MHSA Stakeholder Survey on Sequestration March 2013

1. MHSA Stakeholder Survey on SequestrationMarch 2013 Mimi Martinez McKay, M.A. M.L.I.S. Director, MHSA Information Services Mental Health and Substance Abuse Division 18 April 2013

2. About the Survey • On March 1, 2013, a series of automatic spending cuts —called the sequester – became federal law. • In early March, DSHS received guidance regarding this law from the Substance Abuse and Mental Health Services Administration (SAMHSA) about the sequestration cuts to the federal block grants they administer. • Both the substance abuse and mental health grants are scheduled to be reduced by an across the board 5% for this federal fiscal year (ending September 2013). • In Texas, this amounts to a $6.7 million reduction for substance abuse services and a $1.72 million reduction for mental health services. • It is important to note that since an approved federal budget is still pending the award amounts that these figures are based on are still subject to change.

3. About the Survey • To assist us in determining how sequestration cuts will be imposed, DSHS solicited input from our stakeholders via the short, anonymous survey presented below, which would have taken approximately five minutes to complete. • Section 1 focused on reductions to substance abuse funding; Section 2 focused on reductions to mental health funding, and concluded with an opportunity to provide additional input via the survey as well as information to contact us directly outside of the survey. General demographic information was requested at the end of the survey in an optional area. • For background information on the projected impact of sequestration, by state, respondents were advised to review the Sequester Fact Sheet for Texas published by the White House (http://www.whitehouse.gov/sites/default/files/docs/sequester-factsheets/Texas.pdf ) • The deadline to submit this survey was Friday, March 22 at 5 PM. There were 259 responses submitted by the deadline.

4. Substance Abuse Services • 1. Should reductions in federal funding for substance abuse services be applied to targeted programs or populations, or should the reduction be applied across programs in equal measure? Page 4

5. Substance Abuse Services • 2. If program funding is reduced, should the reduction target programs for children and adolescents or adults? Page 5

6. Substance Abuse Services 3. If program funding is reduced, should the reduction target programs at a specific point on the service continuum? Page 6

7. Substance Abuse Services 4. If program funding is reduced through targeted reductions, should the reductions hold harmless any programs for the following reason: Page 7

8. Substance Abuse Services “Other” responses for Substance Abuse Services question 4: • All underserved groups share in cuts equally • Rural communities • I don’t understand what hold harmless means • Indigent/homeless • Treatment for pregnant and detox participants • Minority populations • No -- keep the cuts even • Outreach/communications efforts • Evidence based treatment over recovery supports that don’t work • Low income/uninsured • Either avoid small projects or completely eliminate them • Homeless • Red Ribbon Rally – only way DSHS reached kids directly • Eliminate OSARs • Use stats to find out’s not working and cut those programs • Residential detoxification • Homeless & offender programs • Economically deprived • Rural areas should not be targeted • Don’t give up on rural communities. Urban areas are better-equipped to help their populations even if they complain about it. • Opiate addicted pregnant women • Detox and inpatient • Partnership for a Drug-Free Texas, the Capitol Red Ribbon Rally, and the 877-966-3784 (877-9-NO DRUG) • Direct messaging on how to access substance abuse services • Homeless pops • Dual Diagnosis treatment programs (treat substance abuse + mental illness at the same time) • Seniors • Ex-offenders, veterans • Forensic • Coalitions • Communication efforts on parity • substance abuse user referral hotline • Homeless and mentally ill • Clients served through DFPS referral • Criminal Justice/Reentry • Increased requests for services and proven results for evidence based practices, any services to women & children

9. Mental Health Services 1. Should reductions in federal funding for mental health services be applied to targeted programs or populations, or should the reduction be applied across programs in equal measure? Page 9

10. Mental Health Services • 2. If program funding is reduced, should the reduction target programs for children and adolescents or adults? Page 10

11. Mental Health Services 3. If program funding is reduced through targeted reductions, should the reductions hold harmless any programs for the following reason: Page 11

12. Mental Health Services “Other” responses for Mental Health Services question 3: • All underserved groups • All share in cut equally • Rural communities • I don’t know what hold harmless means • Indigent/homeless • Crisis intervention services • No keep it even • Outreach efforts • Services beyond SMI! • Low income/uninsured • Homeless • Communication efforts to the public at large • Homeless, offenders • Economically deprived • Rural areas should be targeted last • Don’t give up on rural communities. Urban areas are better-equipped to help their populations even if they complain about it. • Overserving in Childrens and in Adult Services • Project LAUNCH • None • Mental Health care is so lacking in Texas and I would hate to see any reduction in care. Alcoholism is a disease, not a crime, so more education should be done re the responsibilities of family and friends of alcoholics. • Homeless, children in state custody, uninsured • Treatment for dual diagnosis population (individuals with both substance abuse and mental illness diagnoses) • Seniors • Veterans, ex-offenders • Forensic • MCOT department • Care services • Jail diversion • Underprivileged youth • Special needs children need access to all services

