Texas Mental Health and Substance Abuse Crisis Services Redesign

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Texas Mental Health and Substance AbuseCrisis
Services Redesign

• Joe Vesowate
• Assistant Commissioner
• Mental Health Substance Abuse Services

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Crisis care which encompasses a large range of
non-acute and out-patient mental health care
issues is becoming more and more of a priority
among state and local officials.


Big Spring Herald,
February 27, 2006
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Crisis Services Redesign Committee
Steven P. Shon, M.D., Co-Chair, DSHS Joe
Vesowate, Co-Chair, DSHS Carey Boethel, Austin,
TX ? Texas Association of Counties Denise Brady,
Austin, TX ? Mental Health Association in
Texas Joe Burkett, M.D., Fort Worth, TX ? MHMR of
Tarrant County Patrick Crocker, D.O., Emergency
Physician, Austin, TX ? Brackenridge
Hospital Gary Etter, M.D., Emergency Physician,
Fort Worth, TX ? Trinity Springs Pavilion Avrim
Fishkind, M.D., Emergency Physician, Houston,
TX Aaryce Hayes, Austin, TX ? Advocacy, Inc. The
Honorable Guy Herman, Austin, TX ? County Probate
Courts Mark Janes, M.D., Lufkin, TX ? Burke
Center Roberto Jimenez, M.D., San Antonio, TX ?
The Center for Health Care Services Merily
Keller, Austin, TX ? Texas Suicide Prevention
Coalition Greg Leveling, Dallas, TX ? National
Sheriffs Association ? Board of Denton County
MHMR Susan Marshall, Austin, TX ? Council of
Families for Children Reid Minot, Austin, TX -
Community Clinical Research ? DSHS Advisory
Committee on Inpatient Mental Health
Services Beth Mitchell, Austin, TX ? Advocacy,
Inc. Sylvia Muzquiz, M.D., Houston, TX ? MHMR
Authority of Harris County Lauren Parsons, M.D.,
Vernon, TX ? North Texas State Hospital Robin
Peyson, Austin, TX ? NAMI Texas Sandy Potter,
Coppell, TX ? Value Options NorthSTAR Eileen
Rosen, Austin, TX ? Depression and Bi-Polar
Support Alliance Ernest Schmid, F.A.C.H.E.,
Austin, TX ? Texas Hospital Association Sanford
Sandy Skelton, Austin, TX ? Texas Council of
Community MHMR Centers, Inc. Larry Stone, M.D.,
Bandera, TX - Texas Society of Child and
Adolescent Psychiatry ? DSHS Advisory Committee
on Inpatient Mental Health Services John Theiss,
Ph.D., Austin, TX ? Texas Mental Health Consumers
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Charge

• To develop recommendations for a comprehensive
  array of specific services that will meet the
  needs of Texans who are having a mental health
  and/or substance abuse crisis. In order to
  accomplish this, the committee will gather and
  analyze information from mental health
  literature, medical experts, members of the
  public, and staff. The recommended redesign will
  address the necessary elements of crisis services
  (including substance abuse), rural issues,
  clinical competencies, finance (cost), and
  important collaborations and partnerships.

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Part 1
Need for Crisis Services Redesign
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DSHS Quality Management Review of Mental Health
Crisis Services

• 77 of law enforcement and 71 of hospital
  surveyed indicated waits for LMHA/BHO crisis
  provider face-to-face assessment that exceed the
  one hour timeframe as required
• 87.5 of the LMHAs reviewed onsite did not meet
  the requirement of conducting face-to-face
  assessments immediately, but no later than one
  hour
• 74 of law enforcement and 62 of hospital
  surveyed indicated the ability to reach the
  hotline 24 hours a day/7 days per week
• 75 of the LMHAs reviewed onsite that were
  contracting with telephone answering services
  (non-credentialed employees) did not meet the
  requirement for immediate telephone contact with
  a qualified professional within 15 minutes
• 50 of the LMHAs reviewed onsite provided ongoing
  intervention until the crisis was resolved or the
  person was placed in a clinically appropriate
  environment and
• 37.5 of the onsite reviews indicated that
  arrangement for a physicians assessment within
  twenty four hours of the emergency care
  determination did not occur.

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Number of Persons Per Year Receiving Front-Door
Community Mental Health Crisis Services at
DSHS-Funded Community Mental Health
CentersContinues to Increase
13 Increase
Source DSHS Mental Retardation and Behavioral
Health Outpatient Warehouse, Business Objects
Corporate Report LBB Crisis Admit Served for
FY2005 and FY2006, used for LBB reporting for
number of persons receiving community mental
health front-door crisis services per year.
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Number of Persons Served Per Year in DSHS-Funded
Community Mental Health HospitalsContinues to
Increase
25 Increase
Source DSHS Client Assignment and Registration
(CARE) system as reported in LBB Performance
Measures, ABEST. Note Gulf Coast Center
contracts with The University of Texas Medical
Branch at Galveston MHMR Authority of Harris
County contracts with the Department of
Psychiatry, The University of Texas Health
Science Center in Houston for the operation of
The University of Texas Harris County Psychiatry
Center and Sunrise Canyon Hospital is operated
by the Lubbock Regional MHMR Center.
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State Mental Health Hospital Capacity Decreased
25 from 1994-2004
SPECIAL LEGISLATIVE AUTHORIZATION
El Paso Psychiatric Center Added to the System
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Suicide in Texas

• Suicide is the 9th leading cause of death in
  Texas.
• 2,304 Texas residents committed suicide in 2002.
  
