Closing the State Hospital: Transforming Mental Health Services in East Tennessee Ben Harrington Mental Health Association of East Tennessee

Historical Context 1826 Almshouse System established in Anderson Co 1827 Almshouse System expands statewide  tradition of charity, the public hospital traces its ancestry to the development of cities and community efforts to shelter and care for the chronically ill, deprived, and disabled. 1840’s Dorthea Dix shames states to change the poor system of care to asylums or hospitals 1852 TN Hospital for Insane opens in Nashville

State Hospital Timeline 1865 Nashville overcrowded 1886 Lakeshore opens for 99 “inmates” transferred from Nashville by train 1889 Western opens 1961 Moccassin Bend opens in Chattanooga 1962 Tennessee Psychiatric Hospital opens in Memphis 1963 Community MH Center Act 1971 “Midnight Raid” at Lakeshore 1960’s “Deinstitutionalization”

Community Services Timeline 1947 Helen Ross McNabb opens in Knoxville 1947 Fortwood Center opens in Chattanooga 1957 Ridgeview Center opens in Oak Ridge 1957 Frontier Health opens in Johnson City 1959 Cherokee Health opens in Morristown 1972 Peninsula Hospital opens 1972 Overlook (now Peninsula Outpatient) opens

Transforming the System: Trends to Consider Downward trend/need for RMHI beds in TN More conservative public sentiment for LESS government funded services Contradicts need to grow community mental health services No new funding for TDMH budget $150 M serves 10,000 annually at RMHIs $151 M serves 250,000 in community based MH & A&D Services “Do more with less or what we have”

RMHI Task Force Report Paves the Road in East Tennessee 1.Develop community placements for long term residents who cannot be discharged 2. Update the role of the RMHI 3. Implement successful models to REDUCE IP admission /ALTERNATIVES to IP care 4. Reinvest $$ saved in community services 5. ID # beds needed in each region

Lakeshore Profile 2237 patients in Average daily census 91% (2036) 10 days or less 70% (1566) 6 days or less 7% (157) stay 11 days + 2% - 52 “sub acute” LONG TERM RESIDENTS years – 50 people 30+ years – 2 people

Funding Reinvestment Plans Lakeshore Mental Health Institute $20,523,600 - State General Funds PLUS $5-7M in Fee Revenues* State Inpatient Safety Net # Projected to be Served MTMHI / MBMHI 25‐Bed Acute Unit & Transportation $3,141, Inpatient Care Private Nonprofit Inpatient Providers $5,391,600 & fees ($5-$7M)*4586 patients (PLUS 704 Legislature appropriated Indig. Funds) Community Residential Treatment Services Intensive Supportive Services (32Beds) $1,140, Bed Crisis Stabilization Unit $2,196, Medically Monitored Crisis Detox $1,525, Community Outpatient Services Behavioral Health Safety Net $500, Other Community Investments ($6,629,500) 2000 (more via flexible spending Safety Net, A&D, Peer Support) Total Projected to be Served: 9,668 more people

Funding Reinvestment Plans Private Nonprofit Inpatient Services Private Nonprofit Inpatient Providers $5,391,600 Community Residential Treatment Services Intensive Supportive Services (32Beds) $1,140,000 Lakeshore Mental Health Institute $20,523,600 *State General Funds 16 Bed Crisis Stabilization Unit $2,196,200 Medically Monitored Crisis Detox $1,525,100 State Inpatient Safety Net Community Outpatient Services MBMHI 25-Bed Acute Unit & Transportation $3,141,200 Behavioral Health Safety Net $500,000 No proposed bed reductions in other state hospitals Other Community Investments ($6,629,500)