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Texas Mental Health and Substance Abuse Crisis Services Redesign

Texas Mental Health and Substance Abuse Crisis Services Redesign. Joe Vesowate Assistant Commissioner Mental Health & Substance Abuse Services.

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Texas Mental Health and Substance Abuse Crisis Services Redesign

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  1. Texas Mental Health and Substance AbuseCrisis Services Redesign Joe Vesowate Assistant Commissioner Mental Health & Substance Abuse Services

  2. Crisis care – which encompasses a large range of non-acute and out-patient mental health care issues – is becoming more and more of a priority among state and local officials. — Big Spring Herald, February 27, 2006 Texas Mental Health and Substance Abuse Crisis Services Redesign  Joe Vesowate  NAMI Texas Conference  October 17, 2006

  3. Crisis Services Redesign Committee Steven P. Shon, M.D.,Co-Chair, DSHS Joe Vesowate, Co-Chair, DSHS Carey Boethel, Austin, TX  Texas Association of Counties Denise Brady, Austin, TX  Mental Health Association in Texas Joe Burkett, M.D., Fort Worth, TX  MHMR of Tarrant County Patrick Crocker, D.O., Emergency Physician, Austin, TX  Brackenridge Hospital Gary Etter, M.D., Emergency Physician, Fort Worth, TX  Trinity Springs Pavilion Avrim Fishkind,M.D., Emergency Physician, Houston, TX Aaryce Hayes, Austin, TX  Advocacy, Inc. The Honorable Guy Herman, Austin, TX  County Probate Courts Mark Janes,M.D., Lufkin, TX  Burke Center Roberto Jimenez,M.D., San Antonio, TX  The Center for Health Care Services Merily Keller, Austin, TX  Texas Suicide Prevention Coalition Greg Leveling, Dallas, TX  National Sheriff’s Association  Board of Denton County MHMR Susan Marshall, Austin, TX  Council of Families for Children Reid Minot, Austin, TX - Community Clinical Research  DSHS Advisory Committee on Inpatient Mental Health Services Beth Mitchell, Austin, TX  Advocacy, Inc. Sylvia Muzquiz,M.D., Houston, TX  MHMR Authority of Harris County Lauren Parsons,M.D., Vernon, TX  North Texas State Hospital Robin Peyson, Austin, TX  NAMI Texas Sandy Potter, Coppell, TX  Value Options NorthSTAR Eileen Rosen, Austin, TX  Depression and Bi-Polar Support Alliance Ernest Schmid, F.A.C.H.E., Austin, TX  Texas Hospital Association Sanford “Sandy” Skelton, Austin, TX  Texas Council of Community MHMR Centers, Inc. Larry Stone,M.D., Bandera, TX - Texas Society of Child and Adolescent Psychiatry  DSHS Advisory Committee on Inpatient Mental Health Services John Theiss,Ph.D., Austin, TX  Texas Mental Health Consumers Texas Mental Health and Substance Abuse Crisis Services Redesign  Joe Vesowate  NAMI Texas Conference  October 17, 2006

  4. Charge • To develop recommendations for a comprehensive array of specific services that will meet the needs of Texans who are having a mental health and/or substance abuse crisis. In order to accomplish this, the committee will gather and analyze information from mental health literature, medical experts, members of the public, and staff. The recommended redesign will address the necessary elements of crisis services (including substance abuse), rural issues, clinical competencies, finance (cost), and important collaborations and partnerships. Texas Mental Health and Substance Abuse Crisis Services Redesign  Joe Vesowate  NAMI Texas Conference  October 17, 2006

  5. Part 1 Need for Crisis Services Redesign

  6. DSHS Quality Management Review of Mental Health Crisis Services • 77% of law enforcement and 71% of hospital surveyed indicated waits for LMHA/BHO crisis provider face-to-face assessment that exceed the one hour timeframe as required; • 87.5% of the LMHAs reviewed onsite did not meet the requirement of conducting face-to-face assessments immediately, but no later than one hour; • 74% of law enforcement and 62% of hospital surveyed indicated the ability to reach the hotline 24 hours a day/7 days per week; • 75% of the LMHAs reviewed onsite that were contracting with telephone answering services (non-credentialed employees) did not meet the requirement for immediate telephone contact with a qualified professional within 15 minutes; • 50% of the LMHAs reviewed onsite provided ongoing intervention until the crisis was resolved or the person was placed in a clinically appropriate environment; and • 37.5% of the onsite reviews indicated that arrangement for a physician’s assessment within twenty four hours of the emergency care determination did not occur. Texas Mental Health and Substance Abuse Crisis Services Redesign  Joe Vesowate  NAMI Texas Conference  October 17, 2006

