Access Task Force Report
Presentation to House Health, Welfare and Institutions
General Assembly Building September 6, 2007
Report to HWI – September 2007
2
What the system looks like now...
TRIAGECrisis response/Resolution & Referral
JAIL
Crisis Stabilization &
ReferralNon-emergency & clinical
support services
Report to HWI – September 2007
3
Non-emergency & clinical support services
Crisis Stabilization & Referral
TRIAGECrisis response/Resolution & Referral
JailInpatient
/State Facility
What it should look like
EmergencyPsychiatric
Services CenterAnytown,
Virginia
Report to HWI – September 2007
4
Background• Inability to access community based,
private and public mental health services – Large volume of Temporary Detention
Order (TDO) hearings– Unnecessary arrest and incarceration of
individuals affected by psychiatric illness – Inappropriate use of hospital emergency
rooms– Untreated individuals in distress or at
risk
Four Decades of Study…
Previous Commissions have studied and recommended
changes for the Commonwealth’s Mental Health System
Report RecommendationGov. Tuck 1949
Willey 1962
Comm.MH/MR
1965
Hirst Comm. 1970-72
JLARC 1979
Bagley Comm. 1980
Emick Comm. 1985
JLARC 1986
JLARC1995
Comm. MH/MR
1997
Hall-Gartlan 1998
HammondComm,1998
Hall-Gartlan 2000
Need for Availability of Community Services Statewide to Prevent/Reduce Hospitalizations
Need for Services/Core Services, Prevention/Early diagnosis, Treatment/care, Housing/day treatment, Emergency interventions
Single System of Care, Continuum of Services. and Continuity of Care
Individualized Services in Least Restrictive Environment
Discharge Planning by CSBs
Funding Needed for Community Services
Maximize Medicaid
Reinvest Funding from Facilities/Downsizing
Define Eligible/Priority Populations
Barriers to Community Services
Lack of Resources
Lack of Even, Standardized Services Statewide
Consensus Recommendations from MHMRSAS Legislative Studies (1949-2000)
Report to HWI – September 2007
7
Solutions will be found in …
Resources
Law
Reform
Service
Capacity
Report to HWI – September 2007
8
The Three Legged Stool• Law Reform
– the statutory framework for delivering mental health services
– State and local policies governing care provided by public and private agencies and providers
• Service Capacity– the continuing need for private and public community-
based services accessible by all Virginians
• Resources – funding (SGF, local funds, Medicaid/Medicare and other
insurance, SSDI, Auxiliary Grant support, etc.)
Report to HWI – September 2007
9
Conceptual Model• Capacity Components necessary to improve
access to other private and public community based services
Early Intervention and Treatment services
Crisis Response Services
Intensive Support Services
Report to HWI – September 2007
10
Early Intervention and Treatment services(Crisis Avoidance)
•Outpatient Counseling•Outpatient Psychiatry•Open referral to one # for all services•Education•Advance Directives•In-home or community respite•Linkages with other agencies
Capacity Components
Report to HWI – September 2007
11
Crisis Response Services
•Crisis Intervention•Crisis Stabilization•Inpatient Acute Care•Urgent care•Crisis Intervention Teams (CIT)•Non criminal justice transportation•Peer and natural supports
Capacity Components
Report to HWI – September 2007
12
DISPOSITION
INTERVENTION STABILIZATION REFERRAL
EMERGENCY MENTAL HEALTH CONTINUUM
CRISIS, ACCESS & RECOVERY
ASSESSMENT
ARRAY OF COMMUNITY RELEVANT SERVICES AND CENTERS
POLICE/SHERIFFSMAGISTRATES
EMSER
MH-ESHOTLINE
URGENT APPOINTMENTSQUICK MED VISITSMED AVAILABILITYDAY PROGRAMS
CRISIS STAB PROGRAMSCONSUMER RUN SUPPORTS
CRISIS CASE MGMTCRIMIINAL JUSTICE LIAISON
JAIL DIVERSIONJAIL MH SERVICESQUICK BENEFITSMEDICAL CARE
BLENDED SERVICESSA TREATMENT
LOCAL HOSPITAL BEDSSPECIAL JUSTICES
RESIDENTIAL SUPPORTSHOUSING
COMPETENT SYSTEM: ATTITUDE KNOWLEDGE SKILL
Report to HWI – September 2007
13
Intensive Support Services
•Case Management•Psychiatry/Medication and treatment•Intensive Outpatient•In Home Crisis Management•Aggressive Engagement Services (PACT/ICT/ICM)•Day Treatment/Psychosocial
Capacity Components
Report to HWI – September 2007
14
Intensive Support Services(cont.)
•Job Training and placement•Aggressive linkage with SUD services•Intensive Home Based services (MH supports)• Housing supports•Peer Support services
Capacity Components
Report to HWI – September 2007
15
Proposed Mandated Services – All
CaseManagement
Outpatient
Residential/Housing
In-Home
Respite
Family Supports
Emergency ServicesCrisis Stabilization
Consumer
C&A
Inpatient/Acute Care
Both
Adult
Report to HWI – September 2007
16
Va. Code Ann. § 37.2-500• Purpose; community services board;
services to be provided– The core of services provided by
community services boards within the cities and counties that they serve shall include emergency services and, subject to the availability of funds appropriated for them, case management services. The core of services may include…
Report to HWI – September 2007
17
Proposed Revisions• Purpose; community services board; services to
be provided– The core of services provided by community
services boards within the cities and counties that they serve shall include emergency, crisis stabilization, case management, outpatient, respite, in-home, residential and housing support services. The core of services may include a comprehensive system of inpatient, prevention, early intervention, and other appropriate mental health, mental retardation, and substance abuse services necessary to provide individualized services and supports to persons with mental illnesses, mental retardation, or substance abuse.
Report to HWI – September 2007
18
Policy and Resource Issues
• Health care insurance– Private and public– Benefits and reimbursement parity
• Medicaid Eligibility– 80% of FPL versus 100% of FPL
• Role of DMHMRSAS– Facilities versus communities
Report to HWI – September 2007
19
Action PlanPhase One FY 2009 Phase Two FY 2010
Goal : Initiate a full array of crisis response services
Establish 29 crisis stabilization facilities Establish 9 additional crisis stabilization facilities
Goal : Revise § 37.2-500 of the Code of Virginia
Expand mandated core services n/a
Goal : Expand capacity of CSB targeted Case Management
Dedicated resources to increase CSB Case Management by 125 FTEs
Dedicated resources to increase CSB Case Management by 175 FTES
Report to HWI – September 2007
20
Action Plan (cont.)Phase One FY 2009 Phase Two FY 2010
Goal : Implementation of CIT in each law enforcement jurisdiction
One third of all law enforcement jurisdictions implement CIT
Additional third of all law enforcement jurisdictions implement CIT
Goal : Expand access to Community Mental Health Outpatient Psychiatry (Public and Private)
DMHMRSAS comprehensive study of community psychiatry capability
Dedicated resources to expand community mental health outpatient psychiatry by 100 FTEs
Goal : Expansion of Medicaid eligibility
Change from 80% to 100% - $40 million
Sustaining expansion - $60 million
Report to HWI – September 2007
21
Action Plan (cont.)Phase One FY 2009 Phase Two FY 2010
Goal : Expansion of Intensive Community Treatment Program/PACT
Funding for additional 18 Teams Funding for additional 9 Teams
Goal : Improved access to permanent housing
Creation of Portable Auxiliary Grants n/a
Questions ?
Contact Info:Charles A. Hall, Executive Director
Hampton-Newport [email protected]
Phone: (757) 245-0217