MHMRA of Harris County - Fiscal Year 2012 Annual Report

2012 AnnuAl RepoRtMHMRA of HARRis County

Investing in Healthy Minds

and a Healthy Community

In the early 1990s,

law enforcement was not trained

to respond to people, such as Felix,

who were exhibiting signs of a psychiatric

crisis. Now, MHMRA has joined forces with

the Houston Police Department and

the Harris County Sheriff’s Office to create

Crisis Intervention Response Teams. MHMRA

licensed clinicians accompany officers to respond

to calls involving people who may have mental illness.

The result is safer interactions that have a better

chance of appropriately redirecting people into

mental health care, not jail.

Investing in Dignity

Felix Martinez believes that one big reason for his being alive today is to

help people. He is the chairman of the Consumer Advisory Council at MHMRA. He offices at MHMRA’s Southwest Mental Health Outpatient Clinic, where he provides peer advising and support to other consumers.

Felix himself receives services through the Southwest clinic, and he uses his life experience to relate to the people he helps.

He has battled schizo-affective bipolar disorder, which can cause him to hear voices that other people can’t hear, since 1989. His condition has led to multiple suicide attempts and dangerous encounters with law enforcement. He has come close to death more than once, but each time, he has been pulled out of harm’s way.

One time, when Felix was living in the Rio Grande Valley, the voices frustrated him so much that he attempted to stab them. He was stabbing a door frame with a knife when police found him. He would not respond to the policemen’s commands, so one officer hit him on the head with a baton. Felix has the scar to this day. Felix wheeled around to see who had hit him, and the police thought he was going to stab one of them. They were about to shoot him when his brother, who was one of the officers, told them to stop.

At that time, law enforcement was neither trained nor equipped to help people with mental illness, so Felix went to jail without receiving treatment. In time, he was released from jail, but because his mental illness had not been addressed, he experienced another crisis. Again, his behavior was misconstrued as an attempt to hurt others, and he went back to jail.

Felix bounced between jail and the hospital for some time. Eventually, a doctor diagnosed Felix with schizo-affective bipolar disorder and

prescribed him the appropriate medication. This allowed Felix to begin working toward recovery.

Felix moved to Houston to live with his daughter and began receiving services at MHMRA. In 2006, he joined the Consumer Advisory Council (CAC). He first worked as a volunteer, but when MHMRA adopted the CAC as an official program, he began to receive a stipend.

Serving as a peer advisor is Felix’s job now, but it’s also his passion.

“We [consumer advocates] tell people that it’s possible to recover from mental illness,” he said. “It’s rewarding to see when people ask for assistance, and we provide it. We see people who are in crisis, but then later they are happy and talkative.”

Felix’s story reminds me of one of the six goals put forth by The 2003 President’s New Freedom Commission on Mental Health. That goal, known as the recovery model, was to make mental health care be consumer and family driven. Throughout the Commission’s deliberations, the theme of recovery kept emerging with multiple meanings and implications. The Commission determined that recovery should become a defining expectation of future mental health care.

The emergence of the recovery model has occurred, in part, because of advocacy done through the consumer movement. Many definitions of recovery describe it as a process of positive adaptation to illness and disability, linked strongly to self-awareness and a sense of empowerment. I like Dr. Bill Anthony’s version, which says, “It is a way of living a satisfying, hopeful, and contributing life even with the limitations caused by illness. Recovery involves the development of new meaning and purpose in one’s life as one grows beyond the catastrophic effects of mental illness.” Felix’s story is a great example of this.

In order to succeed in providing recovery-oriented services, we need to expand and grow the mental health outpatient care system in our community. Unfortunately, funds continue to be directed to emergency services and not to outpatient recovery care. While the availability of emergency services is critical, the long term ability to maintain meaningful recovery is dependent upon a robust, ongoing outpatient system that is evidence-based and supports the provisions of excellent care by expert psychiatrists, psychologists, nursing staff, other mental health professionals and peer advocates. The key to helping people grow beyond their limitations and enjoy improved quality of life is to provide a care system that supports lifelong recovery efforts.

Sylvia Muzquiz-Drummond, M.D. Medical Director, Mental Health Services Division

Intervention and appropriate mental health care helped Felix Martinez break the crisis cycle that led to multiple jail stays. Now, he’s helping others realize their own recovery. It’s time we invested in dignity, providing all people who have mental illness care - not punishment.