  7. Number of Persons Per Year Receiving Front-Door Community Mental Health Crisis Services at DSHS-Funded Community Mental Health CentersContinues to Increase 13% Increase Source: DSHS Mental Retardation and Behavioral Health Outpatient Warehouse, Business Objects Corporate Report LBB Crisis Admit Served for FY2005 and FY2006, used for LBB reporting for number of persons receiving community mental health front-door crisis services per year. Texas Mental Health and Substance Abuse Crisis Services Redesign  Joe Vesowate  NAMI Texas Conference  October 17, 2006

  8. Number of Persons Served Per Year in DSHS-Funded Community Mental Health HospitalsContinues to Increase 25% Increase Source: DSHS Client Assignment and Registration (CARE) system as reported in LBB Performance Measures, ABEST. Note: Gulf Coast Center contracts with The University of Texas Medical Branch at Galveston; MHMR Authority of Harris County contracts with the Department of Psychiatry, The University of Texas Health Science Center in Houston for the operation of The University of Texas Harris County Psychiatry Center; and Sunrise Canyon Hospital is operated by the Lubbock Regional MHMR Center. Texas Mental Health and Substance Abuse Crisis Services Redesign  Joe Vesowate  NAMI Texas Conference  October 17, 2006

  9. State Mental Health Hospital Capacity Decreased 25% from 1994-2004 SPECIAL LEGISLATIVE AUTHORIZATION El Paso Psychiatric Center Added to the System Texas Mental Health and Substance Abuse Crisis Services Redesign  Joe Vesowate  NAMI Texas Conference  October 17, 2006

  10. Suicide in Texas • Suicide is the 9th leading cause of death in Texas. • 2,304 Texas residents committed suicide in 2002. • Suicide is the 3rd leading cause of death among 10-24 year olds nationally and in Texas, following accidents and homicides. — From DSHS News Release, September 2004, http://www.dshs.state.tx.us/news/releases/20040910.shtm Texas Mental Health and Substance Abuse Crisis Services Redesign  Joe Vesowate  NAMI Texas Conference  October 17, 2006

  11. The lack of a quickly responsive system with an appropriate range of crisis services has contributed to the increased incarceration of mentally ill individuals in jails. — Texas Mental Health and Substance Abuse Crisis Services Redesign, DSHS, September 2006 Texas Mental Health and Substance Abuse Crisis Services Redesign  Joe Vesowate  NAMI Texas Conference  October 17, 2006

  12. Many Adult Offenders in Texas State Prison, on Parole, or on Probation Are Current or Former Clients of the DSHS Public Mental Health System Source: TDJC-CARE Match, DSHS, January, 2005, from Ruggiero, K. M., and Mason, M. (2005). A second look at mental health and criminal justice involvement in Texas: Correlates and costs. Austin, TX: Texas Department of State Health Services. Texas Mental Health and Substance Abuse Crisis Services Redesign  Joe Vesowate  NAMI Texas Conference  October 17, 2006

  13. Greater Percentage of Victims of Child Abuse/Neglect (as confirmed by DFPS in FY2003) with Juvenile Justice Contact Had a Behavior Problem and/or Substance Abuse Issue > > > Source: DFPS Child Protective Services and TYC client databases, from Ruggiero, K.M., and Mason, M. (2006). The role of behavioral health services among youth in Texas at risk for juvenile justice involvement: Multi-agency data-matching project for the Policy Academy on Co-Occurring Substance Abuse and Mental Health Disorders. Austin, TX. Texas Mental Health and Substance Abuse Crisis Services Redesign  Joe Vesowate  NAMI Texas Conference  October 17, 2006

  14. But Less Than Half Received Behavioral Health Services Funded by the State Source: DFPS Child Protective Services, DSHS Mental Health and Substance Abuse, HHSC Child Medicaid, and TYC client databases, from Ruggiero, K.M., and Mason, M. (2006). The role of behavioral health services among youth in Texas at risk for juvenile justice involvement: Multi-agency data-matching project for the Policy Academy on Co-Occurring Substance Abuse and Mental Health Disorders. Austin, TX. Texas Mental Health and Substance Abuse Crisis Services Redesign  Joe Vesowate  NAMI Texas Conference  October 17, 2006

