Transcript Division of Mental Health, Developmental Disabilities and

Re-Balancing the Service System
for People with
Mental Illness, Developmental
Disabilities and Addictive Diseases
(MHDDAD)
What is MHDDAD?
Department of Human Resources
Division of
Mental Health,
Developmental Disabilities
and Addictive Diseases
5 MHDDAD Regional Offices
7 State Hospitals
Community Providers
Georgia Department of Human Resources
Division of Mental Health, Developmental Disabilities and Addictive Diseases
State Governor
DHR Commissioner
MHDDAD Division Director
Assistant Director
Program Devel. & Operations
Assistant Director
Administrative Services
Consumer
Relations & Recovery
Child & Adolescent
Systems of Care
Office of
Addictive Diseases Serv
Forensic Services
Office of
Developmental Disabilities
Medical Director
Provider Network Mgt.
Investigations
Prevention Services
Office of
Mental Health Services
Provider Certification
Planning
Financial Support
Legal Services &
Governmental Relations
Project Specialist
Quality & Operat’l Sup’t
Continuous Quality
Improvement
Evaluation
Information Management
Information Systems
Research & Grants
Constituent and
Legislative Services
Case Expeditor
Policy & Training
Regional Operations
Hospital System
Administration
Regional Offices
Regional Hospital
Administrators
Who we serve:
Children & Adults with:
serious mental illness
developmental disabilities
addictive diseases
Funding Sources
 State funds
 Federal Block Grant funds
 Medicaid funds
 Medicare funds
 Private insurance / private pay
 County funds
 Various public and private grants
MHDDAD
Services for children & adolescents
MHDDAD
Children & Adolescents Services
Preserve families
Avoid hospitalization
Support participation in everyday life
Community Services - C&A Served
Serious Emotional Disturbances
50,000
Persons
40,000
44,696
30,000
20,000
41,004 40,064
33,076
35,199
39,918
10,000
0
FY 01
FY 02
FY 03
FY 04
FY 05
FY 06
Community Services - C&A Served
Addictive Diseases
5,000
Persons
4,000
4,300
3,000
2,998
2,000
1,000
3,121
2,496
1,605
1,986
0
FY 01
FY 02
FY 03
FY 04
FY 05
FY 06
Hospital Services - C&A Served
Serious Emotional Disturbances
3,000
Persons
2,500
2,000
1,500
2,053
2,262
2,274
2,350
FY 02
FY 03
FY 04
2,589
2,000
1,000
500
0
FY 01
FY 05
FY 06
Services for adults with
mental illness and/or addictive
diseases
Adults (MH &AD) Services
 Best Practices
 Transition from institutions
 Assure availability of medication
Community Services - Adults Served
Mental Health
125,000
Persons
100,000
75,000
104,850
84,472
90,716
FY 01
FY 02
98,902
100,822 100,402
50,000
25,000
0
FY 03
FY 04
FY 05
FY 06
Community Services - Adults Served
Addictive Diseases
50,000
Persons
40,000
30,000
39,078 39,437 37,889
34,717 36,734
40,230
20,000
10,000
0
FY 01
FY 02
FY 03
FY 04
FY 05
FY 06
Hospital Services - Adults Served
Mental Health
20,000
Persons
15,000
10,000
14,123
14,950 14,415 14,287
12,009
12,670
5,000
0
FY 01
FY 02
FY 03
FY 04
FY 05
FY 06
Services for people with
developmental disabilities
Developmental Disabilities Services
 Reduce the waiting list
 Transition from institutions
 Ensure provider availability
 Ensure community capacity
Community Services - Adults Served
Developmental Disabilities
Persons
15,000
12,670
10,000
5,000
11,907
11,548
11,391
12,103
12,293
0
FY 01
FY 02
FY 03
FY 04
FY 05
FY 06
Community Services - C&A Served
Developmental Disabilities
5,000
Persons
4,000
3,000
2,000
1,000
2,383
1,951
FY 01
