1. Delaware Health and Social Services Joint Health Committee, Legislative Hall: May 15, 2013 Secretary Rita Landgraf and Director Kevin Ann Huckshorn, DHSS Update: Delawares Settlement Agreement with USDOJ

2. Delaware Health and Social Services DPC and the DOJ Settlement The July 6, 2011, agreement between the State and the U.S. Department of Justice resolved a three-year investigation of the Delaware Psychiatric Center. More importantly, the agreement became the blueprint for how Delaware would provide mental health services to individuals with severe and persistent mental illness. The settlement stretches from 2011 to 2016.

3. Delaware Health and Social Services What the USDOJ Team Found in 2007 at DPC Adult state hospital with 8 units, including Level 5 forensic service and a nursing home. Average daily census: 264 clients. Average length of stay: 8+ years; more than 80 clients did not meet hospital stay criteria, with their length of stay up to 25 years. Excessive use of sedation and restraint, stat meds, and adverse events. Homogenized treatment approaches, control-based.

4. Delaware Health and Social Services DPC Changes from 2009-11 Trained staff on principles of recovery, trauma-informed care, and reducing conflict and violence. Reduced the use of involuntary medication administration by 90%. Reduced the use of sedation and restraint by 62.5 to 96.2% respectively. Brought in a new hospital leadership team.

5. Delaware Health and Social Services USDOJ Final Findings: Nov. 2010 Focus on ADA and Olmstead compliance: Lack of overall approach to prevent institutionalizations or incarcerations. Lack of evidence-based care management service teams (ACT, ICM, TCM) Lack of integrated housing options/choices. Lack of an integrated data system with ability to use data to show individual outcomes and system outcomes. Clients remaining at DPC without clinical rationale.

6. Delaware Health and Social Services Target Population Defined The USDOJ target population covers all persons who are at risk for or who are institutionalized. Delaware citizens with serious and persistent mental illness (SPMI) who are at the highest risk of unnecessary institutionalization and whose expenses for care have been state-funded in whole or in part. 6,000+ citizens meeting this criteria have been identified. Individuals served by these agencies: Department of Correction (DOC); Division of Medicaid and Medical Assistance (DMMA); Division of Substance Abuse and Mental Health (DSAMH)

7. Delaware Health and Social Services USDOJ: Year 2 Status Report 24/7 Mental Health Crisis Hotline Hotline live Publicity materials and training provided statewide 24/7 Mobile Crisis Services New Castle team fully staffed. Average time from end of crisis call to return to base confirms one-hour response time statewide Crisis Apartments: In compliance but need better geographic mix. Crisis Stabilization Services: Increased acute care services at DPC by 18 beds New Crisis Walk-In Center in Ellendale opened Aug. 20, 2012. Mobile Crisis Services at Ellendale ¾ staffed.

8. Delaware Health and Social Services USDOJ: Year 2 Status Report Community Services contracts were awarded for new service system components: –2 Community Reintegration Services Program (CRISP) –10 Assertive Community Treatment Teams (ACT) –5 Intensive Care Management Teams (ICM) –2 Targeted Care Management Teams (TCM) Two new providers now in our system –We are RFPing for additional new services this year based on need

9. Delaware Health and Social Services USDOJ: Year 2 Status Report Integrated Housing –By July 1, 2013 the State will provide housing vouchers or subsidies and bridge funding to a total of 450 individuals. (This is done) Supported Employment –By July 1, 2013 the State will provide supported employment to 300 additional individuals per year. (Done) Family and Peer Supports –By July 1, 2013 the State will provide family or peer supports to 250 additional individuals per year. (Done)

10. Delaware Health and Social Services Employment

11. Delaware Health and Social Services DPC Efficiencies FY10-FY13 Discharge of Long-Term Clients and Right Sizing: Added 18-bed acute care unit through long-term discharges. Closed 32-bed psychiatric nursing home in May 2010, with successful discharge of 28 clients to more appropriate settings. DPC FY13 Average Daily Census through January: 143 clients (FY08: 252) January Average Daily Census: 135

12. Delaware Health and Social Services Building Up Community-Based Services DSAMH FY13 Budget

13. Delaware Health and Social Services Ongoing Plans 2013-14 We are carefully reorganizing our mental health system of care as set forth in the USDOJ agreement and our strategic plan done in 2009. We are reorganizing our Substance Use Disorders system of care to better meet national best practice standards and improve our outcomes. For all of us, running the current system while trying to build a second system is difficult. DSAMH had the only salary surplus this year of any DHSS division. That was a $3 million surplus that was absorbed into DHSS.

14. Delaware Health and Social Services Mental Health Detainment Law On July 24, 2012, Gov. Markell recognized two pieces of legislation to reform Delaware's emergency mental health detainment law (HB311) and to create a study group (HJR17) to review the states civil mental health laws. This is another step in the right direction, Gov. Markell said at the signing of HB311 at the Rick Van Story Resource Center in Wilmington.

15. Delaware Health and Social Services HB9: Immunity Provision HJR17 required a report an recommendation on immunity provisions during a 24-hour involuntary detention. HB9 was a consensus recommendation of diverse stakeholders. It does not cover medical negligence claims after the mental health assessment. HB9 passed the House in January, the Senate in March and was signed into law by Gov. Markell on March 28, 2013.

16. Delaware Health and Social Services HJR17 Study Group HJR17 Study Group, chaired by Secretary Landgraf, is reviewing Delawares mental health laws and procedures. Sub-groups are: Youth, Definitions/Criteria, Operational, Court Procedures/Due Process, Out-Patient Commitment, and Intersection with Criminal Law. Final report is due in January 2014. Bryce Hewlett, executive director of the Delaware Consumer Recovery Coalition