  15. A Vicious Cycle? Parental Involvement with Criminal Justice System May Become a Parent Youth Behavioral Problem DFPS Youth Juvenile Justice Contact Youth Substance Abuse Issue Texas Mental Health and Substance Abuse Crisis Services Redesign  Joe Vesowate  NAMI Texas Conference  October 17, 2006

  16. Part 2 What the Public Had to Say

  17. Local residents will have an opportunity today in San Antonio to provide feedback on state mental health services during a five-hour public hearing on the topic. — Kerrville Daily Times, February 8, 2006 ________ In the third of four public hearings, the Department of State Health Services Committee held an open meeting to hear concerns and develop recommendations to re-design services for the State, both rural and urban. — KOSA-TV Odessa, February 23, 2006 ________ Mental health care providers and clients spent much of Thursday at Big Spring State Hospital addressing a state committee tasked with recommending changes to the state’s method of providing mental health crisis services and treatments…When devising those recommendations, area mental health officials hope committee members keep rural needs and problems in mind. — Big Spring Herald, February 27, 2006 Texas Mental Health and Substance Abuse Crisis Services Redesign  Joe Vesowate  NAMI Texas Conference  October 17, 2006

  18. Public Hearings • Four public hearings in February 2006: • Big Spring (rural); • San Antonio (urban); • Harlingen (border); and • Austin (statewide). • Written and oral comments from more than 200 citizens: • Consumers; • Family members; • Advocates; • Police officers; • Sheriffs; • Judges; • Hospital administrators; and • Mental health and Substance abuse professionals. Texas Mental Health and Substance Abuse Crisis Services Redesign  Joe Vesowate  NAMI Texas Conference  October 17, 2006

  19. Issues Raised • Transportation • Rural Issues • Admission Criteria for State Hospitals • Financial Resources • Training • Integration with Health • Medical Evaluations/Clearance • Attention to Families • Mobility Orientation • Information About Obtaining Services • Attitude of Providers • Specialists • No Harm Contracts • Standardized Approach • Types of Services • Jail as an Option • Forensic System • Children • Mental Health & Substance Abuse Courts • Collaboration • Cultural Competency • Data Texas Mental Health and Substance Abuse Crisis Services Redesign  Joe Vesowate  NAMI Texas Conference  October 17, 2006

  20. Part 3 Crisis Services Redesign Report

  21. Texas Mental Health and Substance Abuse Crisis Services Redesign  Joe Vesowate  NAMI Texas Conference  October 17, 2006

  22. Core Crisis Services Recommended 1. Crisis Hotline Services 2. Psychiatric Emergency Services with Extended Observation (23-48 Hours) 3. Crisis Outpatient Services 4. Community Crisis Residential Services 5. Mobile Outreach Services 6. Crisis Intervention Team (CIT)/Mental Health Deputy/Peace Officer Program Texas Mental Health and Substance Abuse Crisis Services Redesign  Joe Vesowate  NAMI Texas Conference  October 17, 2006

  23. Rural Issues • Crisis hotline services and mobile outreach; • Telemedicine; • Crisis residential and crisis respite services; and • Larger areas could serve as hubs by providing specialized emergency services to smaller local areas. Texas Mental Health and Substance Abuse Crisis Services Redesign  Joe Vesowate  NAMI Texas Conference  October 17, 2006

  24. Financing:Annual Costs X Four Years Texas Mental Health and Substance Abuse Crisis Services Redesign  Joe Vesowate  NAMI Texas Conference  October 17, 2006

  25. Collaboration Needed Local Law Enforcement Mental Health Authority Emergency Rooms Social Service Agencies Courts Texas Mental Health and Substance Abuse Crisis Services Redesign  Joe Vesowate  NAMI Texas Conference  October 17, 2006

  26. Special Issues • Transportation; • Children’s crisis services; and • Forensic services. Texas Mental Health and Substance Abuse Crisis Services Redesign  Joe Vesowate  NAMI Texas Conference  October 17, 2006

  27. Conclusions • Standards of care. • Local system — shared responsibility. • Least restrictive setting — family environment. • Help now is better than help later. • Breaking the cycle. Texas Mental Health and Substance Abuse Crisis Services Redesign  Joe Vesowate  NAMI Texas Conference  October 17, 2006

  28. Next Steps 1. Resources 2. Planning Texas Mental Health and Substance Abuse Crisis Services Redesign  Joe Vesowate  NAMI Texas Conference  October 17, 2006

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