1. House Human Services Committee
Mental Health and Substance Abuse Services
May 24, 2006

2. Public Mental Health System in Texas
DSHS mental health services are only part of the public mental health system in Texas.
Law enforcement, education, Medicaid, CHIP, the criminal justice system, hospitals and other entities all play major roles in treating Texans with mental illnesses.
House Human Services Committee  DSHS Mental Health and Substance Abuse Services Overview  May 24, 2006

3. Behavioral Health Issues Impact Other Systems
75% of children placed in foster care have parents with behavioral health problems: DFPS, DSHS, DARS
75% of kids in the juvenile justice system have behavioral health problems: TJPC, TYC, TDCJ, DSHS
30% of kids in the juvenile justice system will end up in the adult justice system: TJPC, TYC, TDCJ, DSHS
46% of all ER visits have behavioral health issues as a basic or contributing factor: DADS, TWC, DSHS
30% of all truancy is related to behavioral health problems: TEA, TWC, TJPC, TYC, DSHS
House Human Services Committee  DSHS Mental Health and Substance Abuse Services Overview  May 24, 2006

4. Mental Health as a Public Health Crisis
Comparative mortality statistics, 2001
Source: Centers for Disease Control and Prevention
House Human Services Committee  DSHS Mental Health and Substance Abuse Services Overview  May 24, 2006

5. Mental Illness Strikes More Americans Each Year Than Other Serious Illnesses
CVD
Diabetes
Cancer
Asthma
CDC BRFSS, SEER Cancer Statistics Review, , “Prevalence, Severity, and Comorbidity of 12-Month DSM-IV Disorders”  Arch Gen Psychiatry.  Vol. 62, June 2005
House Human Services Committee  DSHS Mental Health and Substance Abuse Services Overview  May 24, 2006

6. DSHS Mental Health and Substance Abuse Services
Community-based services
39 Local Mental Health Authorities
Dallas Area NorthSTAR Authority
180 Substance Abuse contracts
10 State Hospitals
House Human Services Committee  DSHS Mental Health and Substance Abuse Services Overview  May 24, 2006

7. Funding Mechanisms
Community Mental Health and Substance Abuse payment mechanisms:
Substance Abuse Treatment: Fee-for-service
Substance Abuse Prevention: Cost reimbursement
Community Mental Health Centers: Prepayment for services
House Human Services Committee  DSHS Mental Health and Substance Abuse Services Overview  May 24, 2006

8. Funding Equity for MH Services
The General Appropriations Act (Article II, Special Provisions, Sec. 29) requires the Department of State Health Services to implement a long term plan to achieve equity in state funding allocations among local mental health authorities.
The plan will be implemented from fiscal years The goal of the plan is to achieve equity to the greatest extent possible by fiscal year 2013.
Any funding reductions to a local authority for the purpose of achieving equity may not exceed 5 percent of allocated general revenue in a fiscal year.
The plan also ensures that improving funding equity is a priority in distributing any new state or federal funds that may become available for allocation to community centers.
Progress to date: 5 percent estimated to be achieved by end of FY06.
House Human Services Committee  DSHS Mental Health and Substance Abuse Services Overview  May 24, 2006

9. Community Mental Health Services
Community mental health centers are locally- governed components of the Department of State Health Services (DSHS) service delivery system.
DSHS delegates to a community mental health center the responsibilities of a local mental health authority which ensures the provision and continuity of services for individuals with mental illness, efficient use of resources, consumer satisfaction, and accountability.
House Human Services Committee  DSHS Mental Health and Substance Abuse Services Overview  May 24, 2006

10. Contract Management
Performance contracts between DSHS and the Local Mental Health Authorities include important general provisions denoting the terms of the contract.
Attachments to the contracts stipulate the services targets, performance measures, outcomes, and remedies, sanctions, and penalties that may result from failing to fulfill contract expectations.
Provisions include expectations of low administrative overhead, utilization management completion rates, and measures related to appropriateness of services delivered and percentage of clients receiving the minimum number of Resiliency and Disease Management service package hours.
Penalties/recoupment for the Second Quarter of Fiscal Year 2006 totaled $163,858.
House Human Services Committee  DSHS Mental Health and Substance Abuse Services Overview  May 24, 2006