RecoveRy is possible

Investing in Healthy Minds and a Healthy Community

| 32012 Annual Report | MHMRA of Harris County

Mental Health ServicesMajor mental illness is a chronic condition - it can affect people for long periods of time and in multiple aspects of their lives. It is important to provide continuous appropriate care for individuals living with mental illness to ensure that their symptoms are manageable, that their risk of experiencing a psychiatric crisis is lower than it would be without services, and that they can lead productive, dignified lives. Our Mental Health Services Division provides an array of outpatient clinical services in the community, including medication, nursing, talk therapy, and case management, as well as specialized services for individuals who are involved in the justice system. Our data shows that individuals who receive our outpatient mental health services for more than three months reduce their admission rates to emergency services such as MHMRA’s Psychiatric Emergency Services (49% reduction), the Harris County Psychiatric Hospital (50% reduction) and the Harris County Jail (36% reduction). In FY 2012, we evaluated 12,700 individuals for eligibility to receive our services. We treated 21,900 adults who had a primary diagnosis of major depression, schizophrenia, or bipolar disorder, over half of whom had no form of health insurance coverage. We also served around 9,300 children between the ages of 3 and 17 who were diagnosed with a mental illness disorder.

Comprehensive Psychiatric Emergency ProgramsA psychiatric crisis is a traumatic event and can include thoughts or actions pertaining to harming oneself or others, acute psychotic symptoms, increased substance abuse, and sudden changes in mental status. Crises demand rapid attention and intervention to ensure that the individual experiencing the crisis is as protected and safe as possible. Many services provided through our CPEP Division are available to all adults living in Harris County, regardless of their financial standing or diagnosis. Some services are also available to children. The CPEP Division served 12,747 individuals in FY 2012, often times serving one individual through several programs. Our services include a 24/7 phone counseling hotline, an emergency room specifically for individuals experiencing psychiatric crises, community mobile crisis services and short-term residential programs for those who need time to recover from their crisis. In many instances, psychiatric crises can cause individuals to act in ways that lead to incarceration. We have developed strong partnerships with local law-enforcement to divert people committing low-level offenses away from jail and into appropriate mental health care services where they can receive treatment for the root causes of their behavior.

Intellectual and Developmental Disabilities ServicesIntellectual and developmental disabilities (IDD) involve delays or impairments in physical, learning, language, or behavior. These conditions may impact day-to-day functioning, and usually last throughout a person’s lifetime. Examples of these conditions include Intellectual Disabilities, Autism Spectrum Disorders, Fetal Alcohol Spectrum Disorders, Down’s Syndrome, and others. Intellectual and developmental disabilities affect over 200,000 individuals of all ages in Harris County. Through funding received from state and local sources, our IDD Services Division was able to serve 17,185 people in FY 2012. The Division provides a wide range of services and supports to assist people affected by IDD, all of which are focused on helping people rise to their full potential and be as integrated in the community as they can be. Services include Early Childhood Intervention, employment assistance, supervised residential living, autism services, and clinical services for individuals diagnosed with IDD and mental illness or a behavioral challenge.

MHMRA of Harris County serves the residents of Harris County who are financially disadvantaged and living with a serious mental disability. We care for people through three service divisions:

MHMRA at a GlanceInvesting in Healthy Minds and a Healthy Community

2012 Annual Report| MHMRA of Harris County4|

Fiscal Year 2012 was another successful year for MHMRA of Harris County. Despite economic difficulties at state and county levels that led to substantial funding reductions for our Agency, we were able to rebalance and readjust our expenses and service commitments – never an easy process. We could not have done this without incredible effort and dedication from our staff, contract providers, community partners, consumers and their family members, and advocates.

As you read this year’s annual report, please consider the challenges we have experienced and overcome, as well as the critical nature of the services we provide. So many of the people MHMRA serves have conditions that are long-term, if not lifelong in nature. We are not able to cure these conditions, but when we are given the resources to wrap services and supports around our consumers, we are able to assist many in achieving a higher level of functioning and positive participation in the community.

Our community can not afford to ignore those with mental illness or intellectual disabilities, or limit resources to address these conditions. Society will always pay – one way or another – for these conditions. Either we will pay through a positive, appropriate system of interventions and supports, or we will invest our limited resources in more reactionary, less effective approaches.

