CDA 2007-08 Budget Change Proposal - Mental Health

Exhibit A

California Department of Aging 2007-08 Budget Change Proposal

Mental Health Services Act

STATE OF CALIFORNIA BUDGET CHANGE PROPOSAL - COVER SHEET FOR FISCAL YEAR DF-46 (WORD Version)(REV 0705) lease re ort dolarc in thousands BCP PRIORITY NO 10 2

ORGCODE DEPARTMENT 4170 AGING

PROGRAM 40

ELEMENT COMPONENT

TITLE OF PROPOSED CHANGE IMPROVING ACCESS TO MENTAL HEALTH SERVICES FOR OLDER PERSONS AND ADULTS WITH DISABILITIES

SUMMARY OF PROPOSED CHANGES

This Budget Change Proposal requests approval for one (10) position and $93000 authority to coordinate and monitor efforts to Improve access to mental health services for older persons and adults with disabilities This position will be funded from the Mental Health Services Fund

n FUTURE SAVINGS o REVENUElZl FULL-YEAR COSTS

BUDGET IMPACT-PROVIDE LIST AND MARK IF APPLICABLE J OI~E-TIME COST

CODE SECTION(S) TO BE AMENDEDADDED

DYES lZl NO

REQUIRES LEGISLATION

FOR IT REOUESTS SPECIFY THE DATE SPECLtL PROJECT REPORT (SPRi OR FEASIBILITY STUDY REPORT (FSR) WtS APPROVED BY THE OOPARTMENT OF FINANCE

DATE PROJCT FSR 0 OR SS ~

IF ROPOSlL-pF=C7S ~NJ~HEr DFJR IiENT DC1cS O-rrl== CJ=PAR ~ MEN I CONUR VTH P~()OS~L7

TTumiddotri )-~llmiddotJicl-TS OF JCmiddot~2[ DEPfRTImiddot1cfr SlJhlCD l-middotJD D--E[ B- -IE DcPA27 iJlEliT DIRECTOF- ) 0ESI31JE

DEPARTMENT Or FINANCE ANALYST USE AODITIO)iAL REViEW)

40

STATE OF CALIFORNIA IDepartmentefiFinanoe BUDGET CHANGE PROPOSAL-FISCAL DETAIL ~15iLStreet --- shy - - __ STATE OPERATIONS SaclltlTllenlo LA 95B1i1 DF-46 (REV 07106) IMSWiail Code A-15_ _

~ R r~ ~

TITLE OF PROPOSED CHANGE Iv1EI~TAL HEALTH

PROGRAM

IDATE

ELEMENT COMPONENT

TOTAL SALARIES AND WAGES 1

PERSONNEL YEARS

CY BY BY + 1

10 10 CY

$ BY

$ 56 BY + 1

$59

SALARY SAVINGS --3 --3

NET TOTAL SALARIES AND WAGES

STAFF BENEFITS

$

$

$53

$21

$ 56

$22

TOTAL PERSONAL SERVICES $ $74 $78

OPERATING EXPENSES AND EQUIPMENT lt-FNERAI EXPENSE 11 l PRINTING 1 1 COMMUNICATIONS 1 1 POSTAGE TRAVEL IN STATE 6 6 TRAVEL-DUT OE STATE TRAINING 1 1 FACILITIES OPERATIONS 6 6 UTILITIES CONSULTIIG amp PROFEESIOIAL SERICS Imerder-artmenlalmiddot CONSULTING amp PROFESSIOIAL SERVICES External DEPT OF TECHNOLOGY SERVICES CONSOLIDATED DATA CENTER DATA PROCESSI NG 1 1 EQUIPMENT DEBT SERVICE OTHER ITEMS OF EXPENSE (soecifv below

TOT AL OPERATING EXPENSES AND EQUIPMENT $ $19 $19 SPECIAL ITEMS OF EXPENSE $ $ $

TOTAL STATE OPERATIONS EXPENDITURES $ I s 93 I S ~J7

SOURCE OF FUNDS APPROPRIATION NO

ORG I RF I FUND i 1 $ - ---- -

=EDEFA iUIDS CTrl=F FUND I1-F) 001 2EIf5IJF~ScMI~ IS

-- =AIZ=(- ~~7ll JI- ~ - ~=- 8~ _lt~IL7Ilmiddot ~ It- SAFI-- ~ 4CE 3JPP=iJ~~ln P~0VlD LIEraquoI- 81 -LGE l~

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ST AFF BENEFITS DETAIL

CY BY BY 1 (WHOLE DOLLARS)