11. HB 2292 Mental Health Service Requirements
Integration of Physical Health and Behavioral Health
Priority Population Redefined
Resiliency and Disease Management
Jail Diversion
House Human Services Committee  DSHS Mental Health and Substance Abuse Services Overview  May 24, 2006

12. Resiliency and Disease Management (RDM)
Evidence-based
Intended to better match services to Mental Health consumers’ needs, and to use limited resources most effectively by providing the right service to the right person in the right amount to have the best outcomes.
Includes medication management, case management, skills training, family training, supports and partners, psychosocial rehabilitation, individual and group counseling, supported employment, supported housing, and Assertive Community Treatment (ACT)
House Human Services Committee  DSHS Mental Health and Substance Abuse Services Overview  May 24, 2006

13. RDM Key Components Uniform Assessment Standard Service Packages
Utilization Management
Data Analysis and Performance Evaluation
House Human Services Committee  DSHS Mental Health and Substance Abuse Services Overview  May 24, 2006

14. Numbers Served in Community Mental Health Services in FY2005
House Human Services Committee  DSHS Mental Health and Substance Abuse Services Overview  May 24, 2006

15. Percent of Clients Receiving Minimum Number of Service Hours Shows 50 Percent Improvement from When RDM Implemented Statewide in Quarter 1 FY2005
House Human Services Committee  DSHS Mental Health and Substance Abuse Services Overview  May 24, 2006

16. Community MH Service Outcomes
Average monthly number of adults receiving community mental health services
House Human Services Committee  DSHS Mental Health and Substance Abuse Services Overview  May 24, 2006

17. Individuals with Criminal Justice Involvement Experienced Positive Clinical Outcomes at DSHS Community Mental Health Centers, All of which Implemented Jail Diversion during FY2005
House Human Services Committee  DSHS Mental Health and Substance Abuse Services Overview  May 24, 2006

18. FY2005 Texas Monthly Hospital Emergency Room (ER) Costs 31 Percent Lower for Medicaid Clients with Mental Illness or Substance Abuse Receiving DSHS Behavioral Health Treatment
ER COST OFFSET
- $36
Average per Client per Month
31%
REDUCTION
Source: Prepared by Research Team, Strategic Decision Support, HHSC, 3/23/2006. Average of ER costs per month for Medicaid clients not receiving needed DSHS Mental Health and Substance Abuse services (Untreated) vs. average of ER costs per month for Medicaid clients receiving needed DSHS Mental Health and Substance Abuse services (Treated).
House Human Services Committee  DSHS Mental Health and Substance Abuse Services Overview  May 24, 2006

19. Innovative Local Treatment Models
Crisis Stabilization
Tri-County MHMR (Montgomery, Liberty and Walker Counties)
Jail Diversion
Center for Health Care Services (Bexar County)
MHMRA of Harris County
House Human Services Committee  DSHS Mental Health and Substance Abuse Services Overview  May 24, 2006

20. Community Substance Abuse Services
Prevention – Primarily school-based
Intervention – OSAR; HIV; PPI
Treatment:
Adults
Specialized Female Programs
Women with children
Youth
Pharmacotherapy
COPSD
House Human Services Committee  DSHS Mental Health and Substance Abuse Services Overview  May 24, 2006

21. Numbers Served in Substance Abuse Prevention and Intervention Services in FY2005
House Human Services Committee  DSHS Mental Health and Substance Abuse Services Overview  May 24, 2006

22. 53,420 People Accessed Substance Abuse Treatment in FY2005
House Human Services Committee  DSHS Mental Health and Substance Abuse Services Overview  May 24, 2006

23. Access to Recovery (ATR)
Access to Recovery supports clients by providing needed treatment or recovery support services to successfully complete their drug court program
Drug courts offer a cost-effective alternative to incarceration by providing community-based treatment as a condition of probation
Cost effectiveness of the ATR drug court program in Texas is reflected by preliminary data, which indicates that participating ATR clients are experiencing the following successful outcomes:
92% Abstinent
59% Employed or in School
91% No Further Arrests
99% Not Homeless
87% Socially Connected
House Human Services Committee  DSHS Mental Health and Substance Abuse Services Overview  May 24, 2006

24. State Mental Health Hospitals
10 Mental Health facilities provide inpatient hospitalization for persons with severe mental illness who need intensive treatment
North Texas State Hospital—Vernon campus, serves as the statewide maximum-security unit
The Waco Center for Youth is the only state-operated residential treatment facility in Texas for youths
All facilities are JCAHO Accredited
House Human Services Committee  DSHS Mental Health and Substance Abuse Services Overview  May 24, 2006

