Access Task Force Report Presentation to House Health, Welfare and Institutions General Assembly Building September 6, 2007

Report to HWI – September What the system looks like now... TRIAGE Crisis response/Resolution & Referral JAIL Crisis Stabilization & Referral Non-emergency & clinical support services

Report to HWI – September Jail TRIAGE Crisis response/Resolution & Referral Crisis Stabilization & Referral Non-emergency & clinical support services Inpatient/ State Facility What it should look like Emergency Psychiatric Services Center Anytown, Virginia

Report to HWI – September 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 Recommendation Gov. Tuck 1949 Willey 1962 Comm. MH/MR 1965 Hirst Comm JLARC 1979 Bagley Comm Emick Comm JLARC 1986 JLARC 1995 Comm. MH/MR 1997 Hall- Gartlan 1998 Hammond Comm, 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 ( )

Report to HWI – September Solutions will be found in … Resources Law Reform Service Capacity

Report to HWI – September 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 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 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 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 DISPOSITION INTERVENTION STABILIZATION REFERRAL EMERGENCY MENTAL HEALTH CONTINUUM CRISIS, ACCESS & RECOVERY ASSESSMENT ARRAY OF COMMUNITY RELEVANT SERVICES AND CENTERS POLICE/SHERIFFS MAGISTRATES EMS ER MH-ES HOTLINE URGENT APPOINTMENTS QUICK MED VISITS MED AVAILABILITY DAY PROGRAMS CRISIS STAB PROGRAMS CONSUMER RUN SUPPORTS CRISIS CASE MGMT CRIMIINAL JUSTICE LIAISON JAIL DIVERSION JAIL MH SERVICES QUICK BENEFITS MEDICAL CARE BLENDED SERVICES SA TREATMENT LOCAL HOSPITAL BEDS SPECIAL JUSTICES RESIDENTIAL SUPPORTS HOUSING COMPETENT SYSTEM: ATTITUDEKNOWLEDGESKILL

Report to HWI – September 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 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 Proposed Mandated Services – All C&A Inpatient/ Acute Care Both Adult

Report to HWI – September Va. Code Ann. § 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 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 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 Action Plan Phase One FY 2009Phase Two FY 2010 Goal : Initiate a full array of crisis response services Establish 29 crisis stabilization facilitiesEstablish 9 additional crisis stabilization facilities Goal : Revise § 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 Action Plan (cont.) Phase One FY 2009Phase 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 Action Plan (cont.) Phase One FY 2009Phase Two FY 2010 Goal : Expansion of Intensive Community Treatment Program/PACT Funding for additional 18 TeamsFunding for additional 9 Teams Goal : Improved access to permanent housing Creation of Portable Auxiliary Grantsn/a

Questions ? Contact Info: Charles A. Hall, Executive Director Hampton-Newport CSB Phone: (757)