OASDI $ $ $

HEALTH INSURAICE

RETIREMENT

WORKERS COMPENSLTIOI

risc~1 Detail Continued LOCAL ASIQ ANCE AIgtlD DTAIL OF S~AFF BIcFITC AND PPSOIJAL SiPVICiS - - - - shy

-----_

$56287 $591

~ ~

LOCAL ASSISTANCE $( I 5( ) I $1

gtOURCE OF FUNDS

APPROPRI~TION ID I

ORG REF FUND

ENERAL FUND $ $ $

SPECIAL FUNDS $ $ $

FEDERAL FUNDS $ $ $

OTHER FUIJDS $ $ $

REIMBURSEMENTS $ $ $

POSITIONS SALARYRANGE AMOUNT

CLASSIFICATION 1 CY BY BY 1 (WHOLE DOLLARSI I CY BY BY + 1

Assoc Gov Prog An 10 10 $4255-5172 $ $56287 $591C

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10fjTOT AL SALARIES AND 10 0shy S WAGES bull

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CALIFORNIA DEPARTMENT OF AGING 2007-08 GOVERIlORS BUDGET

BUDGET CHAI~GE PROPOSAL 10

Titlelmproving Access to Mental Health Services for Older Persons and Adults with bisabilities

A Nature of the Request

This Budget Change Proposal (BGP) requests one permanent AGPA position effective fisc11) year (FY) 2007-08 tDprDvide programmatic expertise on the mental health issues of the population seNeaby the California Department of Aging (GOA Dr Department) This postion is necessary in Drder fDr GDA to participate in addressing the significant under serving of the older adults by the existing mental health system The position would (1) facilitate and provide technical assistance to local entities in their ellorts to establish andlor expand mental health service models responsive to the needs of older adJ~s a11dlqr adultswith disabilities (2) serve as an internal consultant to CDA

prcigranw onptbmising practicesthat increase access to effective merita I health serviceslor older persqnsand adults with disabilities and (3) support CDAs active participation in the state leveipolicy and implementation activities pertaining to the implementation of the Mental Health Services Act (Iv1HSA) and the implementation of

the Older Adult System of Care model

The position will be 100 percent funded through the Department of Mental Health IJlemal Health Services Fund state operations monies

B BackgroundHistory

Historicallneouities in Mental Health Services for Older Adults

An estimated 20 percent of adults age 55 and over experience mental disorders that are not a part of normal agfng The most common disorders in order of prevalence are anxiety disorders such as phobias and obsessive-compulsive disor6ers severe cognitive impairments including Aliheimers Disease and mood disorderssuch as depression Schizophrenia and personality disorders are less common2

However some studies indicate that mental disorders In older adults arc substantially undem~ported One study for example bund thai 8middot20 percent of older dults in a community and up to 37 peren1 of thase receiving tgtnmary care erpe~len(E symptOIT1S of deDression i Ar estimated two thirds 07 Ii Ifsing hJnlE reSidents sJner from 3 nlent3

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Poor physical health is a key risk factor for mental disorders One of the hallmarks of late life depression is its co-existence with physical health conditions Medical illnesses may develop independently from mental illness but may also be associated with them For example one epidemiological study found that chronic depression (lastin9 an average of four years) raises therisk for cancer by 8a percent in older adults

Left untreated mental illness can tum minor medna~ic9ndt~nsintg life-threateping condition 2 Medical comorbidity is present in the majority of older adults with s~iious mental illness and isassociated with worse medical outcomes~ncffiigFiermortality compared to ind ividuals without mental illness 14 -

While family care giving has been docul11ent~d as delayinQ th~institutionalization of an ill relative that role puts family caregivers themselve~ at risk of physical and mental illness

4 Older spouses siblings ancJ childrerlin their 90~ ~nd 10smake up a sizeable

portion Qf tt1f~t cEiregiver gro~ROnestiJdyjqup~hElt 4~ ~er~~~~ffamflYcaregivers wece c1inicaily depressedbUt only 10-20 percent ofJhose individuals usecl any formal serviceslfhichmJ9hj have i~dfJped thEjfJev~ fstr~s56]

~Id~[adult~~av~ the hi~h~~f ~~idde rates in the us poplllatidn SLiiciCJe rates increase with ag~Cldec whit~l)1poundln ha~ihg a fCite of suiCidefwPtbfive tiines Iliat of the general population~ Caiifornias suicicle rate mirror~the naflohaf rates with males age

85 and over account for the highest age-specific SUicide iates middot

Althougmiddotti older adults repres~nt 13 percent rlthe US ppulation they receive only 6 percent of community mental health services 10 In California 46 percent 6f county Medi-Cal mental health services are spent in care for older adultsl