Though we achieved positive results for the people we serve and our community, FY 2012 was a challenging year that necessitated continuing systematic adjustments. The challenges and opportunities in FY 2013 are expected to continue, if not intensify. We can and will be successful in navigating the ever-changing health care environment, but we will not do it without your help. Thanks to all who participated in helping us to achieve our accomplishments in FY 2012. Most of all, thanks to our many consumers and their families for believing in us and allowing us to assist in their recovery journey. Sincerely yours, Lynne A. Cleveland,Board of Trustees Chairperson

Steven B. Schnee, Ph.D.,Executive Director

Letter from our Leaders

Steven B. Schnee, Ph.D.Executive Director

Scott P. Strang, Ph.D., MBAChief Operating Officer

Rose Childs, MSWDeputy Director, Mental Health Services

Kenneth Collins, LMSWDeputy Director, IDD Services

Ronald Coots, RN, MSHPDirector, Information Services

Barbara Dawson, M.Ed.Deputy Director, CPEP

Carson Easley, MS, RNDirector, Nursing Services

Sarah Flick, M.D.Medical Director, IDD Services

J. Scott Hickey, Ph.D.Director, Outcomes Management

Daryl Knox, M.D.Medical Director, CPEP

Alex V. Lim, CPA, MBAChief Financial Officer

Jeanne Mayo, MS, JDGeneral Counsel

Sylvia Muzquiz, M.D.Medical Director, Mental Health Services

Charlotte SimmonsInterim Director, Human Resources and Public Affairs

Robert Stakem, MPM, CPHQDirector, Quality Management

Steve SuarezDirector, Human Resources and Public Affairs

Paul WilsonDirector, Facility Services

Lynne A. ClevelandChairperson

Mae F. McMillan, M.D.Vice-Chair

Jane B. CherrySecretary

Board of Trustees

Executive Staff

Victor C. Alvarez

Bob Borochoff

Alfred H. Forsten

Tom Hamilton, Ph.D.

Jo Monday

Gerald W. Womack



Investing in Well-BeingFor Brian Palmer, one of

the most meaningful parts of MHMRA’s

Crisis Residential Unit’s (CRU) alumni program is the constant reminder of how far he has come.

The CRU is a short-term residential alternative for people experiencing a mental health crisis who are ready to step-down from the hospital but are not quite ready to re-enter the community. A typical stay lasts between one and two weeks, and during that stay, a person receives appropriate medication, psychotherapy, intensive psychosocial rehabilitation and other services.

The alumni program, which is 1,800 members strong, provides a “safe harbor” for graduates of the CRU, said Mende Snodgress, assistant deputy director of MHMRA’s

crisis division. If the alumni did not have this, they might return to the old influences and triggers that first caused them to experience a crisis. At the CRU, alumni can attend support groups and therapy sessions, access the computer lab and enjoy occasional meals. Participation in the alumni program has helped members reduce their rate of recidivism to hospitals and jail.

Brian visits the CRU three days a week. “When you come back and see people coming behind you [into the program], it reminds you where you come from,” he said. “This place helps you because it keeps you connected. I see people come back [to visit], and they’re still stable, and that gives me hope.”

Brian battled depression for over 20 years but refused to seek help. A string of bad events – going to jail

repeatedly, losing his home twice and falling into drug addiction – brought him to a point where he felt isolated and deeply depressed. For two or three weeks, he cut off all contact with his family. One day, it became too much, and he checked into MHMRA’s Psychiatric Emergency Services. There, he was evaluated, diagnosed, began to be stabilized and later referred to the CRU.

Once at the CRU, “I got a lot of information about myself,” Brian said. He learned how to take his medication as prescribed, and he also learned about his diagnosis, coping skills and how he could prevent a relapse.

If you met Brian now, you wouldn’t guess that he once struggled so much. He lives independently, attends church and has rekindled a relationship with his family. He receives ongoing mental health care through MHMRA’s Northwest Adult Mental Health Outpatient Clinic. On Wednesday evenings, he facilitates a support group at the CRU for people who are overcoming substance abuse, and he recently took a job as a residential care technician at Lord of the Streets. Staff from the CRU provided him the references he needed.

“I’m living a life I never thought I would live,” he said.

This place helps you because it keeps you connected. I see people come back [to visit], and they’re still stable, and that gives me hope.