FY 02
2,478
2,289
2,403
FY 03
FY 04
FY 05
2,580
0
FY 06
Consumers with DD Served in State Hospitals
Olmstead ‘99
2,059 2,004
1,947
1,685 1,640 1,637
1,543
1,423 1,402
1,305
1,201
1,064
FY96
FY97
FY98
Source: BHIS Dec.’06 HB
FY99
FY00
FY01
FY02
FY03
FY04
FY05
FY06
FY07
Note: FY07 Data is Oct. 31, ‘06
Developmental Disabilities Waiver Planning List
Persons Waiting for Waiver Services
6,441
FY 2007
6,948
FY 2006
5,263
FY 2005
4,842
FY 2004
FY 2003
FY 2002
FY 2001
FY 2000
Source: MHDDAD Dec. ’06 HB
3,281
2,781
2,541
2,820
Nov. ‘06
Forensic Services
Forensic Services
 Ensure timely movement from jails
 Ensure appropriate treatment setting
Division of MHDDAD - Forensic Services
Patients Needing Secure Beds vs. Current Secure Beds
(Vertical Line represents May 1, 2006)
900
800
Current # of Secure Beds
700
Number of patients
804
Actual / Projected Number of Consumers
600
465
500
400
300
200
100
Date
State Mental Health Administrators in the major of the states report
increasing percentages of forensic patients in state hospitals.
Source: State Profile Highlights: National Association of State Mental Health Program Directors
Research Institute, Inc. (NRI)
-09
Jan
08
Jul-
-08
Jan
07
Jul-
-07
Jan
06
Jul-
-06
Jan
05
Jul-
-05
Jan
04
Jul-
-04
Jan
03
Jul-
-03
Jan
02
Jul-
-02
Jan
01
Jul-
Jan
-01
0
Why does the system need to
be re-balanced?
Old Paradigm
• Isolation of people with mental illness, addictive diseases
and developmental disabilities in hospitals and institutions
• Use of hospitals as the preferred treatment forced people
and resources into “deep end” services
- Example: Central State Hospital housed 13,000+ people
in the 1960s. Today’s system of 7 hospitals has 2,513
beds
Old Paradigm
• Historical grant-in-aid funding to CSBs not driven by
need, demographics or outcomes
• Children not considered priority customers
• Lack of accountability for the people most in need getting
effective services
New Paradigm
• People served as close to home, family and community as
possible
• Provider competition affords greater consumer choice
• Fee for service and utilization review ensure that the right
people are getting the right services in the right amount at
the right price
• Children get their fair share of the resources
• Nobody should live in a hospital (particularly children and
people with developmental disabilities)
Hospitals are our Burning Platform
•
Public behavioral health system is the “safety net” when
private systems are exhausted
•
Increased demand for substance abuse treatment is
driving people into deep end services such as emergency
rooms and state hospitals
•
Courts are increasingly relying on state hospitals
•
Mental illness causes more disability than any other class
of medical illness in America.
Distribution of Georgia's Mental Health Expenditures Betweeen State Hospital
Inpatient Care and Community-Based Programs, 1981-2004
100%
90%
Georgia’s Mental
Health System…
…is about 8 years
behind other
states in
transitioning
resources to
community-based
services
…only since 2001
has Georgia been
spending more
resources on
community
services than
hospital services
Georgia Community
Georgia State Hospital
91%
80%
70%
60%
54%
50%
43%
40%
30%
20%
7%
10%
0%
1981
1983
1985
1987
1990
1993
1997
2001
2002
2003
2004
Distribution of U.S. Mental Health Expenditures Betweeen State Hospital
Inpatient Care and Community-Based Programs, 1981-2004
100%
90%
U.S. Community Avg.
U.S. State Hospital Avg.
