“It’s Time for a Revolution” State Mental Health System Reorganization NAMI National Convention June 20, 2005

“It’s Time for Systems Change” Systems change “……..Systems change is a complex and multi-faceted construct that may be approached in a variety of fashions. Evolution ….Evolution views the transformation of systems as a necessarily slow and ongoing process that requires consensus among all levels of stakeholders about changes in attitude and behavior. Revolution …..Revolution reflects stakeholder impatience with slow change seeking to replace tortuous evolutions with more immediate and dramatic modifications in status quo.” Patrick Corrigan, University of Chicago Center for Psychiatric Rehabilitation

THE MENTAL HEALTH SERVICE SYSTEM IS IN DISARRAY The Commission is united in the belief that the mental health service delivery system needs dramatic reform. It is becoming clear that the mental health services system does not adequately serve millions of people who need care. New Freedom Commission, Interim Report 10/29/02

2003 NAMI TRIAD REPORT: SHATTERED LIVES 3,400 individuals/families with SMI – 50 states responded 62% never married – 80% dependent on disability and support from others – ½ with diagnosis of schizophrenia – 44% - criminal justice contact -60% had more than 1 diagnosis. 99% received medication – 85% hospitalized Less than 1/3 rd had access to effective & valued interventions

Flowchart For Problem Resolution Don’t Mess With It! YES NO YES YOU IDIOT! NO Will it Blow Up In Your Hands? NO Look The Other Way Anyone Else Knows? You’re SCREWED! YES NO Hide It Can You Blame Someone Else? NO NO PROBLEM! Yes Is It Working? Did You Mess With It?

BOIL IT ALL DOWN? “If you ran your business the way the state ran its mental health system you’d be out of business.”

Texas Revolution HB 2292 Consolidation of Health & Human Services Agencies Reprioritize Existing Resources Implement Disease Management & Jail Diversion Strategies Supplemental Rebates, Preferred Drug List (No Carve outs)

HB TRANSFORMATION OF HEALTH & HUMAN SERVICES Consolidation of 12 to 5 Department of State Health Services includes physical health, mental health and substance abuse (3 agencies to 1) Transformation into a customer-focused health and human services “enterprise” Operate like GE – Jack Welch Departments will focus on client needs and program delivery Performance goals and successful outcomes

HB 2292 Sec Redefined our Priority Population to serve: 1.Schizophrenia 2.Bipolar Disorder 3.Severe Clinical Depression 4.Children with serious emotional disturbances Implements Disease Management for each illness Prevalence, Severity, and Unmet Need – Prevalence & Severity of Mental Disorders, 6/2/2004

Sec (Cont’d) Recovery Based Old system – programs decided what services to offer & person was expected to fit into the available services Person only guaranteed to get crisis, hospital & medications Disease Management is based on specific diagnosis and level of need The service system is arrayed to deliver the services matched to what the person needs Focused on a process of recovery

Sec (Cont’d) Accountable Care System Guidelines for consistent levels of care across the system – hospital and community services Utilizing sound business practices Performance-based contracting Fee for Service The delivery system WILL BE HELD ACCOUNTABLE Report.pdf

Sec & SB 1145 CIVIL SIDE JAIL DIVERSION Targets appropriate services for individuals with schizophrenia and bipolar disorder – as in disease management – plus collaboration with TCOOMMI, CIT Training, Mental Health Courts Allows an urban area to prioritize its available funding for programs designed to divert persons with mental illness from jail Texas Correctional Office on Offenders with Medical and Mental Impairments (TCOOMMI) An agency created by the legislature to work with adult and juvenile offenders with mental impairments in the criminal justice system to place them on separate paths from regular offenders.

Sec , Preferred Drug List Supplemental Rebates, PDL & PA required of all drugs (No Carve Out for Behavioral Health) P & T Committee must exercise clinical judgment Option to place supplemental rebate into Alternate Benefit Program Results – Open Access Redefined PA Protocol - Texas Medication Algorithm

CONTACT INFORMATION JOE LOVELACE Executive Director NAMI Texas 512/