Brian’s story is an excellent example of recovery-oriented mental health care in action. The best treatment encompasses more than just psychotropic medication. While medication is usually necessary, it is, by itself, often insufficient in getting patients to their highest level of functioning, given the severity of their illness. Severe mental illness can take a toll on one’s ability to communicate and engage in meaningful social activity. It can also diminish a person’s ability to think clearly, solve problems or overcome the stressors of everyday living.

Programs such as the CRU meet patients where they are in their illness and provide them with a variety of services. These services include medication, psychotherapy, nursing care, case management and referrals to community resources that can help them address their medical, employment and housing needs. The residential component of the CRU program affords patients an immediate opportunity to gain strength by taking part in a therapeutic community of fellow patients and staff. When

patients graduate from the CRU, they are offered enrollment in one of MHMRA’s mental health outpatient clinics and a lifelong membership in the alumni program. The alumni program provides a forum in which participants can continue to grow, be encouraged when undergoing challenges, develop friendships and offer support to those who are just beginning their recovery journey. The alumni program operates on the principal that recovery does not happen in a moment, and it is not sustained without ongoing support from a community and long-term, holistic treatment. When patients receive this care, though, they may find themselves marveling, “I’m living a life I never thought I would live.”

Daryl Knox, M.D., Medical Director Comprehensive Psychiatric Emergency Services Division

sustaining RecoveRy



Two years ago, Brian Palmer lived

on the streets, isolated and

depressed. Thanks to his

determination and ongoing help

from MHMRA, he has now built

a fresh life for himself - complete

with his own apartment, stable

employment, and support

from his family.

The theme of this year’s annual report is Investing in Healthy Minds and a Healthy Community. When we, as a community, fund mental health and IDD services, we’re making a good investment decision. We’re choosing to take a proactive approach and pay for early intervention and ongoing care, rather than, by our inaction, choosing to pay the high emotional and fiscal tolls of crises that can result when people do not receive the care they need.

Friends of MHMRA of Harris County (“Friends”)

is a vehicle that allows you, as an individual community member, to invest in MHMRA and the critically important services it provides our community. Friends is an independent nonprofit organization that seeks to enhance and expand the services and supports provided by and through MHMRA.

Through your generosity, we have made a variety of grants to support MHMRA and its consumers. In FY 2013, we will make our biggest grant yet to the Interim Care Clinic, located at the Neuropsychiatric Center

in Houston’s Medical Center. The purpose of the clinic is to provide care for people waiting to receive an appointment at one of MHMRA’s mental health outpatient clinics, to prevent further deterioration of their illness. Friends will cover the costs of one-month prescriptions for psychotropic medications in collaboration with HEB’s $4/$5 prescription program. This is important because equipping a person with the appropriate medication is often the first step in helping him work toward recovery.

We could not provide support to the Interim Care Clinic and other MHMRA programs without help from donors like you. If you have donated, thank you for investing in us and for recognizing that mental health care and IDD services are good for you, your loved ones and the entire community. If you have not donated, please consider making a donation. Learn more at friendsofmhmra.org.

Invest in Us

VisionThe vision of MHMRA of Harris County is that the public mental health and mental retardation system will act in partnership with consumers, family members, service providers and policy makers to create options responsive to individual needs and preferences. This vision includes recognition of these values:• The individuals that MHMRA serves share common human

needs, rights, desires and strengths.• MHMRA celebrates cultural diversity and individual

uniqueness and is committed to support individual choices and preferences.

• MHMRA is committed to developing an environment that inspires and promotes innovation, fosters dynamic leadership and rewards creativity among our staff, volunteers and consumers.

MissionIt shall be the mission of MHMRA of Harris County, within the resources available, to provide or ensure the provision of services and supports in a respectful fashion that are high quality, efficient, and cost effective such that persons with mental disabilities may live with dignity as fully functioning, participating, and contributing members of our community as possible, regardless of their ability to pay or third party coverage.• Persons with severe mental illness should be able to live in

homes of their own, develop relationships, work, and remain out of hospitals and jails.

• Persons with intellectual or developmental disabilities should be able to acquire the skills and access community resources to develop networks of human relationships, learn, work, and live in environments of their choosing.

• Children and adolescents with serious emotional disturbance should be able to live in homes with families, develop normal relationships with their peers, attend school, and remain out of hospitals and juvenile justice facilities.



