DSHS COMMUNITY MENTAL HEALTH CRISIS SERVICES

IMPLEMENTATION OVERVIEWMEETING

Thursday, August 2, 20079:30 a.m. – 4:00 p.m.

AGENDAI. Welcome and Introductions – Joe Vesowate 9:30 amII. Opening Remarks – Dr. Lakey 9:45 amIII. Review of Committee’s Work – Joe Vesowate 10:00 amIV. Results of Legislature – Kirk Cole 10:30 amV. Implementation Overview – Mike Maples 10:45 amVI. Break for Lunch 11:30 amVII. Committee Discussion – Implementation Overview 12:45 pmVIII. Public Comment 2:15 pmIX. Final Comments – Committee Members 3:45 pmX. *Adjourn 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

CrisisRedesign@dshs.state.tx.us

OPENINGREMARKS

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

Clinical Design Rural Collaboration Finance

Report

NEED FOR MENTAL HEALTH AND SUBSTANCE ABUSE

CRISIS REDESIGN

Projected Number of Persons Needing Crisis Servicesto Increase Dramatically Compared to that

Expected from a General Population Increase

47,32150,769

55,67960,502

65,832

47,321 48,272 49,242 50,323 51,242

0

30,000

60,000

90,000

FY2005 FY2006 FY2007 FY2008 FY2009

Num

ber o

f Per

sons

Projected Number Needing Crisis ServicesExpected General Population Increase

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: 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

LMHAsAll appeared to recognize the need for coordination to

improve the system.

SITE VISITS AND HEARINGS

1. February 7, 2006 – San Antonio2. February 15, 2006 – Austin3. February 23, 2006 – Big Spring4. February 27, 2006 - Harlingen

CRISISTHEMES

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 Services2. Rural3. Finance4. Collaboration and Partnerships

* Special issue subcommittee - Transportation

CORE CRISIS SERVICESREPORT 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 OFLEGISLATURE

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: 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

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.