Title: House Human Services Committee
1House Human Services Committee
- Mental Health and Substance Abuse Services
- May 24, 2006
2Public Mental Health System in Texas
- DSHS mental health services are only part of the
public mental health system in Texas. - Law enforcement, education, Medicaid, CHIP, the
criminal justice system, hospitals and other
entities all play major roles in treating Texans
with mental illnesses.
3Behavioral Health Issues Impact Other Systems
- 75 of children placed in foster care have
parents with behavioral health problems DFPS,
DSHS, DARS - 75 of kids in the juvenile justice system have
behavioral health problems TJPC, TYC, TDCJ,
DSHS - 30 of kids in the juvenile justice system will
end up in the adult justice system TJPC, TYC,
TDCJ, DSHS - 46 of all ER visits have behavioral health
issues as a basic or contributing factor DADS,
TWC, DSHS - 30 of all truancy is related to behavioral
health problems TEA, TWC, TJPC, TYC, DSHS
4Mental Health as a Public Health Crisis
Comparative mortality statistics, 2001
Source Centers for Disease Control and
Prevention
5Mental Illness Strikes More Americans Each Year
Than Other Serious Illnesses
Mental Illness
Serious Mental Illness
CVD
Diabetes
Cancer
Asthma
CDC BRFSS, SEER Cancer Statistics Review,
1975-2002, Prevalence, Severity, and Comorbidity
of 12-Month DSM-IV Disorders Arch Gen
Psychiatry. Vol. 62, June 2005
6DSHS Mental Health and Substance Abuse Services
- Community-based services
- 39 Local Mental Health Authorities
- Dallas Area NorthSTAR Authority
- 180 Substance Abuse contracts
- 10 State Hospitals
7Funding Mechanisms
- Community Mental Health and Substance Abuse
payment mechanisms - Substance Abuse Treatment Fee-for-service
- Substance Abuse Prevention Cost reimbursement
- Community Mental Health Centers Prepayment for
services
8Funding Equity for MH Services
- The 2006-07 General Appropriations Act (Article
II, Special Provisions, Sec. 29) requires the
Department of State Health Services to implement
a long term plan to achieve equity in state
funding allocations among local mental health
authorities. - The plan will be implemented from fiscal years
2006-2013. The goal of the plan is to achieve
equity to the greatest extent possible by fiscal
year 2013. - Any funding reductions to a local authority for
the purpose of achieving equity may not exceed 5
percent of allocated general revenue in a fiscal
year. - The plan also ensures that improving funding
equity is a priority in distributing any new
state or federal funds that may become available
for allocation to community centers. - Progress to date 5 percent estimated to be
achieved by end of FY06.
9Community Mental Health Services
- Community mental health centers are locally-
governed components of the Department of State
Health Services (DSHS) service delivery system. - DSHS delegates to a community mental health
center the responsibilities of a local mental
health authority which ensures the provision and
continuity of services for individuals with
mental illness, efficient use of resources,
consumer satisfaction, and accountability.
10Contract Management
- Performance contracts between DSHS and the Local
Mental Health Authorities include important
general provisions denoting the terms of the
contract. - Attachments to the contracts stipulate the
services targets, performance measures, outcomes,
and remedies, sanctions, and penalties that may
result from failing to fulfill contract
expectations. - Provisions include expectations of low
administrative overhead, utilization management
completion rates, and measures related to
appropriateness of services delivered and
percentage of clients receiving the minimum
number of Resiliency and Disease Management
service package hours. - Penalties/recoupment for the Second Quarter of
Fiscal Year 2006 totaled 163,858.
11HB 2292 Mental Health Service Requirements
- Integration of Physical Health and Behavioral
Health - Priority Population Redefined
- Resiliency and Disease Management
- Jail Diversion
12Resiliency and Disease Management (RDM)
- Evidence-based
- Intended to better match services to Mental
Health consumers needs, and to use limited
resources most effectively by providing the right
service to the right person in the right amount
to have the best outcomes. - Includes medication management, case management,
skills training, family training, supports and
partners, psychosocial rehabilitation, individual
and group counseling, supported employment,
supported housing, and Assertive Community
Treatment (ACT)
13RDM Key Components
- Uniform Assessment
- Standard Service Packages
- Utilization Management
- Data Analysis and Performance Evaluation
14Numbers Served in Community Mental Health
Services in FY2005
15Percent of Clients Receiving Minimum Number of
Service Hours Shows 50 Percent Improvement from
When RDM Implemented Statewide in Quarter 1 FY2005
16Community MH Service Outcomes
- Average monthly number of adults receiving
community mental health services
17Individuals with Criminal Justice Involvement
Experienced Positive Clinical Outcomes at DSHS
Community Mental Health Centers, All of which
Implemented Jail Diversion during FY2005
18FY2005 Texas Monthly Hospital Emergency Room (ER)
Costs 31 Percent Lower for Medicaid Clients with
Mental Illness or Substance Abuse Receiving DSHS
Behavioral Health Treatment
ER COST OFFSET - 36 Average per Client per
Month 31 REDUCTION
Source Prepared by Research Team, Strategic
Decision Support, HHSC, 3/23/2006. Average of ER
costs per month for Medicaid clients not
receiving needed DSHS Mental Health and Substance
Abuse services (Untreated) vs. average of ER
costs per month for Medicaid clients receiving
needed DSHS Mental Health and Substance Abuse
services (Treated).
