Mobilizing Community Support for Community Mental Health

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Mobilizing Community Support for Community Mental
Health

• María Félix-Ortiz, PhD
• San Antonio Express-News Columnist

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In this presentation

• Whats community mental health?
• What are the resources in San Antonio and Texas?
• What are the gaps
• Whats being done to address community needs?
• What can we do?

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What is community mental health? A brief
history (so we dont make the same mistakes over
and over againtoo late!)

• Ancient societies the ill as seers, as
  opportunities for charity to obtain divine
  indulgences.
• 1500s In English society, those in need had a
  right to aid, and the nobleman had a duty to
  provide it as a matter of social justice.
• 1600-1800 Poorhouses and prisons for the poor,
  mad, and bad supported financially by taxes from
  the community so treatment became harsher.
• 1800s Tuke, a Quaker, and Pinel, a French
  physician, advocate for humane treatment of the
  mentally ill who were, in France, literally
  chained to the walls. In 1830, Massachusetts
  opens the first state hospital to cure and
  rehabilitate, but so many early failures damaged
  the reputation of early state hospitals and led
  to the creation of privates.

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What is community mental health? A brief
history (so we dont make the same mistakes over
and over againtoo late!)

• Early 1900s military psychiatry develops early
  intervention and has many successes in treatment.
  The psychophysiology of stress is detailed by
  Selye.
• 1940-50s exposes of exceedingly poor state
  hospital conditions and local government
  corruption in managing them the first
  psychotropic medications are introduced
  (thorazine). In 1946, the NIMH is signed into
  law by President Truman. In 1955, Congress
  created the Joint Commission on Mental Illness
  and Health to develop a comprehensive mental
  health plan. They report to the new president,
  Kennedy, that the current system could provide
  only a tiny fraction of the care neededThere was
  no aftercare for those released from state
  hospitals.

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What is community mental health? A brief
history (so we dont make the same mistakes over
and over againtoo late!)

• 1960s In 1963, President Kennedy (who had a
  developmentally-delayed sister that was
  involuntarily lobotomized) addressed Congress and
  advocated the reduction of mental hospital
  censuses, reintegration of the mentally ill into
  the community, prevention of mental illness, and
  promotion of mental health?The Community Mental
  Health Centers Act of 1963 to create 1500
  community mental health centers. First War on
  was Johnson War on Poverty?social change as well
  as direct aid, and community control.
• 1980 Many CMHC were closed. Now we have about
  a quarter of what we hadand fewer hospitals,
  toobut our incarceration rate of the mentally
  ill has increased dramatically.

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Back to the 1800s? (TX MHA, 2005)

• Texas is the 2nd largest state and 2nd in rate of
  population growth, yet we spend fewer dollars per
  person on the public mental health system than 48
  other states. State funding, when adjusted for
  inflation, has declined 6 from 1981.
• Texas law enforcement has become the first line
  of contact to people who are in crisis and our
  jails and prisons have become the "asylums of the
  new millennium." Recently, Texas reached an
  undesirable form of mental health parity in this
  state
• 150,000 adults and children with serious mental
  illness are seen and undertreated in our public
  mental health system.
• 150,000 adults and juveniles, who were former
  patients in our public mental health system, are
  now in our prisons, jails, or on probation or
  parole.
• The national average length of jail stay is 80
  days for the mentally impaired offender (inmate)
  vs. 20 days for the general (inmate) population
  their prison stay is 15 months longer (Gonzalez,
  2004)
• 14 of the Bexar County Jail population is
  mentally ill

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• As the hospital census has declined in Texas, the
  number of mentally ill inmates has increased.
• Taxpayer cost 44 per day in TDCJ vs. 8 in
  mental health services.

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• COSTS TO COUNTY HEALTH After a 7.5 budget cut
  (_at_ 59 mil) in the first few months of 2003,
  visits to primary care clinics and ERs increased
  dramatically.
• While overall ER and clinic visits did NOT
  increase, there was a 43 increase in visits from
  low income people with mental health disorders
  between February and September of 2003 in the
  central Texas area.
• Taxpayers pay 265 per visit to the ER versus
  125 per visit (or less) for mental health
  services.

