty.

“The greatest empowerment is working with each other, broadening and including others,” he said.

In his own life, Krelstein stays centered by spending time with his wife and family. He also gets out on the trails and beaches around San Diego to hike whenever he can.

He enjoys reading and movies, and while you’d think choosing entertainment with a focus on mental illness might not be much of a break for him, his constant search for knowledge often sends him down that path.

Among his favorites are nonfiction works like “An Unquiet Mind” by Kay Jamison and “The Man Who Mistook His Wife for a Hat” by Oliver Sacks. Fiction favorites include “I Never Promised You a Rose Garden” by Hannah Green, and “Ordinary People” by Judith Guest.

At the top of his topical movie list are “A Beautiful Mind,” “The Silver Lining Playbook” and “Shutter Island,” which he said is “not very realistic — but a great suspense film.”