Transcript State Mental Health Authority

Department of Mental Health
Commonwealth of Massachusetts
Elizabeth Childs, MD
Commissioner
Our Vision
Mental health is an essential part of health care.
The Massachusetts Department of Mental
Health, as the State Mental Health Authority,
promotes mental health through early
intervention, treatment, education, policy and
regulation so that all residents of the
Commonwealth may live full and productive
lives.
Mission Statement
The Department of Mental Health, as the State Mental
Health Authority, assures and provides access to services
and supports to meet the mental health needs of
individuals of all ages, enabling them to live, work and
participate in their communities. The Department
establishes standards to ensure effective and culturally
competent care to promote recovery. The Department sets
policy, promotes self-determination, protects human rights
and supports mental health training and research. This
critical mission is accomplished by working in partnership
with other state agencies, individuals, families, providers
and communities.
Principles
•
•
•
•
Excellence: Pursuing quality, adopting
Excellence
evidence based treatment practices and
operating in a continuous quality
improvement framework to produce
accountable outcomes
Innovation/Creativity: Adopting
promising treatment practices that
Value
promote recovery and implementing best
of breed administrative practices to
support system operations
Efficiency: Ensuring cost effective, local Innovation/
Efficiency
Creativity
services and supports that maximize
outcomes.
The SMHA Value Proposition
Value: Promoting effective care that has
high value to consumers, citizens and our
communities. Value is the product of
Ensure high value treatment and supports to
excellence, efficiency and innovation.
people with mental illnesses to empower
personal growth and to promote an optimal and
productive life in the community.
National Context: New Freedom Commission
In a Transformed Mental Health System:
– Americans understand that mental health is essential to overall health
– Mental health care is consumer and family driven and recovery
oriented
– Disparities in mental health services are eliminated
– Early mental health screening, assessment, and referral to services are
common practice
– Excellent mental health care is delivered and research is accelerated
– Technology is used to access mental health care and information
Citation: President’s New Freedom Commission
New Change ~ New Governance
EOHHS Reorganization
Leadership defined the focus of reorganization around coordinating
services and programs while streamlining core administrative
Through April 30
April 1- June 30
processes.
• Incorporate
Broader
EOHHS
• Leadership
agencies:
and A common
health and
human services
• Phaseenterprise.
III: Incorporate
DMH and MHBH Staff
Senior Management
Other Agencies,
Participation
into
Develop Strategic
Advocates
Three
new offices established:
Children, Youth andConsumers,
Families; Health
Plan Specifications
Framework
Community
Services; Disabilities and
Services.and
DMH
is part of Leaders
the
andCommunity
Implementation
Health Services cluster along
with the Department of Public Health.
Strategies
Mental Health emerged as a critical lynchpin service provider that
cuts across all EOHHS offices in a fundamental way.
DMH Mandate
MGL, Chapter 19, Section 1:
“The Department shall take cognizance of all
matters affecting the mental health of the
citizens of the Commonwealth.”
DMH Overarching Principles
1. All services are consumer-centered and family-driven.
2. Resiliency and recovery are the ultimate goals for all services
and supports.
3. Quality improvement principles must be embedded in
everything we do.
4. Services should be local.
5. We must add value to our local communities.
6. Effective behavioral health services are critical to the success
of many other state agencies and we must actively partner
with these organizations to achieve our common mission.
What We Do
•
The Secretary of Health and Human Services has charged the DMH
Commissioner with responsibility for coordinating mental health
service issues across the EOHHS agencies, with particular
attention to children and adolescents, and the homeless. Focusing
on community care services, DMH
•
provides supportive clinical and rehabilitative services for adults with serious
mental illness and children and adolescents with serious mental illness or
serious emotional disturbance
•
integrates public and private resources for optimal community-based care
opportunities
•
has oversight of the Behavioral Medicaid programs, including acute
inpatient psychiatric services, emergency services, and other behavioral
medicine services and programs
What We Do
The Department of Mental Health provides an array of
services from adult extended stay inpatient services and
latency age and adolescent inpatient and intensive
residential treatment facilities to a community-based
services continuum.
Employment
Housing
Clubhouses
DD
Trtmnt
Inpatient
DMH
PACT
Residential
options
Case
Mgmt.