Make the Smart InvestmentBetter state funding for MHMRA could make our neighborhoods safer, sick people healthier and our tax bills lighter. -Harris County Sheriff Adrian Garcia,Cypress Creek Mirror, Dec. 31, 2012

Adult MentAl HeAltH outpAtient seRviCes

Continuity of care through MHMRA’s clinics helped consumers reduce their use of more expensive crisis services. Compared to the year before beginning treatment, consumers actively receiving outpatient care reduced their admission rates to crisis services by:

36%50%Harris CountyJail

Harris County Psychiatric Center (HCPC)

MHMRA’s ongoing, community-based care is more effective at preventing future crises, and it is also more cost-efficient. Compare the average costs of one day of service:

$ 21per day

approximately $ 130per day

approximately$ 500per day

approximately

MHMRA AdultMental health outpatient services

Harris CountyJail

Acute inpatient care at HCPC

CRisis inteRvention Response teAMs

MHMRA’s licensed, master-level clinicians partner with experienced Houston Police officers and Harris County Sheriff’s deputies certified in crisis intervention training to respond to calls that may involve people with mental illness. In the past, these calls may have led the subjects to jail, but thanks to the work of our compassionate teams, we divert approximately 99% of the individuals away from jail and into appropriate care.

MHMRA Psychiatric Emergency Services

49%

funding And ACCess ConCeRns236,831 children and adults in Harris County have severe mental illness. As of 2010, 89,100 of these people were unable to access both public and private mental health service systems, reported the Mental Health Needs Council.

Furthermore, 11,442 individuals living with intellectual and developmental disabilities are on the

wait list for Home and Community Based services, meaning they are currently unable to get the full range of Medicaid services they need, due to lack of funding at the state level to draw down Federal match dollars.

Individuals who received services for co-occurring mental illness and intellectual and developmental disabilities through MHMRA’s Specialized Therapies and Rehabilitative Services (STARS) clinic reduced their annual hospitalization costs by 98%.

Dual-Diagnosis services

2,357 emergency detention orders (31%)

70 individuals taken to jail (1%)

5,196 situations resolved at the scene (68%)

7,623 CALLS IN FY 2012



Investing in Independence

Since inception in 2006, the Coffeehouse program hashelped over 80 adults with Asperger’s Disorder or high-functioning Autism make friends and develop social skills.

In FY 2012, the Employment Connections program helped 39 people find new jobs.

In FY 2012, the Specialized Therapies and Rehabilitative Services (STARS) clinic treated 493 children and adults with co-occurring mental illness and IDD.

Myriam Lisette Arguello works two jobs, pays taxes and

is saving money to move into her own apartment. She thinks of herself as a role model, and she’s not alone in thinking that. She was recently honored for her self-advocacy at the American Association on Intellectual and Developmental Disabilities - Texas annual conference.

Myriam Lisette did not always present herself as such a powerhouse, however. There was a time when her communication skills were not polished, her confidence was low, and she was too nervous to perform well in job interviews. She found the help she needed, however, at MHMRA.

Over the years, Myriam Lisette has received a variety of services through MHMRA. Her mother, Lisette Arguello, said that MHMRA’s Dual Diagnosis Services (DDS) helped Myriam Lisette

develop her self-esteem, and the Coffeehouse program has helped her maintain her self-esteem and continue to develop critical social skills. DDS is a day program for adults who have both developmental disabilities and mental illness. Individuals learn to manage their symptoms of mental illness so they can participate more actively in the community. The Coffeehouse program is a drop-in day program for adults living with Asperger’s Disorder and other Autism Spectrum Disorders. Participants interact with each other and staff members, both in groups and one-on-one, to practice communication, social and independent-living skills.

Through MHMRA’s Employment Connections

program, Myriam Lisette learned how to write an effective resume and give strong interviews. These job readiness skills, combined with her growing confidence and communication abilities helped Myriam Lisette land a job after six years of unsuccessful searching.

“I was shocked when I got my first job,” she said. “I never had a job before. I was mostly surprised that I did well in the interview, that I answered the questions right and that they liked me. I was proud.”

Myriam Lisette now works concessions at Reliant Stadium. She also works for the Texas Young Autism Project, helping children who, like herself, have Autism Spectrum Disorders

and need special services to develop life skills. She worked hard to get this job. Through Coffeehouse, she developed a career contact at the University of Houston – Clear Lake who helped her get the training she needed to work with the children. After that, she relied on her own self-esteem, courage and initiative”to call behavioral day treatment centers around the community to inquire about employment opportunities, her mother said.

