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DSHS COMMUNITY MENTAL HEALTH CRISIS SERVICES. IMPLEMENTATION OVERVIEW MEETING Thursday, August 2, 2007 9:30 a.m. – 4:00 p.m. AGENDA. Welcome and Introductions – Joe Vesowate 9:30 am Opening Remarks – Dr. Lakey 9:45 am Review of Committee’s Work – Joe Vesowate 10:00 am

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Dshs community mental health crisis services
DSHS COMMUNITY MENTAL HEALTH CRISIS SERVICES

IMPLEMENTATION OVERVIEW

MEETING

Thursday, August 2, 2007

9:30 a.m. – 4:00 p.m.


Agenda
AGENDA

  • Welcome and Introductions – Joe Vesowate 9:30 am

  • Opening Remarks – Dr. Lakey 9:45 am

  • Review of Committee’s Work – Joe Vesowate 10:00 am

  • Results of Legislature – Kirk Cole 10:30 am

  • Implementation Overview – Mike Maples 10:45 am

  • Break for Lunch 11:30 am

  • Committee Discussion – Implementation Overview 12:45 pm

  • Public Comment 2:15 pm

  • Final Comments – Committee Members 3:45 pm

  • *Adjourn 4:00 pm

    *The adjournment time may be extended to 4:30 p.m. to allow

    more time for public comment, if needed.



OPENING

REMARKS


OVERVIEW OF

CRISIS REDESIGN

COMMITTEE


Crisis redesign committee
CRISIS REDESIGN COMMITTEE

  • Medical professionals (TSPP, Medical Directors of MH Centers)

  • Hospitals (THA, Hospital Districts)

  • Law enforcement (Sheriffs, Police)

  • Judges

  • Advocacy organizations (MHA, NAMI, Advocacy, Inc., et al)

  • Community MH centers

  • DSHS staff


Charge
CHARGE

Develop recommendations for a comprehensive array of specific services to meet the needs of Texans having a mental health and/or substance abuse crisis


Work process
WORK PROCESS

  • Evaluation of existing services and data review

  • Review of biomedical and social services literature

  • Public testimony

  • Formation of four subcommittees

    • Clinical Design

    • Rural

    • Collaboration

    • Finance

  • Report



Projected Number of Persons Needing Crisis Servicesto Increase Dramatically Compared to that Expected from a General Population Increase

Note: Projected number of persons needing crisis services based on 13% increase in number receiving front-door crisis services from FY2005 to FY2006 projected forward each year, and 5% increase in number receiving community mental health services from FY2005 to FY2006 projected forward each year, 21% of whom receive community crisis services. Expected general population estimates based on 2.01% increase in Texas population (all ages) each year from 2005 to 2009.

Sources: DSHS Mental Retardation and Behavioral Health Outpatient Warehouse (MBOW); Texas Population Percent Change, All Ages, 2004-2010, Texas Data Center.


Background
BACKGROUND

The committee was composed of more than 20 individuals representing local government, mental health professionals, hospitals, judges, law enforcement, advocacy organizations, local mental health authorities and DSHS staff.


COMMUNITY

SURVEYS


Community surveys
COMMUNITY SURVEYS

  • 1600 surveys were mailed before

    September 1, 2005.

  • 700 returned for overall return rate of 44%.

  • 570 to Community Hospital Emergency Departments

    • 258 were returned for a response rate of 45%

  • 1030 to Law Enforcement, Sheriff Departments, Chiefs of Police

    • 442 returned for a response rate of 43%


Survey results
SURVEY RESULTS

  • Primary concerns of both Hospital/ER staff and Law Enforcement:

    • Timeliness of MHMR response

    • Use of “No Harm Contracts”

    • Issues related to requiring medical clearance

    • Need for improved communication and coordination

  • Law Enforcement also frequently mentioned:

    • Issues related to substance abuse

    • Need for more procedures and written agreements with LMHAs

      All appeared to recognize the need for coordination to improve the system.


