Access Task Force Report Presentation to House Health, Welfare and Institutions General Assembly Building September 6, 2007

Access Task Force Report

Presentation to House Health, Welfare and Institutions

General Assembly Building September 6, 2007

Report to HWI – September 2007

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What the system looks like now...

TRIAGECrisis response/Resolution & Referral

JAIL

Crisis Stabilization &

ReferralNon-emergency & clinical

support services


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Non-emergency & clinical support services

Crisis Stabilization & Referral

TRIAGECrisis response/Resolution & Referral

JailInpatient

/State Facility

What it should look like

EmergencyPsychiatric

Services CenterAnytown,

Virginia


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Background• Inability to access community based,

private and public mental health services – Large volume of Temporary Detention

Order (TDO) hearings– Unnecessary arrest and incarceration of

individuals affected by psychiatric illness – Inappropriate use of hospital emergency

rooms– Untreated individuals in distress or at

risk

Four Decades of Study…

Previous Commissions have studied and recommended

changes for the Commonwealth’s Mental Health System

Report RecommendationGov. Tuck 1949

Willey 1962

Comm.MH/MR

1965

Hirst Comm. 1970-72

JLARC 1979

Bagley Comm. 1980

Emick Comm. 1985

JLARC 1986

JLARC1995

Comm. MH/MR

1997

Hall-Gartlan 1998

HammondComm,1998

Hall-Gartlan 2000

Need for Availability of Community Services Statewide to Prevent/Reduce Hospitalizations

Need for Services/Core Services, Prevention/Early diagnosis, Treatment/care, Housing/day treatment, Emergency interventions

Single System of Care, Continuum of Services. and Continuity of Care

Individualized Services in Least Restrictive Environment

Discharge Planning by CSBs

Funding Needed for Community Services

Maximize Medicaid

Reinvest Funding from Facilities/Downsizing

Define Eligible/Priority Populations

Barriers to Community Services

Lack of Resources

Lack of Even, Standardized Services Statewide

Consensus Recommendations from MHMRSAS Legislative Studies (1949-2000)


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Solutions will be found in …

Resources

Law

Reform

Service

Capacity


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The Three Legged Stool• Law Reform

– the statutory framework for delivering mental health services

– State and local policies governing care provided by public and private agencies and providers

• Service Capacity– the continuing need for private and public community-

based services accessible by all Virginians

• Resources – funding (SGF, local funds, Medicaid/Medicare and other

insurance, SSDI, Auxiliary Grant support, etc.)


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Conceptual Model• Capacity Components necessary to improve

access to other private and public community based services

Early Intervention and Treatment services

Crisis Response Services

Intensive Support Services


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Early Intervention and Treatment services(Crisis Avoidance)

•Outpatient Counseling•Outpatient Psychiatry•Open referral to one # for all services•Education•Advance Directives•In-home or community respite•Linkages with other agencies

Capacity Components


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Crisis Response Services

•Crisis Intervention•Crisis Stabilization•Inpatient Acute Care•Urgent care•Crisis Intervention Teams (CIT)•Non criminal justice transportation•Peer and natural supports

Capacity Components


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DISPOSITION

INTERVENTION STABILIZATION REFERRAL

EMERGENCY MENTAL HEALTH CONTINUUM

CRISIS, ACCESS & RECOVERY

ASSESSMENT

ARRAY OF COMMUNITY RELEVANT SERVICES AND CENTERS

POLICE/SHERIFFSMAGISTRATES

EMSER

MH-ESHOTLINE

URGENT APPOINTMENTSQUICK MED VISITSMED AVAILABILITYDAY PROGRAMS

CRISIS STAB PROGRAMSCONSUMER RUN SUPPORTS

CRISIS CASE MGMTCRIMIINAL JUSTICE LIAISON

JAIL DIVERSIONJAIL MH SERVICESQUICK BENEFITSMEDICAL CARE

BLENDED SERVICESSA TREATMENT

LOCAL HOSPITAL BEDSSPECIAL JUSTICES

RESIDENTIAL SUPPORTSHOUSING

COMPETENT SYSTEM: ATTITUDE KNOWLEDGE SKILL


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Intensive Support Services

•Case Management•Psychiatry/Medication and treatment•Intensive Outpatient•In Home Crisis Management•Aggressive Engagement Services (PACT/ICT/ICM)•Day Treatment/Psychosocial

Capacity Components


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Intensive Support Services(cont.)

•Job Training and placement•Aggressive linkage with SUD services•Intensive Home Based services (MH supports)• Housing supports•Peer Support services

Capacity Components


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Proposed Mandated Services – All

CaseManagement

Outpatient

Residential/Housing

In-Home

Respite

Family Supports

Emergency ServicesCrisis Stabilization

Consumer

C&A

Inpatient/Acute Care

Both

Adult


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Va. Code Ann. § 37.2-500• Purpose; community services board;

services to be provided– The core of services provided by

community services boards within the cities and counties that they serve shall include emergency services and, subject to the availability of funds appropriated for them, case management services. The core of services may include…


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Proposed Revisions• Purpose; community services board; services to

be provided– The core of services provided by community

services boards within the cities and counties that they serve shall include emergency, crisis stabilization, case management, outpatient, respite, in-home, residential and housing support services. The core of services may include a comprehensive system of inpatient, prevention, early intervention, and other appropriate mental health, mental retardation, and substance abuse services necessary to provide individualized services and supports to persons with mental illnesses, mental retardation, or substance abuse.


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Policy and Resource Issues

• Health care insurance– Private and public– Benefits and reimbursement parity

• Medicaid Eligibility– 80% of FPL versus 100% of FPL

• Role of DMHMRSAS– Facilities versus communities


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Action PlanPhase One FY 2009 Phase Two FY 2010

Goal : Initiate a full array of crisis response services

Establish 29 crisis stabilization facilities Establish 9 additional crisis stabilization facilities

Goal : Revise § 37.2-500 of the Code of Virginia

Expand mandated core services n/a

Goal : Expand capacity of CSB targeted Case Management

Dedicated resources to increase CSB Case Management by 125 FTEs

Dedicated resources to increase CSB Case Management by 175 FTES


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Action Plan (cont.)Phase One FY 2009 Phase Two FY 2010

Goal : Implementation of CIT in each law enforcement jurisdiction

One third of all law enforcement jurisdictions implement CIT

Additional third of all law enforcement jurisdictions implement CIT

Goal : Expand access to Community Mental Health Outpatient Psychiatry (Public and Private)

DMHMRSAS comprehensive study of community psychiatry capability

Dedicated resources to expand community mental health outpatient psychiatry by 100 FTEs

Goal : Expansion of Medicaid eligibility

Change from 80% to 100% - $40 million

Sustaining expansion - $60 million


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Action Plan (cont.)Phase One FY 2009 Phase Two FY 2010

Goal : Expansion of Intensive Community Treatment Program/PACT

Funding for additional 18 Teams Funding for additional 9 Teams

Goal : Improved access to permanent housing

Creation of Portable Auxiliary Grants n/a

Questions ?

Contact Info:Charles A. Hall, Executive Director

Hampton-Newport [email protected]

Phone: (757) 245-0217

Documents

Access Task Force Report Presentation to House Health, Welfare and Institutions General Assembly Building September 6, 2007