Transcript House Human Services Committee Mental Health and Substance Abuse Services May 24, 2006

House Human Services Committee
Mental Health and Substance Abuse
Services
May 24, 2006
Public Mental Health System in Texas
• DSHS mental health services are only part
of the public mental health system in Texas.
• Law enforcement, education, Medicaid,
CHIP, the criminal justice system, hospitals
and other entities all play major roles in
treating Texans with mental illnesses.
House Human Services Committee  DSHS Mental Health and Substance Abuse Services Overview  May 24, 2006
2
Behavioral Health Issues Impact
Other Systems
• 75% of children placed in foster care have parents with
behavioral health problems: DFPS, DSHS, DARS
• 75% of kids in the juvenile justice system have behavioral
health problems: TJPC, TYC, TDCJ, DSHS
• 30% of kids in the juvenile justice system will end up in
the adult justice system: TJPC, TYC, TDCJ, DSHS
• 46% of all ER visits have behavioral health issues as a
basic or contributing factor: DADS, TWC, DSHS
• 30% of all truancy is related to behavioral health problems:
TEA, TWC, TJPC, TYC, DSHS
House Human Services Committee  DSHS Mental Health and Substance Abuse Services Overview  May 24, 2006
3
Mental Health as a Public Health
Crisis
35,000
30,000
25,000
20,000
15,000
10,000
5,000
0
HIV/AIDS
Homicide
Suicide
Comparative mortality statistics, 2001
Source: Centers for Disease Control and Prevention
House Human Services Committee  DSHS Mental Health and Substance Abuse Services Overview  May 24, 2006
4
Mental Illness Strikes More Americans
Each Year Than Other Serious Illnesses
30
% Adults
25
20
15
10
5
0
Mental
Illness
Serious
Mental
Illness
CVD
Diabetes
Cancer
Asthma
CDC BRFSS, SEER Cancer Statistics Review, 1975-2002, “Prevalence, Severity, and Comorbidity of 12-Month DSM-IV
Disorders” Arch Gen Psychiatry. Vol. 62, June 2005
House Human Services Committee  DSHS Mental Health and Substance Abuse Services Overview  May 24, 2006
5
DSHS Mental Health and Substance
Abuse Services
• Community-based services
– 39 Local Mental Health Authorities
– Dallas Area NorthSTAR Authority
– 180 Substance Abuse contracts
• 10 State Hospitals
House Human Services Committee  DSHS Mental Health and Substance Abuse Services Overview  May 24, 2006
6
Funding Mechanisms
• Community Mental Health and Substance
Abuse payment mechanisms:
– Substance Abuse Treatment: Fee-for-service
– Substance Abuse Prevention: Cost
reimbursement
– Community Mental Health Centers:
Prepayment for services
House Human Services Committee  DSHS Mental Health and Substance Abuse Services Overview  May 24, 2006
7
Funding Equity for MH Services
• The 2006-07 General Appropriations Act (Article II, Special
Provisions, Sec. 29) requires the Department of State Health Services
to implement a long term plan to achieve equity in state funding
allocations among local mental health authorities.
• The plan will be implemented from fiscal years 2006-2013. The goal
of the plan is to achieve equity to the greatest extent possible by fiscal
year 2013.
• Any funding reductions to a local authority for the purpose of
achieving equity may not exceed 5 percent of allocated general
revenue in a fiscal year.
• The plan also ensures that improving funding equity is a priority in
distributing any new state or federal funds that may become available
for allocation to community centers.
• Progress to date: 5 percent estimated to be achieved by end of FY06.
House Human Services Committee  DSHS Mental Health and Substance Abuse Services Overview  May 24, 2006
8
Community Mental Health Services
• Community mental health centers are locallygoverned components of the Department of State
Health Services (DSHS) service delivery system.
• DSHS delegates to a community mental health
center the responsibilities of a local mental health
authority which ensures the provision and
continuity of services for individuals with mental
illness, efficient use of resources, consumer
satisfaction, and accountability.
House Human Services Committee  DSHS Mental Health and Substance Abuse Services Overview  May 24, 2006
9
Contract Management
• Performance contracts between DSHS and the Local
Mental Health Authorities include important general
provisions denoting the terms of the contract.