19Innovative Local Treatment Models
- Crisis Stabilization
- Tri-County MHMR (Montgomery, Liberty and Walker
Counties) - Jail Diversion
- Center for Health Care Services (Bexar County)
- MHMRA of Harris County
20Community Substance Abuse Services
- Prevention Primarily school-based
- Intervention OSAR HIV PPI
- Treatment
- Adults
- Specialized Female Programs
- Women with children
- Youth
- Pharmacotherapy
- COPSD
21Numbers Served in Substance Abuse Prevention and
Intervention Services in FY2005
2253,420 People Accessed Substance Abuse Treatment
in FY2005
23Access to Recovery (ATR)
- Access to Recovery supports clients by providing
needed treatment or recovery support services to
successfully complete their drug court program - Drug courts offer a cost-effective alternative to
incarceration by providing community-based
treatment as a condition of probation - Cost effectiveness of the ATR drug court program
in Texas is reflected by preliminary data, which
indicates that participating ATR clients are
experiencing the following successful outcomes - 92 Abstinent
- 59 Employed or in School
- 91 No Further Arrests
- 99 Not Homeless
- 87 Socially Connected
24State Mental Health Hospitals
- 10 Mental Health facilities provide inpatient
hospitalization for persons with severe mental
illness who need intensive treatment - North Texas State HospitalVernon campus, serves
as the statewide maximum-security unit - The Waco Center for Youth is the only
state-operated residential treatment facility in
Texas for youths - All facilities are JCAHO Accredited
25State Mental Health Hospital Capacity
26Cost of In-patient Mental Health Services
27Population Growth Compared to Funded State
Hospital Beds
Funding for State Mental Hospital Beds has
declined while the Texas population has grown
28Growth in Forensic Patients
Total Forensic Patients as a percent in Texas
Mental Health Facilities
29State Mental Health Hospital Daily Census for
FY2005
30State Mental Health Hospital Capacity
- In February 2006, the LBB approved 13.4 million
in additional expenditures for state mental
health hospital capacity. - As a result, statewide hospital system capacity
was increased by 96 forensic commitment beds and
144 civil commitment beds. - This increase in state hospital capacity has
greatly enhanced our ability to meet the needs of
local communities. - We continue to plan for long-term,
community-based solutions to address the hospital
capacity issue.
31Crisis Services Redesign
- One goal of DSHS mental health services is to
help consumers avoid mental health crises.
However, the reality is that crises do occur. - February 2006, DSHS established the Crisis
Services Redesign Committee to develop
recommendations for a comprehensive array of
crisis services. - Members of the committee include medical experts,
citizen stakeholder groups, law enforcement
representatives, county probate court judge
representation, and county representatives, as
well as individuals from professional
organizations and provider groups. - A redesign of crisis services will build on the
service improvements made by the evidence-based
Resiliency and Disease Management program. - A thorough review of the current crisis system
was conducted, including holding public hearings
around the state.
32Crisis Services Redesign (cont.)
- The committee plans to finalize its
recommendations in June for an evidenced-based
crisis services model that will increase access
to appropriate and cost-effective services. - Initial conclusions for recommended services
include - 24-hour crisis hotline
- Mobile crisis outreach
- 23-hour hold capacity
- On-call psychiatric services
- Crisis residential services
- Respite
- In-home crisis services
- The committee will also put forth recommendations
regarding DSHS staff support, coordination and
training to local professionals (e.g., law
enforcement crisis intervention training).
33Mental Health Service Delivery Models in Other
States
- Ohio California County-based service system
with county taxing authority - Arizona Regional behavioral health authorities
managed care system - New Mexico Single purchasing model
- Pennsylvania County-based, capitated managed
care model - Illinois New York Direct state contracts with
provider network
34Mental Health Transformation
- Overarching goal is to improve the mental health
of all Texans and meet the Presidents New
Freedom Commission goals - New Freedom Commission Goals are shared by those
participating on the Transformation Working
Group - The Governors Office Department of State Health
Services Texas Health and Human Services
Commission Department of Family and Protective
Services Criminal Justice Department Juvenile
Probation Commission Texas Youth Commission
Consumers Family Members Texas Education
Agency Aging and Disability Services Workforce
Commission Veterans Administration etc.
35Mental Health Transformation
- The grant funding is seen as a catalyst to jump
start some of the efforts of framing the public
health approach. The 2 primary areas of focus - Developing and supporting local behavioral health
collaboratives - Using cutting edge technology to change work
processes across agencies - Improvement of the system will be targeted to the
following principles - Apply evidence to health care delivery
- Use information technology
- Align payment policies with quality improvement
- Prepare the workforce