• Suicide is the 3rd leading cause of death among
  10-24 year olds nationally and in Texas,
  following accidents and homicides.

From DSHS News Release, September 2004,
http//www.dshs.state.tx.us/news/releases/2004
0910.shtm
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The lack of a quickly responsive system with an
appropriate range of crisis services has
contributed to the increased incarceration of
mentally ill individuals in jails.

Texas Mental Health and Substance Abuse

Crisis Services Redesign, DSHS,
September 2006
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Many Adult Offenders in Texas State Prison, on
Parole, or on Probation Are Current or Former
Clients of the DSHS Public Mental Health System
Source TDJC-CARE Match, DSHS, January, 2005,
from Ruggiero, K. M., and Mason, M. (2005). A
second look at mental health and criminal
justice involvement in Texas Correlates and
costs. Austin, TX Texas Department of State
Health Services.
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Greater Percentage of Victims of Child
Abuse/Neglect (as confirmed by DFPS in FY2003)
with Juvenile Justice Contact Had a Behavior
Problem and/or Substance Abuse Issue
gt
gt
gt
Source DFPS Child Protective Services and TYC
client databases, from Ruggiero, K.M., and Mason,
M. (2006). The role of behavioral health services
among youth in Texas at risk for juvenile
justice involvement Multi-agency data-matching
project for the Policy Academy on Co-Occurring
Substance Abuse and Mental Health Disorders.
Austin, TX.
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But Less Than Half Received Behavioral Health
Services Funded by the State
Source DFPS Child Protective Services, DSHS
Mental Health and Substance Abuse, HHSC Child
Medicaid, and TYC client databases, from
Ruggiero, K.M., and Mason, M. (2006). The role of
behavioral health services among youth in Texas
at risk for juvenile justice involvement
Multi-agency data-matching project for the Policy
Academy on Co-Occurring Substance Abuse and
Mental Health Disorders. Austin, TX.
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A Vicious Cycle?
Parental Involvement with Criminal Justice
System
May Become a Parent
Youth Behavioral Problem
DFPS Youth
Juvenile Justice Contact
Youth Substance Abuse Issue
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Part 2
What the Public Had to Say
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Local residents will have an opportunity today in
San Antonio to provide feedback on state mental
health services during a five-hour public hearing
on the topic.



Kerrville Daily Times, February 8,
2006 ________ In the third of four public
hearings, the Department of State Health Services
Committee held an open meeting to hear concerns
and develop recommendations to re-design services
for the State, both rural and urban.






KOSA-TV Odessa, February 23, 2006 ________ Ment
al health care providers and clients spent much
of Thursday at Big Spring State Hospital
addressing a state committee tasked with
recommending changes to the states method of
providing mental health crisis services and
treatmentsWhen devising those recommendations,
area mental health officials hope committee
members keep rural needs and problems in mind.





Big Spring Herald, February 27, 2006
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Public Hearings

• Four public hearings in February 2006
• Big Spring (rural)
• San Antonio (urban)
• Harlingen (border) and
• Austin (statewide).
• Written and oral comments from more than 200
  citizens
• Consumers
• Family members
• Advocates
• Police officers
• Sheriffs
• Judges
• Hospital administrators and
• Mental health and Substance abuse professionals.

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Issues Raised

• Transportation
• Rural Issues
• Admission Criteria for State Hospitals
• Financial Resources
• Training
• Integration with Health
• Medical Evaluations/Clearance
• Attention to Families
• Mobility Orientation
• Information About Obtaining Services
• Attitude of Providers
• Specialists
• No Harm Contracts
• Standardized Approach
• Types of Services
• Jail as an Option
• Forensic System
• Children
• Mental Health Substance Abuse Courts

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Part 3
Crisis Services Redesign Report
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(No Transcript)
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Core Crisis Services Recommended

• 1. Crisis Hotline Services
• 2. Psychiatric Emergency Services with Extended
  Observation (23-48 Hours)
• 3. Crisis Outpatient Services
• 4. Community Crisis Residential Services
• 5. Mobile Outreach Services
• 6. Crisis Intervention Team (CIT)/Mental Health
  Deputy/Peace Officer Program

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Rural Issues

• Crisis hotline services and mobile outreach
• Telemedicine
• Crisis residential and crisis respite services
  and
• Larger areas could serve as hubs by providing
  specialized emergency services to smaller local
  areas.

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FinancingAnnual Costs X Four Years
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Collaboration Needed
Local Law Enforcement
Emergency Rooms
Mental Health Authority
Courts
Social Service Agencies
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Special Issues

• Transportation
• Childrens crisis services and
• Forensic services.

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Conclusions

• Standards of care.
• Local system shared responsibility.
• Least restrictive setting family environment.
• Help now is better than help later.
• Breaking the cycle.

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Next Steps

• 1. Resources
• 2. Planning