Flexible
Supports
Key Statistics
 DMH directly serves 26,000 individuals, including about 3,500 children
and adolescents.
 With the integration of DMH and MassHealth Behavioral Health
Programs, DMH has programmatic supervision of behavioral health
services for 900,000 residents of the Commonwealth.
 Of the adult DMH clients, 78 percent receive Medicaid, 24 percent receive
Medicare and 12 percent are uninsured.
Uninsured
Medicaid
Key Statistics
 DMH operates 3 psychiatric hospitals, 8 community mental health centers, one
contracted unit, and psychiatric units in two DPH operated hospitals with a total
inpatient capacity of 996 adult beds and 48 adolescent continuing care beds.
 In FY2004, approximately 14,700 individuals, including children and adolescents,
received statutory evaluations and/or other forensic services from DMH through
the adult and juvenile court system.
 In FY2004, the DMH Forensic Transition Team planned the release and monitored
the transition of 503 inmates with serious mental illness from incarceration to
community mental health services.
 Since the early 1990s, DMH, working alone or with a formal partner or agent, has
developed housing opportunities for more than 5,600 of our clients who previously
lived in substandard housing or were homeless.
Initiative #1
Unified Behavioral Health System
The Commonwealth is realizing the vision of a unified public
behavioral health system since the Department of Mental Health
and its Commissioner has been delegated oversight by the EOHHS
Secretary of the MassHealth Behavioral Health Unit and its
function.
Goals
•
•
•
•
•
Improve access to and quality of services
Standardize criteria for service entry, continuing care and discharge
Evidence based services
Ensure high quality clinical decision making
Provide least restrictive settings to facilitate resiliency and recovery
Unified Behavioral Health System
When fully implemented, the Unified Behavioral Health System will:
• Deliver
person and
family-centered
and treatment
that
is
DMH
has articulated
five high-level
goals for care
the Unified
Behavioral
Health
evidence-based,
and
competent
System.
Together, theserecovery-oriented,
address the challenge
of culturally
delivering adequate,
efficient,
and
care. access to the right treatment at the right time
• coordinated
Support equitable
through coordination of benefits, administration and services
across organizational entities and funding streams
•
Provide a forum where health and human service agencies will
collaborate to improve access to services for special needs populations
and for persons with conditions that are co-occurring with behavioral
disorders
•
Promote a flow of information and knowledge as the foundation for
data supported decision making on standards of care, allocation of
resources, and performance outcomes
•
Produce results that are efficient, economical, and accountable to
the citizens who use publicly funded behavioral health services and to the
taxpayers who support the system
Unified Behavioral Health System
The Unified Behavioral Health System will coordinate services and
administration across the DMH and MassHealth systems of care through
different mechanisms:
•
System Re-Design / Re-Procurement
• Regulatory Change or Waivers
• Contractual Influence
Unified Behavioral Health System
Successful design and implementation of the Unified Behavioral Health
System require active participation from multiple entities.
•
Active collaboration with MassHealth:
– The Steering Group charged with designing the Unified Behavioral Health System will include members from
the Office of Medicaid, Office f Acute and Ambulatory Care, and other areas of MassHealth.
– MHBH program staff are now physically located at DMH and are an integral part of the core Unified System
Steering Group
– MHBH and DMH staff currently collaborate both on longer-term system design plans and on current
management activities
•
Participation from other EOHHS Agencies:
– The Steering Group has established several statewide work groups (Service Planning and Design, Current
State Analysis, Administrative and Financial Strategy) that will include participation from other state agencies
– The Steering Group and statewide work groups will pursue an inter-agency approach as they explores best
practices and system needs, particularly as they relate to children and to people with disabilities
•
Active public dialogue from stakeholders:
– The Steering Committee will release frequent Requests for Information (RFI) and will hold public meetings
and focus groups with consumers, providers, advocates and other stakeholders
Initiative #2 ~ Community Expansion,
Inpatient Consolidation and a New Hospital
The Department’s Inpatient Study Report of March 2004 outlines three
basic issues: The limitations posed by two antiquated facilities;
advanced standards of care and treatment of individuals with mental
illness that have far outpaced our existing infrastructure; and the
need to expand the DMH community service system in order to
sustain client tenure in community placements.