Six factors account for older adults significant underulilization of mental health services

1 Stig ma associated with being diagnosed as having a mentalilrness and myths about what is nomnal aging (eg depression may be viewed as normal given an individuals functional loss painloss of spouse reduced interest in life etc)

2 Lack of PhysicianMental Health Practitioner Geriatric 1raining Older adults most frequently express physical complaints that in fact could be sYmptoms of their mental health problems to their primary care physician (PCPs) But most PCPs have received little if any specialized training on geriatric mental health diagnosis and treatment Most mental health practitioners have also received little if any specialized geriatric education This lack of training has tragic consequences One third of older adults who commit suicide have visited their PCP within a week befo~e their death seventy percen1 have seen their PCP within the month prior to their death These were missed opportunities for depression screening and intervention

3 Need for Specialized Geriatric Assessment and Diaanostic Tools Older adul1s often present different symptorns of mental illness than younger people It may be mar difficult to distinguish mental health symptoms from other potential or co-occurrirq chronic health problems Because of these differences specialized assessmenlad

2

diagnosis tools and treatment models may be needed to effectively treat an older adults menial disorder

4 Limited Illedicare Coverage Medicare the primary health insurer for older adults reflects the tradrtionallack of parity in covering mental health services Given thai limited coverage it is not surprising that only 057 percent of tolal lv1edicare expenditures are for mental health services Medicare provide 80 payment for medically based services the beneficiary is then responsible for the 20 copayrnent But for non-medical mental health services~ middotsuch as psychotherapy

rViedicare provides only5Q percent of the payment reqLirirrgmiddotthe Ereneficiaryto pay the 50 copayment Prior to the implementation of Medicare Part 0 thebeneficiary wouid also have to pay 100 percent of any medications prescribed for their mental health condition Medicares low provider reimbursement to psychiatrists has also created a fiscal disincentive to specialize in geriatric psychiatry

5 Frationing Resources SomEstate and federalpolicymakers have rationalizednot funding geriatricmentalhealthservices because older adulishavetradltionally underutilized generic mental health services Others hltjve rationalized that scarce resources should go to younger people more responsive to treatment and with a longer life expectancy Research over the past decade demonstrates that cost effective models of geriatric mental health treatment exist andthat the cost of geriatric mental health problems will be borne by society either through ihcreased mediial health utilization or through appropriate mental health treatment

6 Fear of Overwhelmino the Mental Health Svstem The high incidence of Alzheimers and otrler relatM demeqtias in advancedage ieg an 8stimated 45 percEiJillo the population age 85 aridover has some symptoms ofdementia) and the prevalence

of co-occurring severe mentaJ illness among those with Alzheimers disease or other dementias has traditionally created panic among the funders of mental health due to concerns thatif they treat the cOo-occurring mental health condition they will also end up footing the bill for the individuals on-going long term care costs particularly since it may be difficult to find suitable housing for these individuals

This understandable concern has resulted In older adults with dementia and coshyoccurring mental health conditions receiving very little assistance from county funded mental health services Among persons with dementia an estimated 5middot20 percent have hallucinations while 13-33 percen1 have delusions An estimated 50 percent of persons with Alzheimers disease meet the criteria for major depression or dysthymia ~epression is etremely common in persons with vascular dementia

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Given this patchwork of community services and the large gaps in resources to serve a geriatric population when a crisis does occur older adults with mental illness are significantly more likely to be admitted to a nursing home and remain there because the needed community supports do not exist or are overburdened This pattern persists ever1lhough shorl-term intervention with care ma(lagernent follow up would bemore cbst eff~ctivemiddot than on-going institutionalization

~

Departmentdf Aging Responsibilities

The Cllifomia Department of Aging administers prQgrams serving older adults adults withdisabiJities family caregivers and residents inlongcterm care fqdlities throughout the state Funding for these serviCes comes from the federalOlder AmericanS Act the states Older Californians Act and the Medi-Cal program The array of programs and services includes information and asistance in-home services congregate and home-delivered meals commul1ityservice employment advocacy and prcit~ction health insurance counseling case management long-term care Ombudsman services alid~espite services Tbe Department a150h~s PfoWam oy~r~i~~tfltr app~oximately 200 Adult-DayHealth CareurolCenters and 56 AIhe1rne(s Day Care ResourCe Centers and aciministerslhe Multipurpose Senior Services Program aMedi-Calwaiv~r serving over 10000 seniors throughout the state

CDA also serves on the CaliforniaGeriatr)c Edupation Center (GEC) Advisory Committee (funded under Title VII of the Public Health Services Act) that works with the UC and CSU campuses to ensure that physicians get some basic skills to address geriatric health issues including mental health