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• RESTRICTED FORMULARIES With PDLs, consumers are
  often required to fail first. Consumers must
  endure multiple trials of ineffective medications
  on the states list before gaining access to
  appropriate treatment.
• Requiring prior authorization for needed
  medications delays proper care, creates more time
  spent suffering, and increases the risk of
  negative outcomes, including suicide.
• In Texas, treating people with atypical
  antipsychotics saves an average of 27,850 per
  patient in reduced inpatient hospital costs.
• When Californias Medicaid program restricted
  its formulary, there was a jump in the average
  cost of prescriptions of 196, office visits
  increased by over 100.

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• RESTRICTED ELIGIBILITY CRITERIA Schizophrenia,
  Bipolar, and Major Depression are eligible
  anxiety, personality disorder, adjustment
  disorder, other depression, other psychoses,
  alcohol abuse, drug abuse, cognitive disfunction,
  autism are not.
• 122,000 adults with Schizophrenia, Bipolar,
  and/or Depression continue to be served but
  16,890 people with other serious mental illnesses
  who were receiving services from TDMHMR, or 11,
  no longer get help.

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Unmet Mental Health Needs Hurt the Economy,
Texas Families, and Texas Citizens (TX MHA, 2005)

• One in five Texans will experience a mental
  disorder in any given year (Surgeon General's
  Report on Mental Health) 1 in 3 when you
  include alcohol and other drug abuse/dependence
  (addiction, for many, is a response to mental
  illness).
• On average, nearly six people die from suicide
  every day in Texas. Over ninety percent of
  suicide victims have a significant mental illness
  at the time of their death. (American Association
  of Suicidology, 2002.)
• Up to half of the people who are homeless have a
  severe mental illness that is untreated.
  (National Mental Health Association, 1999.)

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Unmet Mental Health Needs Hurt the Economy,
Texas Families, and Texas Citizens (TX MHA, 2005)

• Forty-four percent of youths sent to the Texas
  Youth Commission have a serious emotional
  disorder. TYC further reported in 2002 that 21
  of its institutional population was on
  psychotropic medication.
• 29,000 prison inmates 106,000 adults and
  juveniles on probation or parole and in excess
  of 15,000 adults in county and city jails had
  contact with the public mental health system in
  the previous 5 years before entering the criminal
  justice system. (Texas Criminal Justice Policy
  Council, 2001/2002)
• Failure to divert people from the criminal
  justice system carries huge costs to the state
• 30,000 a year to house and treat an offender
  with mental illness in the Texas prison system.
  (NAMI Texas, presentation by Tom Hamilton to
  TCOMI, 2000)
• 200 a day for a jail "mental health bed". (Bexar
  County Jail Study, 2002)

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Texas Housing (National Low Income Housing
Coalition, 2004)

• A unit is considered affordable if it costs no
  more than 30 of the renter's income.
• In Texas, an extremely low income household
  (earning 16,780, 30 of the Area Median Income
  of 55,935) can afford monthly rent of no more
  than 420, while the Fair Market Rent for a two
  bedroom unit is 720.
• A minimum wage earner (earning 5.15 per hour)
  can afford monthly rent of no more than 268.
• An SSI recipient (receiving 564 monthly) can
  afford monthly rent of no more than 169, while
  the Fair Market Rent for a one-bedroom unit is
  590.
• In Texas, a worker earning the Minimum Wage
  (5.15 per hour) must work 108 hours per week in
  order to afford a two-bedroom unit at the area's
  Fair Market rent.
• The Housing Wage in Texas is 13.84. This is the
  amount a full time (40 hours per week) worker
  must earn per hour in order to afford a
  two-bedroom unit at the area's Fair Market rent.