Site visits and hearings
SITE VISITS AND HEARINGS

  • February 7, 2006 – San Antonio

  • February 15, 2006 – Austin

  • February 23, 2006 – Big Spring

  • February 27, 2006 - Harlingen


CRISIS

THEMES


Major issues
MAJOR ISSUES

  • Information

  • Attitude of providers

  • Specialists – competent, well-trained, appropriate attitude

  • No harm contracts

  • Standardized approach – assessment, services, etc.


Major issues1
MAJOR ISSUES

  • Training – crisis workers - assessment, suicide, substance abuse, law enforcement (CIT, MH Deputies), families

  • Integration with health

  • Medical evaluations/clearance – waiting time, consistency

  • Attention to families

  • Mobility orientation


Major issues2
MAJOR ISSUES

  • Types of services – crisis hotline, mobile outreach, 23 hr. evaluation, residential, trained law enforcement, etc.

  • Jail as an option – due to long waiting time, lack of options, unreceptiveness

  • Need for forensic system – individuals who may be dangerous

  • Courts – mental health and substance abuse


Major issues3
MAJOR ISSUES

  • Transportation – responsibility, availability, distance, cost, diversion of resources

  • Rural issues – distance, transportation, lack of professionals (MH/SA, healthcare, law enforcement), telemedicine

  • Involuntary status as admission criteria for state hospitals

  • Financial resources necessary


Major issues4
MAJOR ISSUES

  • Children

  • Data

  • Cultural competency

  • Collaboration

  • Outpatient services


Subcommittees
SUBCOMMITTEES

  • Clinical Services

  • Rural

  • Finance

  • Collaboration and Partnerships

    * Special issue subcommittee - Transportation


Core crisis services report recommendations
CORE CRISIS SERVICESREPORT RECOMMENDATIONS

  • Crisis Hotline

  • 23-48 Hour Observation

  • Crisis Outpatient Services

  • Community Crisis Residential Services

  • Mobile Outreach

  • Law Enforcement Crisis Intervention Team (CIT) and MH Deputy Programs


RESULTS OF

LEGISLATURE


Funding for mh crisis services redesign
FUNDING FOR MH CRISIS SERVICES REDESIGN

For the Years Ending

Aug. 31, 2008Aug. 31, 2009

$27,317,890 $54,682,110


Dshs budget rider
DSHS BUDGET RIDER

  • Use methodology that allocates a portion of the funds to achieve equity in state funding among local mental health authorities, a portion on a per capita basis, and a portion using a competitive process.

  • DSHS to submit allocation plan to Legislative Budget Board (LBB) and Governor prior to distribution of funding.

  • DSHS to report quarterly to LBB and governor on implementation of community mental health crisis services.


Dshs budget rider1
DSHS BUDGET RIDER

  • DSHS to develop performance measures for quarterly reporting, which may include:

    • Number of new psychiatric emergency 23/48 hour observation sites;

    • Number of persons receiving 23/48 observation, mobile outreach, and children’s crisis outpatient services;

    • Mental health relapse and hospitalization rates for clients receiving crisis services;


Dshs budget rider2
DSHS BUDGET RIDER

  • Number of DSHS-funded staff with hotline certification;

  • Percent of stakeholders satisfied with crisis services; and

  • Criminal justice recidivism rates for clients receiving crisis services.


Dshs budget rider3
DSHS BUDGET RIDER

  • DSHS to contract with independent entity for an evaluation of community mental health crisis services.

  • Evaluation to include analysis of the implementation of crisis services.

  • Evaluation to include analysis of the impact of crisis services on clients, local communities, mental health and health care providers, and law enforcement.


Dshs budget rider4
DSHS BUDGET RIDER

  • DSHS to submit evaluation to LBB, Governor, and standing committees of Senate and House of Representatives having primary jurisdiction over health and human services by January 1, 2009.


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