“She has become very independent and a better communicator,” her mother said. “We want to thank each one of the people who work in MHMRA’s programs that helped Myriam Lisette.”

Myriam Lisette Arguello always had the knowledge she needed for work

she wanted - but she couldn’t communicate that in interviews. MHMRA’s

programs came together to give her the boost of self-confidence she

needed to nail the interview and land the job.

valuing integRation and independence

Sigmund Freud once said, “Love and work are the cornerstones of our humanness.” Many years later, we continue to find that the ability to engage in meaningful interaction socially and vocationally is indeed at the heart of becoming a happy and healthy human being. Myriam Lisette has made this journey as she participated in MHMRA’s IDD Services Division programs. She has grown personally and professionally with the support of services from MHMRA, and she continues to overcome challenges in her daily life.

We all face challenges. When individuals with disabilities are integrated into our communities, it becomes clear that we all share more commonalities than differences. Contributing to our community offers all of us opportunities for inclusion and belonging. As our communities become more diverse and accepting of differences, we all benefit from each other’s presence. The IDD Services Division promotes and values independence and integration as benefits both to the individuals and families we serve as well as to the larger community.

The IDD Services Division strives to encourage, equip, and empower those we serve to remove barriers in their lives and move forward. We endeavor to provide this support in as many ways as we can. Our Agency faces ongoing constraints and reductions in funding, and we do our best to be creative and flexible in the face of these challenges. Whether providing support in times of crisis, vocational programming, social skills training or clinical services, we remain committed to the mission of promoting independence and integration for those we serve. These are the cornerstones that sustain hope for a better tomorrow, for persons with IDD and their families and for our entire community.

Sarah Flick, M.D., Medical Director

Intellectual & Developmental Disabilities Services Division



• Patient Assistance Programs, or PAP, offered by some pharmaceutical manufacturers, allowed us to distribute free medications to patients who were financially eligible. Because PAPs saved us more than $29 million by providing prescriptions at no cost to MHMRA or our consumers, we were able to redirect those funds to providing other critical services.

• The opening of an El Centro de Corazon primary care clinic inside our Southeast Mental Health Outpatient facility created an integrated health care setting that provided our consumers the ability to access primary healthcare and mental health services in one location. Approximately 2,000 adults and 800 children received integrated services at this facility each month for a period of over one year.

• The Houston Chapter of the National Alliance for Mental Illness (NAMI) celebrated the grand opening of the Support, Education, and Advocacy (SEA) Center, which is housed at MHMRA’s Eligibility Center. It is the only Center of its kind in Houston that provides one-on-one information about mental illness and available community resources. When an individual’s situation doesn’t meet the state-established criteria to receive MHMRA services, the individual has an opportunity to visit the SEA Center to learn about alternative options and services. In FY 2012, SEA Center staff and volunteers received around 15 referrals from MHMRA each day, and 50 to 80 phone inquiries each week.

• Through strategic partnerships with local businesses and government agencies, our

Collaboration for Action program provides mentor opportunities for mental health patients to compete for jobs in the workplace. This past year, CFA celebrated patient recovery along with the Mayor’s

Office of People with Disabilities and the Houston Commission on Disabilities by unveiling a colorful

mural showing “The Faces of Disability” - people who are actual clients celebrating their achievements.

• Over 1,800 attendees gathered for Picnic in the Park - an event that provides Harris County families an opportunity to enjoy a day of fun activities and learn more about different community organizations that provide services for people with Intellectual

and Developmental Disabilities (IDD). Over 100 volunteers and representatives from multiple Harris

County organizations made this festival possible. Food and drinks were provided by MHMRA’s IDD Planning

Advisory Council, and Harris County Commissioner Steve Radack, among others. That day, the Houston Mayor’s Office for People with Disabilities presented MHMRA with a proclamation from Houston Mayor Anise Parker to declare April 21, 2012 as MHMRA

Picnic in the Park Day.

• One of the newest additions to MHMRA’s community collaborations is the Houston Police Department’s

Homeless Outreach Team (HOT). This is a specialized group of Houston police officers and a MHMRA case manager from our Comprehensive Psychiatric Emergency Programs Division who engage in outreach to individuals who live on the streets.