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The good news
SAHA ACHIEVES NEAR PERFECT SCORE ON SECTION 8
PROGRAM SAN ANTONIO, TX (November 4, 2003)
---The U.S. Department of Housing and Urban
Development (HUD) presented the San Antonio
Housing Authoritys (SAHA) Section 8 Housing
Choice Voucher Program with an overall score of
104 percent out of a possible 105 percent on its
Section 8 Management Assessment Program (SEMAP)
score for the fiscal year ending June 30, 2003.
This is great news for SAHA and our Section 8
Department, who have worked diligently to
maximize program performance and provide the best
possible service to as many low-income families
as our resources will allow, said Melvin
Braziel, SAHA President CEO. The Section 8
teams hard work is evident in the addition of 12
percentage points over last years SEMAP score of
92, he added.
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The bad news

• SAHAs Housing Choice Voucher Program (Section 8)
  waiting list is closed.
• Nearly 7,500 people joined the waiting list for
  Section 8 vouchers in the two months the list was
  open.

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San Antonio PD, NAMI, and Center for Health Care
Services

• Specially-trained law enforcement officers
  (mental health professionals)
• Special holding facility and on-site case
  management
• Mental health services before booking and
  incarceration
• Mental health bond for release
• Special probation/parole program that includes
  mental health services
• In Bexar county, interim results of the program
  show over 1,700 diversions from jail
  incarcerations during Fiscal Year 2004,
  potentially resulting in an estimated range of
  3.8 million to 5.0 million dollars in avoided
  costs within the Bexar County Criminal Justice
  System. (White Paper, 2/14/05)

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Mental health disorders respond to medicine,
behavioral therapies, and case management.

• Treatment success for serious mental illnesses
  ranges from 6080 whereas the treatment success
  rate for heart disease ranges from only 4152
  percent.
• In particular, the New Generation medications are
  found to result in huge savings from reduced
  inpatient hospitalization and crisis
  stabilization.

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Disease Management

• What Is Disease Management? It is an approach to
  delivering effective healthcare to populations
  with significant needs, like people with asthma,
  diabetes, or depression. The model emphasizes the
  patients relationship with their physician and
  encourages patients active involvement in the
  planning of their treatment and the management of
  their illness.
• Disease Management is anchored in evidence based
  treatments and requires ongoing evaluation of
  treatment outcomes to ensure that appropriate
  care is being delivered.
• Treatment decisions are dictated by best
  practices guidelines, not available
  fundingstreams.

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Components of Disease Management

• Reliable methods for identifying the population
  to be treated
• Practice guidelines built upon the use of
  evidence-based treatments
• Coordinated care that encourages collaboration
  between patients and service providers
• Education for patients about their illness and
  ways they can manage it
• Consistent measurement of the patients response
  to treatment and its outcomes
• Routine communication between the patient and all
  providers involved in the treatment planning

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What still needs to be done?

• Schools Dont want to refer for assessment
  because it costs them too much.
• Church-based services (e.g. NAMI chapters, CHSC
  liaison)
• Large local businesses (e.g. USAA, Valero,
  Tesoro, Clear Channel, etc.)
• Mass media/public education too much negative
  press

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What can you do?

• Monitor NAMI-Texas website for local legislative
  actions
• http//www.namitexas.org/advocacy/79_legreport.htm
  l
• Write your congressmen (use their website
  http//www.capitol.state.tx.us/fyi/fyi.htm

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What can you do?

• Sponsor a support group meeting at a large
  company meeting room
• Sponsor a booth at a health or community fair
• Offer yourself as a resource to the school
  counselor or PTO
• Educate your religious leader about the need for
  mental health services offer yourself as a
  resource
• Volunteer at Center for Health Care Services as a
  new patient advocate (Frances Wise
  fwise_at_chcs.hhscn.org)
• Inform NAMI Task Force on Mental Health about
  your struggles.
• Alliance for Community Health in San Antonio and
  Bexar CountyMember Organizations Contact any of
  their coalition members and let them know about
  your struggles to obtain care.

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What can you do?

• Write me! mfelixortiz_at_earthlink.net