Although COA does not directly fund Qr admirlister mental healthseryices many of the supportive services administered by CDA help oider adults and adults with disabilities that have a mental illness to remain in the community The Family Caregiver Support Program also provides respite counseling and other supportive services to family members who may be ill equipped overwhelmed or seriously depressed as a result of their care giving responsibilities For example we know th9i 365 of the 47182 clients served in the Adult Day Health Care (ADHC) program have a psychiatric diagnosis

In Caiifornii the MAs are often the lead agency or a strong partner in advocating for increased mental health services for older adults and in seeking to build responsive service models in the counties they serve This is especially true in the larger counties where the County Department of Social Services is also the AAA But while CDA oversees the MAs the Department does not currently have staff to provide any significant input to them on mental health issues

Recent Federal Action

2005 While HOlse Conference on Aging (WHCoA) Every cleci3d~ the Prsiclent ~alls

for a WHCoA to identify from seniors and those who serve them wllat the most critical issues and needs are In December 2005 WHCDA clelegatEs voted on over 50 proposed resolutions Improved recognition assessment and treatment of mental

4

illnessand depression among older Americans -anked in th8tbp ten of the delegates priorities J c -

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r-~eM~~A(ProPQ~itfPnf3Jwas approved qy California voters ih2004 Th~ftJr]ding geriEmlted-bya rpercerit incr~asEith tneplterScicil iricome taido-radjtisledgross income QV~JS~ millOFI i~ tc bE used to expadil not supplant meilU31 hEathserii16eS~~fe MHSA requires that each 9punty develop with diverse local public input ci~pl~~fQrthe use6itl1ose funds This plan mustbe reviewedahd approved Bythe QepartiiP6nt of M~f)tal Health (DMH) and within the first three years the counties mustdetermine how Jh~yvill meet t~e spe~ial corilrnuriity~ervi~e and support needs ofchildren and youth Cldultl aridQldef adu~ts Theoverarching goals are to focus on outcomes and accqiJllfability culturcii 2cimpelehtein6utreach and service delivery and improving swices to underseiyecl populabbns Thelmpetus formiddotthe IvlHSAwas not just to raise additional mer-ital health servlqe revenues Its goal is to transform existing mental health services by identifying and evaluating promising evidence-based clinical practices and disseminating these innovations to increase the use of successful cost effective inteNentions Since older adults represent an underseNed population the county MHSA plans will specify a certain percentage of the overall funding request to improving mental l1ealth service~ for older adulls While each caunty plan must articulate how it will transform it~

local mental health system cJialogue across counties should be encouraged to Identify and share promising models lessons learned opportunities for cross-county cola~oration worUorci trIII1I9 and consumel-beLlsed apoaches for providing mental h~olth secJicl2s thai ar cocrjlnat=c vvith 0ther n~=d~d S)(i3htaltr sEfJimiddotes f~

currently unjersrved age gro~ps

C Stilte Level Considerationsraquo (

Gerleral FUhdCosAvoidance

6

Cos of Informal Careoiving

Not only middotis caregiliing assClated with increased riskto the caregivers physical arid men-tal healthbut the-nur)iber o(hours spellt in categivirig almost doubes when the older family member had mUltipledepressive symptoms Family caregiving Jor depressed older Americans represents a yearly cost of about $9 billion This cost translates into a significant societal economic cost and for many employers and - 18employees lost wor~ proa Uctlvlty

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-middotcmiddot

Promotes Olmstead Goalsand Objectives

Because older adults have historically been underserved by both federal and sJate mental health systems they are more likely to be institutionalized as a result of untreated and potentilly undiagnosed mental illness Family caregivers overwhelmed by i~eir responsibiliiies are not only at risk for health and mental illness but they may endanger the person they are caring for through physical or verbalabLJse or neglect In some cases early intervention respite and other services can support the family member in continuing to caie for their loved one in their own home In other cases the health and safety otboth the caregiver and the care recipient require that other car~ options are found This proposal would promote Californias Olmstead efforts by seeking to expand and beller coordinate the home and community based sErvices needed by older adults adults with physical disabilities and family care givErs w1o are suffering from a mental illness so that they can remain in or return tothe most independent setting possible