• Attachments to the contracts stipulate the services targets,
performance measures, outcomes, and remedies, sanctions,
and penalties that may result from failing to fulfill contract
expectations.
• Provisions include expectations of low administrative
overhead, utilization management completion rates, and
measures related to appropriateness of services delivered
and percentage of clients receiving the minimum number
of Resiliency and Disease Management service package
hours.
• Penalties/recoupment for the Second Quarter of Fiscal Year
2006 totaled $163,858.
House Human Services Committee  DSHS Mental Health and Substance Abuse Services Overview  May 24, 2006
10
HB 2292 Mental Health Service
Requirements
• Integration of Physical Health and
Behavioral Health
• Priority Population Redefined
• Resiliency and Disease Management
• Jail Diversion
House Human Services Committee  DSHS Mental Health and Substance Abuse Services Overview  May 24, 2006
11
Resiliency and Disease Management
(RDM)
• Evidence-based
• Intended to better match services to Mental Health
consumers’ needs, and to use limited resources most
effectively by providing the right service to the right
person in the right amount to have the best outcomes.
• Includes medication management, case management, skills
training, family training, supports and partners,
psychosocial rehabilitation, individual and group
counseling, supported employment, supported housing,
and Assertive Community Treatment (ACT)
House Human Services Committee  DSHS Mental Health and Substance Abuse Services Overview  May 24, 2006
12
RDM Key Components
• Uniform Assessment
• Standard Service Packages
• Utilization Management
• Data Analysis and Performance Evaluation
House Human Services Committee  DSHS Mental Health and Substance Abuse Services Overview  May 24, 2006
13
Numbers Served in Community
Mental Health Services in FY2005
120,000
105,131
100,000
80,000
60,000
40,000
20,000
26,213
19,902
0
Front-Door Crisis
Services
Adult RDM Service
Packages
Child RDM Service
Packages
House Human Services Committee  DSHS Mental Health and Substance Abuse Services Overview  May 24, 2006
14
Percent of Clients Receiving Minimum Number of Service
Hours Shows 50 Percent Improvement from When RDM
Implemented Statewide in Quarter 1 FY2005
100%
84%
73%
80%
62%
55%
60%
42%
40%
34%
20%
0%
Quarter 1
FY2005
Quarter 2
FY2005
Quarter 3
FY2005
Quarter 4
FY2005
Quarter 1
FY2006
House Human Services Committee  DSHS Mental Health and Substance Abuse Services Overview  May 24, 2006
Quarter 2
FY2006
15
Community MH Service Outcomes
Average monthly number of adults receiving community
mental health services
120,000
100,000
80,000
64,828
68,659
73,357
73,758
73,731
75,004
FY2005
Quarter 3
FY2005
Quarter 4
FY2006
Quarter 1
FY2006
Quarter 2
60,000
40,000
20,000
0
FY2005
Quarter 1
FY2005
Quarter 2
House Human Services Committee  DSHS Mental Health and Substance Abuse Services Overview  May 24, 2006
16
Individuals with Criminal Justice Involvement Experienced Positive
Clinical Outcomes at DSHS Community Mental Health Centers, All
of which Implemented Jail Diversion during FY2005
96%
AVOIDED CRISIS
IMPROVED/STABILIZED RISK OF
HARM
85%
IMPROVED/STABILIZED
FUNCTIONING
80%
IMPROVED/STABILIZED
EMPLOYMENT
81%
IMPROVED/STABILIZED
HOUSING
78%
IMPROVED/STABILIZED COOCCURRING SUBSTANCE USE
90%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Percent Who Experienced Positive Outcome
House Human Services Committee  DSHS Mental Health and Substance Abuse Services Overview  May 24, 2006
17
FY2005 Texas Monthly Hospital Emergency Room (ER)
Costs 31 Percent Lower for Medicaid Clients with Mental
Illness or Substance Abuse Receiving DSHS Behavioral
Health Treatment
$115
ER Costs
per Medicaid
Client
per Month
Untreated
$115
ER COST OFFSET
- $36
Average per Client per Month
31%
REDUCTION
Treated
$79
$0
Source: Prepared by Research Team, Strategic Decision Support, HHSC, 3/23/2006. Average of ER costs per month for Medicaid clients not
receiving needed DSHS Mental Health and Substance Abuse services (Untreated) vs. average of ER costs per month for Medicaid clients
receiving needed DSHS Mental Health and Substance Abuse services (Treated).