• The Facility Feasibility Commission, established by section 364 of Chapter 149
of the Acts of 2004, is assessing the feasibility of building a state-of-the-art
DMH psychiatric hospital in Central Massachusetts. The foundation of the
Commission’s work is the imperative to provide community placements for
those individuals in state hospitals who are entitled to live in less restrictive
settings.
Community Expansion, Inpatient
Consolidation and a New Hospital
•
A major feature of the plan is a reduction of DMH’s statewide adult
continuing care bed capacity from 900 to 740, including a reduction of the
combined bed capacity of Worcester and Westborough State Hospitals from
354 beds to 260 and the consolidation of that capacity in a new state-ofthe-art inpatient psychiatric facility.
•
The Department enjoys a history of success in this arena. DMH closed
Medfield State Hospital in 2003 and used the resulting savings to
successfully place 255 clients from across the state in community settings,
including 59 former patients from Medfield.
•
Develop new community placements to serve 268 current DMH hospital
residents
– Completed: 104 individuals placed into the community as of 03/09/05
– Planned: 164 continuing care patients placed by 12/31/05
Initiative #3
Comprehensive Quality Improvement Plan
Goal
Develop a customer-informed, data-driven
infrastructure to continuously improve
behavioral health services in the
Commonwealth
Quality
Program
Management
People
Strategies
Technology Processes
• Use reliable, transparent and
accessible data
• Quality will be defined by the needs
of individuals, families and
communities
• Commitment to evidence-based
practices and the sharing of best
practices
• Commitment to innovation and
creativity
Business
Management
Information
Technology
Quality
Management
Comprehensive Quality Improvement Plan
The meaning of the word “quality” is changing
Service Excellence
Best in Class
Service
Quality
ell
en
ce
Institutionalized Continuous Improvement
Stakeholders
Outcomes
Formal, Documented Quality System
Se
rv
ice
Ex
c
Planned Continuous Improvement
Basic Quality System
Programs and
Services
Leadership
Managed Chaos
Operations
Voice of the Customer
There is momentum in the field to incorporate clinical outcomes with a
broader emphasis on service excellence, increasing value and
reducing waste.
Restraint and Seclusion Reduction:
A CQI Initiative
DMH is committed to eliminating the use of restraint or seclusion in
its facilities and programs. This goal is consistent with a mental
health system that treats people with dignity, respect and
mutuality, protects their rights, provides the best care possible,
and assists them in their recovery.
•
A recent grant award will support DMH efforts to coordinate a statewide R/S
reduction, bolster current efforts, accelerating an already aggressive
program.
•
Evaluate the process and outcomes and consumer roles in a three-year
project.
•
Project will significantly improve mental health services in the 11 DMH
facilities and, by example, help to improve mental health services across
Massachusetts.
Suicide Prevention: A CQI Initiative
DMH collaborates with the Department of Public Health, and is
active in statewide suicide prevention efforts through the
Massachusetts Coalition for Suicide Prevention and the
Statewide Strategic Plan for Suicide Prevention. Three priority
goals of this effort are:
 Build broad support for suicide prevention
 Reduce stigma associated with mental illness
 Trainings to recognize suicidal behavior and risks
DMH Commissioner Elizabeth Childs, M.D., co-chaired the EOHHS Suicide
Prevention Task Force
DMH co-sponsors the annual statewide Suicide Prevention Conference in
May
Our Anti-Stigma Work
The President’s New Freedom Commission identifies stigma as the main barrier
to treatment. Mental illness is a public health problem that requires a public
health approach. Historically, the Department of Mental Health has been in the
forefront of efforts to increase awareness about mental illness and educate the
public that mental illnesses, like cancer and diabetes, are treatable and that
people can recover and live productively in their communities.
In 1997, DMH, along with its advocacy partner, the Massachusetts Association for
Mental Health (MAMH), launched the Changing Minds Campaign ― a
pioneering effort in Massachusetts to remove the stigma of mental illness, the
major barrier to treatment. Our latest anti-stigma work involves a federal mental
illness awareness project called the Elimination of Barriers Initiative (EBI) and
a SAMHSA National Anti-Stigma Campaign.