Health Safell and Qlalitv of Life Issues

Persons with mental illness suffer from debilitating depression delusions paranoia and cognitive disorders All oj these conditions significantly reduce an individuals quality of life and potentially jeopardize their health and safety They may re1use to take needed

medication for physical health conditions fail to maintain safe housing conditions putting them at risk for eviction may be unwilling to leave their home or refuse social service providers access to their home even though they are unable to perform their personal care needs or maintain their home Individuals with mental health disorders regardless of their age can nol only endanger their own well being they can endanger the life and safety of loved ones friends and neighbors and strangers in the community who could be victimied by their dangerous andor anti-social behavior Older middotadults particularly those age 85 and older the fastest growing age group hao the highest rate ot suiclde Without increased mental health screening and interventions cargeted 10 Older aj~lts this rate will likely cortlnCl8 to increase

D FACILITYCAPITAL OUTLAY CONSIDER~TIONS

~one

E JUSTIICLTION

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7

willlikey require additional social and health services a mUltidisciplinary apprDach a1 the local and state level will be required This multidisciplinary effort will need to include the AAAs adult day health care centers and the Med-Cal wavier program for older adults (ie the Multipurpose Senior Services Program [MSSPJ) althe localeve Menta health advocates expect the Department of Aging to be equally involve9 in these efforts at the state lellel HCiweverCDAhas not had any resqurctlsto allocate to these activities on an on-going basis

The Older Americans Act of 2006 establishesnev rElFuirements of tAs pertaining to older adult mental health screening and service delivery As the state unit on aging CDA will be responsible for overseeing AAAs in collaborating with the county mental health department and local mental health servi~e providers

Workload

The additional resources being reqJested would permit GDA to begin addressing these mental health issues across the Departments various programs The wo~ki6ad for the positions includes

Preparing a baseline assessment of AAA involvement in mental health activities Reviewing and updating assessment tools bull Reviewing local program referral protocols Delieloping state staff and local provider in-service training opportunities bull Partnerihg with other agenCies to encourage counties to impiement effective older

adult treatrnentmodels geriatric mental health training opportunities for PCPs and mental health practitioners and outreach to older adults (and their families) potentially in need of these services

bull RepresentingCDAon an on-goingbasis in the MHSA implementation process and at the meetings of the Older Adult Subcommittees of the California MentalHealth Planning Council and the County Mental Heaith Pirectors Association (CMHDA) The Planning Council and CMHDA meet quarterly and provide leadership in coordinating and promoting implementation of the Older Adult System of Care mode

bull DevelopingAAA Area Plan guidance to include AAA involvement in older adult mental health screening and service delivery and monitoring the submitted 33 Area Plans for this element

bull Providing internal CDA technical assistance on programmatic mental health issues and incorporating mental health considerations into the prog rams CPA administers

bull Acting as a liaison to the CA Geriatric Education Center via their Statewide Advisory Committee in fostering opportunities for primary care physicians mental health and social service practitioners to gain geriatric assessment diagnoses and treatment skill as well as an understanding of successful evidence-based mental health interventions for older aduits

-ne DMH does not have sufficient staff resources with expertise in both older adult mental services and the aging services system to directly prOVide thiS technical assistance to local cDunties and cornrnuiIIty partners as they sek fO implemn f the MHSIl

8

There is consensus that older adults havt been underserved by tht existing mental health system Failure to address these needs has translated into poor quality of life for many older Californians and transferred thoSE problems to a medlcalcare sys~em poorly equipped to address geriatric mental health needs Older adults represenUhe fastest growing segment of the states population Unless effective mental health treament options are implemented and practitioners trained to use them within the next decade California will resort to institutionalizing significantly increased numbers of older adults andthat cost will be borne by thellledi-Calltprogram with costly consequences to the slate general fund

Funding

This position would be funded through the Mental Health Services Fund for state operations OMH is aware of and hasa copy of this proposal

F OUTCOMES AND ACCOUNTABILITY

The incumbent In isposition will be reviewing Area Plans workingwith local AAAs monitoring and documenting outcomes to ensure increased coordination and promotion of community based mental health services for underserved older adults and adults with disabilities This position will assess opportunities to better incorporate mental health screening and strategies for improved mental healthreferrals ahd identify promising models and lessons learned across the programsadministered by COA

Through participation on the Older Adult Subcommitteesof the CA Ment1 Health Planning Council anc the CIv1HD AssQciatigtn thi position will be directly involved ir ttiC statewide MHSA efforts to implement improved services

As a liaison to the CA Geriatrlc Education Center via their Statewide Advisory Committee COA will be involved in fostering opportunities for primary care physicians mental health and social service practitioners to gain geriatric assessment-diagnoses and treaimenl skill as well as an understanding of successful evidence-based mental health interventions for older adults

G ANALYSIS OF ALL FEASIBLE ALTERNATIVES

Alternative One Establish one IoGPA position effective July 1 2007 using 1v1HSA services funding Tl1is alternative would assure sufficienl resources to respond to the need~ identified above