80%
69%
70%
60%
63%
50%
40%
33%
28%
30%
20%
10%
0%
1981
1983
1985
1987
1990
1993
1997
2001
2002
2003
2004
Burning Platform
• Children are hospitalized at 3X the national rate
Adults are hospitalized at 3.5X the national rate
Elderly are hospitalized at 24X the national rate
• 417 people currently in state hospitals could be discharged,
but lack needed community services
• People are living in hospitals - 66% have been in the
hospital for over 1 year; 25% for 10+ years
Burning Platform
• Hospital readmission rates are twice the national rate
• Currently exceeding forensic bed capacity by 35% (164
beds). Projecting a 89% capacity shortfall by 2010 (417
beds)
• 64% of forensic consumers have had previous MHDDAD
contact = missed opportunity
• Resources of other systems are drained
- Examples: Sheriff’s Offices, DFCS, DJJ, DOE, local
emergency rooms
Burning Platform
•
2001 - Revenue Maximization projected Medicaid revenue
would replace $37.4M in state funds annually (did not
occur)
•
Medicare earnings were over-projected due to seriously
mentally ill consumers exhausting their lifetime benefit
•
Because public system is “safety net” when other resources
are exhausted, most consumers come with no insurance or
ability to pay
•
Olmstead Decision accelerated community placements
•
Escalating costs – utilities, medical treatment , staff…
Actions Taken
1)
Consistent statewide set of standards for the community:
•
Defined who will be served
•
What basic services will be available to all Georgians
•
Redistributed funding so every area gets their fair
share
Actions Taken
2)
Created a front door to service system:
• Established Single Point of Entry (1-800-715-4225)
• Funded Crisis Intervention Training for 20% frontline
law enforcement officers to divert mentally ill from jails
• Created 23 hour observation units at 4 hospitals to avoid
66% of hospital admissions
• Established crisis stabilization services for children to
avoid 60-75% of hospital admissions
• Increased adult crisis stabilization services by 30% since
FY04
Actions Taken
3)
Increased the number of people that can be served in the
community:
•
Steady increase in number of MR/DD waivers
•
Open competitive market place with fee-for-service
to increase # of providers, consumer choice and
number of people served
•
Use of Case Expeditors to safely move consumers
from hospitals to the community
•
External utilization review of hospital and
community services to ensure the right services for
the right people in the right amount
Actions To Be Taken
• Reduce the cost of pharmacy operations and medications
(estimated annual savings $1.2M)
• Operate smaller, more specialized hospitals
• Privatize specific services such as billing
• Consolidate selected hospital functions
• Potential federal funding of Money Follows the Person Grant
• Legislative proposal allowing misdemeanor defendants found
incompetent to stand trial to be evaluated and treated for
competency restoration in the community
Future Initiatives
• Consolidation of MHDDAD and DFCS child and adolescent
behavioral health systems - positioning MHDDAD to provide
treatment and DFCS to provide protection
• Consolidation of MHDDAD and Public Health substance
abuse prevention services - positioning DHR to impact
health behaviors
Future Initiatives
Restructuring Child & Adolescent Substance Abuse Services
Current System
• $4.9M funding
- 142 inpatient beds
- Length of stay 9-12
months
- 150-200 adolescents
served annually
New System
• $2.5M funding
- 32 inpatient beds
- Length of stay 3-6
months
- 120-150 children served
annually
• $2.4M funding
- Outpatient, communitybased services
- 1,350 adolescents served
annually
Future Initiatives
• Sheriff’s Tele-medicine Pilot
– technology to link Sheriff’s Offices and state
hospitals; only transport those who must be moved
• Crisis Services for children
– add mobile crisis services and funds to purchase
additional crisis beds
Future Initiatives
• Child & Adolescent Parent-to-Parent Peer Support
Program:
- links parents of emotionally disturbed children
with other parents who have successfully
navigated the service delivery system
•
Increase Medicaid waiver service slots and expand
supports to families & consumers with the new
developmental disability waiver:
– Individual Budgets
– Supports Intensity Scale
– Choice of Services
– Financial Support Services
Characteristics of the Reformed System
 Every area of the state will have:
•
•
•
A true single point of entry
Crisis stabilization for children and adults
A set of core services
 Deinstitutionalization of developmentally disabled
and long term mental health consumers
 Individualized treatment planning and utilization
management
 Maximum self-sufficiency and independence for
adults with appropriate supports