Transcript DSHS COMMUNITY MENTAL HEALTH CRISIS SERVICES IMPLEMENTATION OVERVIEW MEETING Thursday, August 2, 2007 9:30 a.m.

DSHS COMMUNITY MENTAL
HEALTH CRISIS SERVICES
IMPLEMENTATION OVERVIEW
MEETING
Thursday, August 2, 2007
9:30 a.m. – 4:00 p.m.
AGENDA
I.
II.
III.
IV.
V.
VI.
VII.
VIII.
IX.
X.
Welcome and Introductions – Joe Vesowate
Opening Remarks – Dr. Lakey
Review of Committee’s Work – Joe Vesowate
Results of Legislature – Kirk Cole
Implementation Overview – Mike Maples
Break for Lunch
Committee Discussion – Implementation Overview
Public Comment
Final Comments – Committee Members
*Adjourn
9:30 am
9:45 am
10:00 am
10:30 am
10:45 am
11:30 am
12:45 pm
2:15 pm
3:45 pm
4:00 pm
*The adjournment time may be extended to 4:30 p.m. to allow
more time for public comment, if needed.
Please send comments to
[email protected]
OPENING
REMARKS
OVERVIEW OF
CRISIS REDESIGN
COMMITTEE
CRISIS REDESIGN COMMITTEE
 Medical professionals (TSPP, Medical
Directors of MH Centers)
 Hospitals (THA, Hospital Districts)
 Law enforcement (Sheriffs, Police)
 Judges
 Advocacy organizations (MHA, NAMI,
Advocacy, Inc., et al)
 Community MH centers
 DSHS staff
CHARGE
Develop recommendations for a
comprehensive array of specific
services to meet the needs of Texans
having a mental health and/or
substance abuse crisis
WORK PROCESS
 Evaluation of existing services and data
review
 Review of biomedical and social services
literature
 Public testimony
 Formation of four subcommittees
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Clinical Design
Rural
Collaboration
Finance
 Report
NEED FOR MENTAL HEALTH AND
SUBSTANCE ABUSE
CRISIS REDESIGN
Projected Number of Persons Needing Crisis Services
to Increase Dramatically Compared to that
Expected from a General Population Increase
90,000
Projected Number Needing Crisis Services
Expected General Population Increase
Number of Persons
65,832
60,502
55,679
60,000
47,321
50,769
48,272
49,242
50,323
51,242
47,321
FY2005
FY2006
FY2007
FY2008
FY2009
30,000
0
Note: Projected number of persons needing crisis services based on 13% increase in number receiving front-door crisis services
from FY2005 to FY2006 projected forward each year, and 5% increase in number receiving community mental health services from
FY2005 to FY2006 projected forward each year, 21% of whom receive community crisis services. Expected general population
estimates based on 2.01% increase in Texas population (all ages) each year from 2005 to 2009.
Sources: DSHS Mental Retardation and Behavioral Health Outpatient Warehouse (MBOW); Texas Population Percent Change, All
Ages, 2004-2010, Texas Data Center.
BACKGROUND
The committee was composed of more
than 20 individuals representing local
government, mental health
professionals, hospitals, judges, law
enforcement, advocacy organizations,
local mental health authorities and
DSHS staff.
COMMUNITY
SURVEYS
COMMUNITY SURVEYS
 1600 surveys were mailed before
September 1, 2005.
 700 returned for overall return rate of 44%.
 570 to Community Hospital Emergency Departments

258 were returned for a response rate of 45%
 1030 to Law Enforcement, Sheriff Departments,
Chiefs of Police

442 returned for a response rate of 43%
SURVEY RESULTS
 Primary concerns of both Hospital/ER staff and Law
Enforcement:
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Timeliness of MHMR response
Use of “No Harm Contracts”
Issues related to requiring medical clearance
Need for improved communication and coordination
 Law Enforcement also frequently mentioned:
 Issues related to substance abuse
 Need for more procedures and written agreements with
LMHAs
All appeared to recognize the need for coordination to
improve the system.
SITE VISITS AND HEARINGS
1. February 7, 2006 – San Antonio
2. February 15, 2006 – Austin
3. February 23, 2006 – Big Spring
4. February 27, 2006 - Harlingen
CRISIS
THEMES
MAJOR ISSUES
 Information
 Attitude of providers
 Specialists – competent, well-trained,
appropriate attitude
 No harm contracts
 Standardized approach – assessment,
services, etc.
MAJOR ISSUES
 Training – crisis workers - assessment,
suicide, substance abuse, law enforcement
(CIT, MH Deputies), families
 Integration with health
 Medical evaluations/clearance – waiting time,
consistency
 Attention to families
 Mobility orientation
MAJOR ISSUES
 Types of services – crisis hotline, mobile
outreach, 23 hr. evaluation, residential,
trained law enforcement, etc.
 Jail as an option – due to long waiting time,
lack of options, unreceptiveness
 Need for forensic system – individuals who
may be dangerous
 Courts – mental health and substance abuse
MAJOR ISSUES
 Transportation – responsibility, availability,
distance, cost, diversion of resources
 Rural issues – distance, transportation, lack
of professionals (MH/SA, healthcare, law
enforcement), telemedicine
 Involuntary status as admission criteria for
state hospitals
 Financial resources necessary
MAJOR ISSUES
 Children
 Data
 Cultural competency
 Collaboration
 Outpatient services
SUBCOMMITTEES
1. Clinical Services
2. Rural
3. Finance
4. Collaboration and Partnerships
* Special issue subcommittee - Transportation
CORE CRISIS SERVICES
REPORT RECOMMENDATIONS
 Crisis Hotline
 23-48 Hour Observation
 Crisis Outpatient Services
 Community Crisis Residential Services
 Mobile Outreach
 Law Enforcement Crisis Intervention Team
(CIT) and MH Deputy Programs
RESULTS OF
LEGISLATURE
FUNDING FOR MH CRISIS
SERVICES REDESIGN
For the Years Ending
Aug. 31, 2008
Aug. 31, 2009
$27,317,890
$54,682,110
DSHS BUDGET RIDER
 Use methodology that allocates a portion of
the funds to achieve equity in state funding
among local mental health authorities, a
portion on a per capita basis, and a portion
using a competitive process.
 DSHS to submit allocation plan to Legislative
Budget Board (LBB) and Governor prior to
distribution of funding.
 DSHS to report quarterly to LBB and
governor on implementation of community
mental health crisis services.
DSHS BUDGET RIDER
 DSHS to develop performance measures for
quarterly reporting, which may include:
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Number of new psychiatric emergency 23/48
hour observation sites;
Number of persons receiving 23/48
observation, mobile outreach, and children’s
crisis outpatient services;
Mental health relapse and hospitalization rates
for clients receiving crisis services;
DSHS BUDGET RIDER
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Number of DSHS-funded staff with hotline
certification;
Percent of stakeholders satisfied with crisis
services; and
Criminal justice recidivism rates for clients
receiving crisis services.
DSHS BUDGET RIDER
 DSHS to contract with independent entity for
an evaluation of community mental health
crisis services.
 Evaluation to include analysis of the
implementation of crisis services.
 Evaluation to include analysis of the impact of
crisis services on clients, local communities,
mental health and health care providers, and
law enforcement.
DSHS BUDGET RIDER
 DSHS to submit evaluation to LBB, Governor,
and standing committees of Senate and
House of Representatives having primary
jurisdiction over health and human services
by January 1, 2009.