Texas Mental Health Transformation: Moving Forward for a Healthier Future

1. TEXAS MENTAL HEALTH TRANSFORMATION MOVING FAST FORWARD David Lakey, M.D. Commissioner, DSHS Presentation at the Transformation Workgroup Meeting, Austin, Texas, July 6, 2007

2. MENTAL HEALTH TRANSFORMATION THE PROBLEM • In any given year, one in 4 Texans suffer from a diagnosable mental disorder. • Mental disorders are the leading cause of disability for ages 15-44. • The number of suicides in Texas has increased by 15% in the last 5 years. This number is 55% higher than homicides and 134% higher than those who died from HIV. • People with serious mental illness served by the public mental health system die, on average, 25 years earlier that the general population. • 75% of all persons with mental illness smoke; persons with mental illness consume 44% of all cigarettes nationally.

3. BEHAVIORAL HEALTH ISSUES IMPACT OTHER SYSTEMS • 75% of children placed in foster care have parents with behavioral health problems • 30% of adults in correctional institutions have received mental health services • 26% of persons served through vocational rehabilitation have behavioral health problems • 48% of youth served by TYC have serious emotional disturbances • 26% of all hospital discharges are related to mental health or substance abuse problems • 46% of all ER visits have behavioral health issues as a basic or contributing factor

4. TEXAS MENTAL HEALTH TRANSFORMATION PROBLEMS ADDRESSED BY TRANSFORMATION • Fragmentation; agency “silos”; continuity of care • Recovery-focus; consumer-orientation • Disparities in services……race/ethnicity; geographic • Back-end vs front-end services • Lack of adequately trained human resources • Coordination of health and mental health services • Use of technology/data not optimal

5. MENTAL HEALTH TRANSFORMATION THE FEDERAL VISION • We envision a future when everyone with a mental illness will recover, mental illnesses can be prevented or cured, mental illnesses are detected early, everyone with a mental illness at any stage of life has access to effective treatment and supports – essentials for living, working, learning, and participating fully in the community. • The vision of a transformed system is one in which Americans understand that mental health is essential to overall health; mental health is consumer and family driven; Disparities in Mental Health Services are eliminated; Appropriate and early mental health screening, assessment and referral to services occurs; excellent mental health care is delivered and research is accelerated; and technology is used to access mental health care and information

6. MENTAL HEALTH TRANSFORMATION THE TEXAS VISION: KEY COMPONENTS • Public health / population-based • All Texans • Early intervention • Mental health care: • Appropriate, high quality services • Quick and easy access • Coordinated • Seamless • Efficient

7. TRANSFORMATION VISION • Persons with mental illness are productive, creative individuals • Children live with their families and families receive the supports they need • Mental health interventions are a societal investment • People living with mental illnesses have choice, self determination and hope • People will have quick easy access • People will access services that are coordinated across agencies so that there is “no wrong door” • The mental health system will have an adequate, competent workforce • Mental health, with physical health, is an integral part of individual well-being • Agencies will operate in partnership, not “silos”

8. TRANSFORMATION INITIATIVES • Partnerships - state agencies, local entities, consumers and family members • Community collaboratives • Consumer voice • Workforce development • Technology / data • Special initiatives – peer support, housing, employment, school-based services, criminal and juvenile justice, older adults

9. ORGANIZATIONAL STRUCTURE TEXAS MENTAL HEALTH TRANSFORMATION INITIATIVE GOVERNOR STATE OF TEXAS • MHT– Grant Operating Agency • DSHS • Transformation Executive Team • ----------------------------------------------------- • David Lakey, M.D/Sam Shore – TWG Chair • Ben Delgado, Associate Commissioner • Luanne Southern, Deputy Commissioner • Bill Race, Medical Director • Joe Vesowate, Assistant Commissioner for Behavioral Health Services TRANSFORMATION WORK GROUP Statewide Transformation Steering Committee CFPS, DADS, DARS, DSHS, HHSC, TDCJ, TJPC, TDHCA, TEA, TVC, TWC, TYC, VA VISN 17, Governor’s Office, Legislature, ConsumerRepresentatives Special Initiatives Workgroups Implementation Team Vijay Ganju – Project Director Ellen Trevino - DSHS, Program Specialist Steve Eichner, – DSHS, IT Program Manager Valarie Garza,- THI, Consumer Coordinator Havovi Katki – THI, Project Associate Contractors– UT – LBJ School of Public Affairs, UT- School of Social Work, Texas Health Institute.

10. MENTAL HEALTH TRANSFORMATIONDSHS INITIATIVES • Early Intervention – Schools • Crisis Redesign • Epidemiology / Data • Disaster Planning • Integration with Health Initiatives

11. MENTAL HEALTH TRANSFORMATION: THE CHALLENGE • OPPORTUNITIES ACROSS ALL AGENCIES • How to identify ? • How to put in a transformation framework ? • RESOURCES • Target – next legislative session • MAKING THE CASE • BUILDING CONSENSUS • Across Agencies • State – Local • Stakeholders

12. TEXAS MENTAL HEALTH TRANSFORMATION KEY MESSAGES • Mental health transformation remains a high priority at DSHS • Mental health transformation will not occur because of a federal grant. Everything we do must be aligned with transformation • The vision of mental health transformation must be the basis for the design and application of programs, policies and resources • Mental health transformation ultimately will depend on partnerships……among state agencies, with local agencies and with consumers, family members and advocates • Mental health transformation is about the lives of Texans, not just about systems.