House Human Services Committee  DSHS Mental Health and Substance Abuse Services Overview  May 24, 2006
18
Innovative Local Treatment Models
• Crisis Stabilization
– Tri-County MHMR (Montgomery, Liberty and
Walker Counties)
• Jail Diversion
– Center for Health Care Services (Bexar
County)
– MHMRA of Harris County
House Human Services Committee  DSHS Mental Health and Substance Abuse Services Overview  May 24, 2006
19
Community Substance Abuse Services
• Prevention – Primarily school-based
• Intervention – OSAR; HIV; PPI
• Treatment:
– Adults
– Specialized Female Programs
– Women with children
– Youth
– Pharmacotherapy
– COPSD
House Human Services Committee  DSHS Mental Health and Substance Abuse Services Overview  May 24, 2006
20
Numbers Served in Substance Abuse
Prevention and Intervention Services in
FY2005
119,920
46,186
331,016
989,569
Youth Prevention
Youth Intervention
Adult Prevention
Adult Intervention
House Human Services Committee  DSHS Mental Health and Substance Abuse Services Overview  May 24, 2006
21
53,420 People Accessed Substance
Abuse Treatment in FY2005
7,360
8,887
23,144
32,800
Youth
Male
Female
Priority Female
House Human Services Committee  DSHS Mental Health and Substance Abuse Services Overview  May 24, 2006
22
Access to Recovery (ATR)
• Access to Recovery supports clients by providing needed
treatment or recovery support services to successfully
complete their drug court program
• Drug courts offer a cost-effective alternative to
incarceration by providing community-based treatment as
a condition of probation
• Cost effectiveness of the ATR drug court program in Texas
is reflected by preliminary data, which indicates that
participating ATR clients are experiencing the following
successful outcomes:
–
–
–
–
–
92% Abstinent
59% Employed or in School
91% No Further Arrests
99% Not Homeless
87% Socially Connected
House Human Services Committee  DSHS Mental Health and Substance Abuse Services Overview  May 24, 2006
23
State Mental Health Hospitals
• 10 Mental Health facilities provide inpatient
hospitalization for persons with severe mental
illness who need intensive treatment
• North Texas State Hospital—Vernon campus,
serves as the statewide maximum-security unit
• The Waco Center for Youth is the only stateoperated residential treatment facility in Texas for
youths
• All facilities are JCAHO Accredited
House Human Services Committee  DSHS Mental Health and Substance Abuse Services Overview  May 24, 2006
24
State Mental Health Hospital Capacity
Beds - By Psychiatric Facility Type
State
Hospitals
2,260
Non Profit
408
For Profit
FoForr Profit
1,526
House Human Services Committee  DSHS Mental Health and Substance Abuse Services Overview  May 24, 2006
25
Cost of In-patient Mental Health
Services
Medicare Costs Per Patient Day
By Psychiatric Hospital Type
State-MH
Non-Profit
For-Profit
Psychiatric
Units
Acute *
$0
$500
$1,000
$1,500
$2,000
* Category represents patients hospitalized in an
acute hospital without a psychiatric unit.
House Human Services Committee  DSHS Mental Health and Substance Abuse Services Overview  May 24, 2006
26
Population Growth Compared
to Funded State Hospital Beds
Funding for State Mental Hospital Beds has declined while the Texas
population has grown
30
25
20
15
10
5
0
State Hospital Beds
Est. Pop. In Millions
.