Since the creation of HOT, more than 200 homeless individuals have been moved into housing.

Leveraging SupportAt MHMRA, improving the lives of the people we serve is at the core of our mission. This is why we work diligently every day to develop and implement services that meet our consumers’ needs. As part of this vision, we have developed a system of integrated services and partnerships with multiple community organizations throughout Harris County to strengthen our services.

In FY 2012, we worked with approximately 400 community partners – from non-profit organizations to local businesses – and developed multiple innovative ways to improve the lives of the people we serve. We also contracted with multiple entities to help ensure the delivery of adequate, high-quality services. In FY 2012, our service contracts totaled almost $40 million. Highlights from our partnerships include:

Through informative and enjoyable activities, vital day-to-day supports, crisis care, and more, MHMRA works to meet the ever-growing needs of the Harris County community. With limited funding, we can only do so much. Our community partnerships are a crucial extension of the services Harris County residents need. Thanks to our community partners we are able to do more with what we have, and though the challenges are pressing, our determination is to continue to strive for a healthier Harris County, for the benefit of our families and our community.



A look back at FY 2012 and the major investments MHMRA made to create a more effective, more comprehensive system of care

Investing in our employeesMore than 1,800 staff at MHMRA provide the services our consumers need, both in direct-care and supportive roles. To provide excellent services, we must recruit and retain top-quality staff, which is why we enacted a tri-phase strategy to address employee salaries to be competitive in the marketplace.

Investing in facilitiesThe MHMRA Facilities Services team renovated our Southeast Adult and Children’s Mental Health Outpatient clinic, allowing staff to more efficiently use the space available. Care teams are now physically proximate to each other, which allows for more timely and efficient communication about patient care. The creation of individual and group interview rooms allows the clinic to hold more therapy sessions at a time. MHMRA staff, not contractors, completed the work and kept disruption of clinic operations to a minimum, making the renovations cost-effective.

Investing in technologyWe continued to work in partnership with MHMR of Tarrant County and CoCentrix, Inc., to develop Project Topaz - a practice management, billing and electronic health record (EHR) information system, with plans to implement it in FY 2013. Once Topaz is fully implemented, it will replace and enhance our current systems and create a uniform electronic record-keeping system. The system will allow for more synchronized processing as well as linkage to consumer databases at other agencies. Through Topaz, MHMRA staff will be able to better coordinate services across the continuum of care.

Investing in integrated careIn Texas, people who have mental illness die an average of 28 to 29 years earlier than their counterparts who do not share these conditions. Overwhelmingly, the cause is due to undiagnosed or under treated medical illness. Thanks to a partnership between MHMRA and El Centro de Corazon, a Federally Qualified Health Center, approximately 2,000 of our adult patients and 800 child patients were able to receive mental health care, IDD services, and primary health care in one location.

Investing in interim careBecause of a lack of funding to adequately care for everyone in Harris County who has mental illness, MHMRA’s adult mental health outpatient clinics have waiting lists. To prevent people from further deteriorating in their illness while they wait for an appointment, we began operating our interim care clinic on a part-time basis in March 2012. The clinic is located at the Neuropsychiatric Center in Houston’s Medical Center. Consumers receive brief psychiatric assessments, prescriptions for up to one month of medication, and linkages to other community resources.

Investing in crisis intervention responseThe Crisis Intervention Response Team (CIRT) program, a partnership between the Houston Police Department and MHMRA, has been extremely successful in diverting people exhibiting signs of a psychiatric crisis away from jail and into appropriate care. Because of this, we expanded the CIRT partnership to the Harris County Sheriff ’s Office in early FY 2012. MHMRA licensed master-level clinicians partner with law enforcement officers and deputies who are certified in crisis intervention to respond to crisis calls involving people who may have mental illness or IDD.

Investing in competency restorationWhen a person suspected of a crime is ruled mentally incompetent to stand trial, he or she must receive competency restoration care within 21 days. Using funds provided by the Texas Department of State Health Services, MHMRA contracted with the Harris County Psychiatric Center to open a 21-bed competency restoration unit in March 2012. This resulted in many inmates at the Harris County Jail can receiving competency restoration care in Harris County, rather than being transferred to a state facility.