Increasing CCT~iU~lily l)as~ct m~)ta hEalth serv~~s 1e oide~ 301lts will r~dus~ C03tS tmiddot th~ G-2nerai FUld The lack )1 aliefJatle~ lTlean~ t~a1 -any oici-=r ci-nt~ middotnrv arE temporaril In5ttuturlaii2~d 10r eV3hlatlln I)r treatm-=n1 ir a ~5 en up slayln il th~ tnstilullDn2d ar pr-venllor and ~Clny mtEfl8ntlr sEric2F GcJid g=f1=rat2 I-Jl~d-=Ed

CJs1 aICnd8n~e 3iC lmprch th Qi3ilty of ilf~ icJ rnan~ (1ldsr an- dJso01~jC2dii3i-~

This aterra~r~lC ~0PCHis J-=tt-=I Jse cd lt~3ilfCJrli21~ scar~ ~J-S=llt- i5DJrS-5-S lr ~r

eilvirollrTl=ni IIVj~ jmiddotl~r~lency ~IJ1IE ElI~ Gver-scNvdec a~middoti t~l=euro- 3= (In-IOlrlg h(SfJl~3~

~ied S~IJ89~~ CCI1Ji12 s entire r~jj~l ci~ ~Y3~=rr i- (2r1i01 =- 18ctd [-

- inefficient treatment of patients with mental health issues It is known that even modest psychologiltai intervlntions have resulted in reduced hospital stays of app[oximately15 daYsP ltjgt

~- ~ ~~ r~ ~ Ii ~)~ j~ bull f ( 1 ~ i ~-c ~~- ibullbull c I

Thisaltfj(natlltew6lldpr6nioteCalitQrtiif~blmsfuadeffprtspySeekil)gtoexpaneJ and c t~t~~jbflr91~~~ff)~ppm~~h~SQlJ)lfll~~ ~~~~centsect~r~pe~~Qyen~~~~~yen~sectJ~c~9H1~~ ~e91~~tiWW~sI~eq~~~2NitsectJj~nclt~JX)II~WIE~J9J~~~~~p~f~pJf~q[g~~YJ~a)~ntar middotllnesssottjat neycanremlrr4IJpf (i1UrAmiddot~tIi~middotmp~t~fP~r1d 1m s~tprQpPSSJRle

~~ ~ ~~t~~j~i~~t~~~~~yen~J~~~ -(~~~~~lj)~~g~~tli ~~ijI3~0~ff1~FiJ~I~1middot Jmiddott5~ i) ~~4~poundiiitmiddot~~~ ~F1iiilr~lii~p~fQvEithi~a1i~J~atiemiddoto9G]4r~~sutr fRgfft~~)I~~lijyjffJ5~~j~ipjI~1ti M~S-Implemptatlo~ eff(~s(2) engaget JrI opp0rtlntl~sJo~~W+(~SA~Pl~~~re9

forgEmafnt mental health ~ervJcestli~t ~esults In sl9nl~9anJ Ci9l(ltDI~tratNe~Q~Pltal bed days when alternative dischaigeopliol]s canncjlbe founqabd (3)impllinerrti[ieiiOAA state oversight requirements pertaining to the AAAHOre in mentalheCilth screehing arid

se~i~)a~ 1i~~-tt~I~-middot~t~lt~~~iit~tr~~~~~~~~_~_~ AltElfflativETwo RecWecsaf(frorillithintheD~ pltirttn~1L

- f- ~ ~C-_middot - ~ ~~ ~ -~ ~~ middot~ ~~t~tft4ii~hJ6iL1r~j~~ ~~~i~~~~t~middot~c~~ - TnisaitefOltitiylgtiSDot pdssibleuro becalJse thcentDepartifienrGaD~ota5scrb-lflisvOtkload

( i~i~~JFW~k~~1Vp~)t~M8i~1f~~~R~I~~r~e~9k9amp~~R~tj$~rij~sectJiim~p~Atrd ~Irry9FJ~9flr~BF~~~~~~~Ut1~~i~19lI~g~8)~~wlB1F~M~~RrB~~Jr~tiii(Ij~lj9-rJij2r~alaudIt