40
35
25.0
20.0
15.0
10.0
5.0
FY '92
FY ' 98
FY '05
3,560
17.7
2,774
19.8
2,268
22.5
House Human Services Committee  DSHS Mental Health and Substance Abuse Services Overview  May 24, 2006
0.0
27
Growth in Forensic Patients
Total Forensic Patients as a percent in Texas Mental Health Facilities
30%
25%
20%
15%
10%
5%
0%
% Forensic
Patients
2001
2002
2003
2004
2005
16%
21%
23%
26%
27%
House Human Services Committee  DSHS Mental Health and Substance Abuse Services Overview  May 24, 2006
28
State Mental Health Hospital Daily
Census for FY2005
2,500
2,400
2,300
2,200
2,100
Sep
Oct
Nov
Dec
Jan
Actual
Feb
Mar
Funded
Apr
May
Jun
Jul
Aug
Average
House Human Services Committee  DSHS Mental Health and Substance Abuse Services Overview  May 24, 2006
29
State Mental Health Hospital Capacity
• In February 2006, the LBB approved $13.4 million in
additional expenditures for state mental health hospital
capacity.
• As a result, statewide hospital system capacity was
increased by 96 forensic commitment beds and 144 civil
commitment beds.
• This increase in state hospital capacity has greatly
enhanced our ability to meet the needs of local
communities.
• We continue to plan for long-term, community-based
solutions to address the hospital capacity issue.
House Human Services Committee  DSHS Mental Health and Substance Abuse Services Overview  May 24, 2006
30
Crisis Services Redesign
• One goal of DSHS mental health services is to help consumers avoid
mental health crises. However, the reality is that crises do occur.
• February 2006, DSHS established the Crisis Services Redesign
Committee to develop recommendations for a comprehensive array of
crisis services.
• Members of the committee include medical experts, citizen stakeholder
groups, law enforcement representatives, county probate court judge
representation, and county representatives, as well as individuals from
professional organizations and provider groups.
• A redesign of crisis services will build on the service improvements
made by the evidence-based Resiliency and Disease Management
program.
• A thorough review of the current crisis system was conducted,
including holding public hearings around the state.
House Human Services Committee  DSHS Mental Health and Substance Abuse Services Overview  May 24, 2006
31
Crisis Services Redesign (cont.)
• The committee plans to finalize its recommendations in June for an
evidenced-based crisis services model that will increase access to
appropriate and cost-effective services.
• Initial conclusions for recommended services include:
– 24-hour crisis hotline
– Mobile crisis outreach
– 23-hour hold capacity
– On-call psychiatric services
– Crisis residential services
– Respite
– In-home crisis services
• The committee will also put forth recommendations regarding DSHS
staff support, coordination and training to local professionals (e.g., law
enforcement crisis intervention training).
House Human Services Committee  DSHS Mental Health and Substance Abuse Services Overview  May 24, 2006
32
Mental Health Service Delivery
Models in Other States
• Ohio & California: County-based service system
with county taxing authority
• Arizona: Regional behavioral health authorities;
managed care system
• New Mexico: Single purchasing model
• Pennsylvania: County-based, capitated managed
care model
• Illinois & New York: Direct state contracts with
provider network
House Human Services Committee  DSHS Mental Health and Substance Abuse Services Overview  May 24, 2006
33
Mental Health Transformation
• Overarching goal is to improve the mental health of all
Texans and meet the President’s New Freedom
Commission goals
• New Freedom Commission Goals are shared by those
participating on the Transformation Working Group:
– The Governor’s Office; Department of State Health
Services; Texas Health and Human Services
Commission; Department of Family and Protective
Services; Criminal Justice Department; Juvenile
Probation Commission; Texas Youth Commission;
Consumers; Family Members; Texas Education
Agency; Aging and Disability Services; Workforce
Commission; Veteran’s Administration; etc.
House Human Services Committee  DSHS Mental Health and Substance Abuse Services Overview  May 24, 2006
34
Mental Health Transformation
• The grant funding is seen as a catalyst to jump start some
of the efforts of framing the public health approach. The 2
primary areas of focus:
– Developing and supporting local behavioral health
collaboratives
– Using cutting edge technology to change work processes across
agencies
• Improvement of the system will be targeted to the
following principles:
–
–
–
–
Apply evidence to health care delivery
Use information technology
Align payment policies with quality improvement
Prepare the workforce
House Human Services Committee  DSHS Mental Health and Substance Abuse Services Overview  May 24, 2006
35