Investing in the Future

Medicaid 1115 WaiverThe 1115 Waiver of the Social Security Act gives states funding and flexibility to develop new, more cost-effective approaches for meeting Medicaid and CHIP goals. In Texas, the new Quality Based Payment Reform plan will phase out the Upper Payment Limit program, which helped cover hospitals’ financial losses from providing under-compensated care. The payment reform plan brings Delivery System Reform Incentive Payment (DSRIP) with almost $3 billion new local, state and federal funds to transform the health care delivery system, reduce high-cost intensive services utilization to address chronic conditions, and improve patient satisfaction and clinical outcomes.

MHMRA has submitted 19 project proposals to our region’s anchor for inclusion in Texas’ funding request to the Centers for Medicare and Medicaid Services. Our top priority among these projects is to expand outpatient behavior health services for adults who have severe mental illness, often life-long psychiatric conditions that require ongoing treatment. In Harris County, there are estimated to be approximately 86,000 adults with a chronic mental health condition without health insurance. Current funding from the Texas Department of State Health Services allows us to serve approximately

only 8,800 adults, with the most severe forms of mental illness. Once authorized and in operation, MHMRA’s DSRIP projects could help eliminate our waiting lists for services. Other projects include developing a day hospital to step people down from psychiatric hospital care and creating more opportunities for integrated mental health and primary care. If we receive funding, we expect to begin implementing approved projects in late FY 2013.

Affordable Care ActOne aspect of the Patient Protection and Affordable Care Act gives each state the option to participate in Medicaid expansion. If Texas were to participate, it has been estimated that the state would receive up to $100 billion in federal money over 10 years to help provide Medicaid coverage to up to 4.1 million people who are currently uninsured. The 10 year cost to the state has been estimated to be between $10 and $15 billion.

This represents a significant opportunity for our state, as 25 percent of Texas’ population is currently uninsured. The lack of health insurance poses a particular problem for the people MHMRA of Harris County serves, as 50 percent of the adults we serve through our Mental Health Services Division have no medical insurance. Because these people do not have insurance, it is difficult for them to afford

sufficient medical care. Studies show that people in Texas who have mental illness die an average of 28 to 29 years earlier than their counterparts who do not have these conditions, and the majority of these premature deaths are caused by undiagnosed or under treated medical illness. Our consumers do not just need mental health care and IDD-related services; they need a variety of wrap-around care. The Medicaid expansion could help people afford more of the care they need. We will be interested to see how Texas proceeds.

IDD ServicesEconomic challenges at the state level led to reduced funding for our IDD Services Division. Coming out of the

82nd Legislative Session, the safety net for people with IDD and their families was dramatically reduced, no additional Home and Community Based Services slots were funded for the 2011-12 biennium, and babies who had been eligible for Early Childhood Intervention were excluded from continuing assistance due to tightening eligibility criteria. We do not know what funding will be authorized through the 83rd Legislative Session, but we do know that our commitment to serving people with IDD in Harris County remains unwavering, and we will continue to make the necessary systematic adjustments to continue providing the best services possible.

Every year brings its own opportunities and challenges. Here’s a look at what we’re expecting for FY 2013:



Financial Information

For the comprehensive annual financial report of MHMRA of Harris County for fiscal year ended August 31, 2012, visit:http://bit.ly/financialreportFY12MHMRAHarris

Fy 2012 Revenues by souRce peR audited Financial RepoRt

Fy 2012 expenses by pRogRam peR audited Financial RepoRt

$28,132,939 , 17%

$84,723,433 , 52%

$4,899,459 , 3%

$9,681,399 , 6%

$33,887,870 , 21%

$385,753 , 0% $1,956,733 , 1%

LOCAL REVENUE

STATE GENERAL REVENUE

STATE OTHER REVENUE

FEDERAL REVENUE

LOCAL BILLINGS

INVESTMENT EARNINGS

MISCELLANEOUS REVENUE

$16,537,855 , 10%

$45,402,782 , 27%

$27,060,660 , 16%

$996,480 , 1%

$34,616,488 , 21%

$14,975,055 , 9%

$26,480,262 , 16%

ADMINISTRATION

ADULT MH

COMMUNITY HOSPITAL (HCPC)

DEBT SERVICE

IDD

CHILDREN'S MH

CPEP

MHMRA of Harris County7011 Southwest Freeway

Houston, TX [email protected]

www.mhmraharris.org

Documents

MHMRA of Harris County - Fiscal Year 2012 Annual Report