f~~i~jfi~~~iBifl~iilffir~ditlli~~( ThiS alternatlve would eliminate the need toethe req Ieste position II would tesult In

~~~1iZtj~~J~1j~~0~~~7~~pound~~~ ThiS pq~ltr9n)NolJld b~esclbhsb~d asoi JulyJ 2007 1nd etfeqlvE Wnef tlie cUdget IS

it~~i1i~~ili~tIS~~~)]2tf~~JfJi CDA recommends approval of AlternativemiddotOn_e~middotltbull bull ~ -

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Establish theAGPA position-to p~rrnit~ CDAto 1) ~cjiely participate in_~~televel efforts aimed at increasing access to mental hea~h services for older adults and adults with disabilities(2) engagEi in efforts tomiddot cre~te effective home and comiriunity based mental health trealment options for older adults and (3) assist MAs in their role in merital health screening and service delivery

References

Department of Health and Human 3erviGes AdrTlInlsta(lon on Aging (January 2001) Older Aduls and MenIal Health Issues and Opportuniles Washmglon DC

Department of Heallh and Human Services (~999) Mental Health A Flepor from tile Surgeon Generat Rockville MD US Departmenl of Health and Human Services Substance AbuSB and Mental

10

- Health dmlnlstratiorl Senter for Mental Health Services l~atlonallnsutute~ aT Healttl llaliona InslltUles of Mental Health

Burns 8 et al (1993) Mental HealthService Use by the Elderly in Nursing Homes American Journal of PubliC Health 83331middot337

4 Whitlach CJ and Noelker LS (1996) Caregiving and Caring In JE Birrer (Ed) Encyclopedia of Gerontqlogy New York Academic Press

bull Cohen D el al (1990) Caring for Relatives With Alzheimers disease The mental health risks to spouses adull children and ottler famil) caregivers Behavior Heallil aM Aging 1 171-182

bull Brody EM (1990) Women in the Middle Their Parent Care Years New York Sprlffger Publisl1ing Company

Gwyther LP (1990) Clfnician and Family A Partnership tor Support In blL Mace(Ed) Dementia Care Patient Family and Community Baltimore MD The John Hopkins -University Press

Hoyert el al Deaths Final Data for 1997 National Vital Statistics Reports47(9) Hyattsville MD National Center for Health Statistics

CA Department of Health Services Center tor Health Statistics Suicide Deaths 2000-2003 Sacramento CA DS05-08001middot

10 US Departmenl of Health and Human ServicesSubstance Abuse ~nd Mental -iealth Services Administration Center for Mental Health Services (2005) COnimunity Integration toOlder Adults with Mental Illness Overcoming Barriers and Seiiing Opportunities Rockviile MD DHHS Publication No (SMA) 05middot4018

Unpublished CP Department at Mental Heatth information

~ Cummings JL Dementia-syndromes Neurobenavlorai ana neuropsycillatnc leaUJres Juurncll 0 Clinical Psychialry 1987 48 (5 Suppl) 3-8

13 Pettracca G Teson A Chemerinski E p double-blind placebo-controlled sludy of clomrpramine in depressed patients with Alzheimers disease JOlrnal of loJelropsychlatric Clinical Nelroscience 1996 8 270-275

Druss BG et al Quality of medical care and excess mortalit) in older patients with mental disorders Archives 01 General Psychiatry 58(6) 565-572

I Unutzer J et al Depressive Symptoms and the Cost 01 Heatt Services in HMO Fatrents pged 65

Years and Older ~ Four-Year ProspeclJVe Study Journal 01 the Amenca Medical ASSOCiation 1997 277 (20) 1e1~ 1623

-ataf WJ e~ at Increased IVleciical Costs of a PopulatlormiddotBased Sample of Depressec Eloerly Fallants Ar-IIile~ of SlIanc Ps)chiarry 200260 (9) 897 I~J03

~

ilum101d e at I- hJ~o ~oCJY al EJIs-fe DOll rEducC G(~S oj iJleolca Utiiiatlcgtr ~cll(lwrig

jlena Hraltrr fE3tmb-n ir18rcar JournClI v PS(uczfy oj get ~ i I ~ ~ -4 S-l ~8

E Lang2- It e~ o~ E~en zn~ C5~ D~ iniurrla Car~QIif lo~ Di=i=f Lmn3~middot IIHmiddot ~vn~Hmiddotlrmiddot

)~pfeSIHmiddot ~r~~Jr J~ur31 of PyG)jar Imiddotjcv ( ~~ isi ~~- middott~

WORKLOAD ANALYSIS Department of A~ing

Establishing a GeriatricMentall1E)alth Specialist

Associate Government Program Analyst I _ --- shy

Activity Number Hours Total of per Hours-

- It~ms Item Represent CDA at quarterly meetings of the general Mental 78 Varies 236 Health Planning Council meetings and the older Adults Subcommittee meetings Attend monthly Mental Health Services Act Oversight and Accountability Comm(ssion meetings Participate iri County Welfare Directors Older Adult Taskforce meetings when adult protective services ahamental health isstleigt for older adults adGlls with disabilities and family caregivers are to be discussed Reporl back to CDA beputy Director for Long Term Care and Aging Division on relevant issues raised at these meetin9s Present key issues at CA Association of Area