25. State Mental Health Hospital Capacity
House Human Services Committee  DSHS Mental Health and Substance Abuse Services Overview  May 24, 2006

26. Cost of In-patient Mental Health Services
House Human Services Committee  DSHS Mental Health and Substance Abuse Services Overview  May 24, 2006

27. Population Growth Compared to Funded State Hospital Beds
Funding for State Mental Hospital Beds has declined while the Texas population has grown
House Human Services Committee  DSHS Mental Health and Substance Abuse Services Overview  May 24, 2006

28. Growth in Forensic Patients
Total Forensic Patients as a percent in Texas Mental Health Facilities
House Human Services Committee  DSHS Mental Health and Substance Abuse Services Overview  May 24, 2006

29. State Mental Health Hospital Daily Census for FY2005
House Human Services Committee  DSHS Mental Health and Substance Abuse Services Overview  May 24, 2006

30. State Mental Health Hospital Capacity
In February 2006, the LBB approved $13.4 million in additional expenditures for state mental health hospital capacity.
As a result, statewide hospital system capacity was increased by 96 forensic commitment beds and 144 civil commitment beds.
This increase in state hospital capacity has greatly enhanced our ability to meet the needs of local communities.
We continue to plan for long-term, community-based solutions to address the hospital capacity issue.
House Human Services Committee  DSHS Mental Health and Substance Abuse Services Overview  May 24, 2006

31. Crisis Services Redesign
One goal of DSHS mental health services is to help consumers avoid mental health crises. However, the reality is that crises do occur.
February 2006, DSHS established the Crisis Services Redesign Committee to develop recommendations for a comprehensive array of crisis services.
Members of the committee include medical experts, citizen stakeholder groups, law enforcement representatives, county probate court judge representation, and county representatives, as well as individuals from professional organizations and provider groups.
A redesign of crisis services will build on the service improvements made by the evidence-based Resiliency and Disease Management program.
A thorough review of the current crisis system was conducted, including holding public hearings around the state.
House Human Services Committee  DSHS Mental Health and Substance Abuse Services Overview  May 24, 2006

32. Crisis Services Redesign (cont.)
The committee plans to finalize its recommendations in June for an evidenced-based crisis services model that will increase access to appropriate and cost-effective services.
Initial conclusions for recommended services include:
24-hour crisis hotline
Mobile crisis outreach
23-hour hold capacity
On-call psychiatric services
Crisis residential services
Respite
In-home crisis services
The committee will also put forth recommendations regarding DSHS staff support, coordination and training to local professionals (e.g., law enforcement crisis intervention training).
House Human Services Committee  DSHS Mental Health and Substance Abuse Services Overview  May 24, 2006

33. Mental Health Service Delivery Models in Other States
Ohio & California: County-based service system with county taxing authority
Arizona: Regional behavioral health authorities; managed care system
New Mexico: Single purchasing model
Pennsylvania: County-based, capitated managed care model
Illinois & New York: Direct state contracts with provider network
House Human Services Committee  DSHS Mental Health and Substance Abuse Services Overview  May 24, 2006

34. Mental Health Transformation
Overarching goal is to improve the mental health of all Texans and meet the President’s New Freedom Commission goals
New Freedom Commission Goals are shared by those participating on the Transformation Working Group:
The Governor’s Office; Department of State Health Services; Texas Health and Human Services Commission; Department of Family and Protective Services; Criminal Justice Department; Juvenile Probation Commission; Texas Youth Commission; Consumers; Family Members; Texas Education Agency; Aging and Disability Services; Workforce Commission; Veteran’s Administration; etc.
House Human Services Committee  DSHS Mental Health and Substance Abuse Services Overview  May 24, 2006

35. Mental Health Transformation
The grant funding is seen as a catalyst to jump start some of the efforts of framing the public health approach. The 2 primary areas of focus:
Developing and supporting local behavioral health collaboratives
Using cutting edge technology to change work processes across agencies
Improvement of the system will be targeted to the following principles:
Apply evidence to health care delivery
Use information technology
Align payment policies with quality improvement
Prepare the workforce
House Human Services Committee  DSHS Mental Health and Substance Abuse Services Overview  May 24, 2006