13. Respondent Demographic Information Please select all that apply:

14. Respondent Affiliation If applicable, please indicate your affiliation with any of the following DSHS-related groups below:

15. Respondent Affiliation “Other” responses for question regarding affiliation: • Mental Health Professional • Concerned Citizen • LCDC • None of the above • TRI & ROSC • CPS • Provider • MHMR Employee • LMHA • ROSC • Clinician • TAAP member • Austin Area HIV Planning Council • Provider • Substance Abuse Prevention • MHP • Provider • TMA Council on Science and Public Health • Veterans’ Services/LMHA • Longtime substance abuse treatment provider • Substance Abuse provider • Counselor • Texas Council of Community Centers • Texas Community Center System • Local MH Authority/Provider • Community center, private provider • Project LAUNCH Advisory Council member • Mental health services consumer • Hospital services • Contribute to and work with mental health and substance abuse programs • Case manager • Advocacy Group • Certified Peer Specialist • Contractor • QMHP-CS Parker County • CPS • Mental Health Professional • None of the above • Mental Health Counselor • YPU/YPS • Council on Alcoholism and Drug Abuse • Council on Alcoholism and Drug Abuse, Pregnant and Postpartum Intervention

16. Additional Comments Of 259 responses, 68 (or nearly 25% of respondents) provided additional information or comments. A representative sample appears below as submitted in response to the following prompt: Please submit your comments regarding sequestration planning for mental health and substance abuse services in Texas below: • If this becomes necessary, the simpler the better. Do across the board for all program types at all locations. Otherwise, there will be a lot of politics and resentments. • The state should plan to replace any federal dollars lost in these programs with state dollars. As I am hearing through the press, Texas has some additional dollars this session that were not foreseen earlier. Those dollars should be kept to support the programs we currently have in place instead of starting new programs and leaving the current programs underfunded and unable to accomplish the goals they were established to meet. • Cutting services across the board will create less of an overall impact on any one system. They are all tied so closely together that to pick one that needs funds more than another is nearly impossible. Cutting funds to one program may lead to an influx into another program (i.e. mom can't get substance abuse treatment so her use increased which leads to abuse/neglect of her children and the need for them to have treatment).

17. Additional Comments • Texas is so below the national average for spending on these serious medical issues-please do not cut services. This will impact our communities and our families drastically. • Reductions in both substance abuse and mental health services should be equally applied across age groups and service categories and targeted reductions should be applied to programs and services that can withstand the reductions with minimal disruption. • When making decisions about cut we should be mindful of very vulnerable populations where our dollars are best served and we get our greatest return on investment. Additionally we should consider cut to programs with poor performance and fund fully programs and projects that have documented proven outcomes with reduce substance use, improved quality of life, and improved quality of community. Spending our limited resources on populations where we have little to show for our efforts (right now) is fruitless. Additionally, strengthening admission criteria for adult treatment would help prioritize service dollars. • Reductions in funding should be targeted towards programs based on their individual merit and productivity. Framing the question in terms of having a reduction in spending for children, adults, or both equally is not sufficient to address such a complex issue.

18. Additional Comments • Following the information available on Sequestration, I am amazed at how mental health and substance abuse services are going to be affected while so much funding is wasted by SAMHSA and this federal government while states, including Texas, gives up the fight and punishes those least able to help themselves. Funding is so important to those of us treating the indigent person for substance abuse and mental health, and we stretch our funding as far as possible to be able to make a difference in people’s lives, only to see our funding getting smaller and smaller because no one in authority in Texas will stand up and say- We truly care for ALL of our Texas residents, or stand up against Washington and say no more cuts to SA or MH. “Survival of the Fittest" seems to be our State motto now. • DSHS is not doing a good job of communicating with the general public on what services they offer and how to access them. Until they do, you can’t expect much support for your programs. Why no social media efforts? Why no direct outreach? • Funding is so horribly low as it is, don't see how anyone could cut more. Cut big corporate tax loopholes! • Texas is already underfunded...this is atrocious! • The state wastes a lot of money on technology projects that are insufficient to meet the needs of providers. They should cut there first.

19. Additional Comments • Substance abuse services will have the largest amount of federal dollars cut and has the most fragile infrastructure of all behavioral health services. If any part of the infrastructure now in place is lost it will be difficult to rebuild these services. Since prevention services are over the 20% required by the Block Grant that would seem to be an obvious place to begin necessary reductions. • Thanks for asking for input. It would have been easy for the state to do whatever it liked in this situation without seeking public comment. • By cutting any mental health or substance abuse services, there will be increases in other areas that are much greater, such as corrections and emergency care. Treating mental health is by nature a preventive strategy. • We will do whatever we can to make cuts that will be necessary to prevent our direct services from being effected. • With the recent events involving unserved individuals with mental health budget cuts to mental health services does not address the safety and treatment needs of our communities.