AdenCies on Aaihg(C4A) meetinQs July 2007on-aoino

Prepare a baseline assessment of AAA cUrrent involvement 33 2 66 in (1 )ffiforts to coordinateimprove mental health access and service delivery (2) public education on these issues (3) screening activities and (4) funding mental health services for these populations Baseline survey will be used to measure local improvements made which will be identified in the AAA Area Plans and annual updates July 20G7-December 2007 Review and approve the 33 AAA area plan sections 66 On-going 198 addressing provision of mental health services for compliance with AoA requirements Provide technical assistanceto MAs whose plans do not meet the reo uirements On-ooina Identify potentially promising practices andor innovative Varies On-going 386 approaches in addressing older adult and caregiver mental health issues from Area Plan reviews Analyze findings from these practicesinnovations to determine their value in increasing public awareness of older adult and caregiver mental health issues improved access to mental health services including screening and the degree to which I Iincreased home and community-based mental health services for these populations can reduce Iinstitutionalization and generate General Fund cost savings I

IlOn-going I - I __-

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Review assessment screening and carE management tools I 308 On-going I 400 and protocols being used by Linlages thE lViuitipurpose iSenior Services Program (MESP) thE AAA Information and

Assistance Programs and the Adult Day Health Care i Program to identify improvements that could be rnade in I

I these programs to better screen for potential mental health 1issues make appropriate reJerrals for services provide

Ineeded services (for ADHC clients) and improve multidisciplinary care management practices to monitor mental health issues On-going Facilitate in-service opportunities for appropriate CDA staff Varies On-going 310 on geriatric mental health issues organize presentations on mental health issues for older adults adults with disabilities and family caregivers at the C4)1 Allied Leadership ConJerence (to include promising practices at the county level MHSA implementation updatesissues etc) convene teleconference technical assistance calis with various CDA contractors (eg AAAs IampA subcontractors MSSP site staff Linkages program staff) in order to increase awareness of and access to mental health services for these popUlations On-goina Identify or develop in conjunction with other relevant state Varies On-going 204 and county organizations public information materials on

the unique mental health issues for these populations that

canbe distributed by the aging network and through ttl medi~ Beginning in January 2008 and On-going Total hours for workload projected for this 1BOO

classification 11 BOO hours = 1 PY IActual number of PYs requested 10

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STATE OF CALIFORNIA BUDGET CHANGE PROPOSAL - COVER SHEET FOR FISCAL YEAR DF-46 (WORD Version)(REV 0705) lease re ort dolarc in thousands BCP PRIORITY NO 10 2

ORGCODE DEPARTMENT 4170 AGING

PROGRAM 40

ELEMENT COMPONENT

TITLE OF PROPOSED CHANGE IMPROVING ACCESS TO MENTAL HEALTH SERVICES FOR OLDER PERSONS AND ADULTS WITH DISABILITIES

SUMMARY OF PROPOSED CHANGES

This Budget Change Proposal requests approval for one (10) position and $93000 authority to coordinate and monitor efforts to Improve access to mental health services for older persons and adults with disabilities This position will be funded from the Mental Health Services Fund

n FUTURE SAVINGS o REVENUElZl FULL-YEAR COSTS

BUDGET IMPACT-PROVIDE LIST AND MARK IF APPLICABLE J OI~E-TIME COST

CODE SECTION(S) TO BE AMENDEDADDED

DYES lZl NO

REQUIRES LEGISLATION

FOR IT REOUESTS SPECIFY THE DATE SPECLtL PROJECT REPORT (SPRi OR FEASIBILITY STUDY REPORT (FSR) WtS APPROVED BY THE OOPARTMENT OF FINANCE

DATE PROJCT FSR 0 OR SS ~

IF ROPOSlL-pF=C7S ~NJ~HEr DFJR IiENT DC1cS O-rrl== CJ=PAR ~ MEN I CONUR VTH P~()OS~L7

TTumiddotri )-~llmiddotJicl-TS OF JCmiddot~2[ DEPfRTImiddot1cfr SlJhlCD l-middotJD D--E[ B- -IE DcPA27 iJlEliT DIRECTOF- ) 0ESI31JE

DEPARTMENT Or FINANCE ANALYST USE AODITIO)iAL REViEW)

40


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PROGRAM

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APPROPRI~TION ID I

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Documents

CDA 2007-08 Budget Change Proposal - Mental Health