Presentation on theme: "Department of Mental Health"— Presentation transcript:
1Department of Mental Health Commonwealth of MassachusettsPresentation to the Citizens’ Health Care Working Group, Boston, MA, August 17, Department of Mental Health, Commonwealth of Massachusetts, Elizabeth Childs, MD, Commissioner.Elizabeth Childs, MDCommissioner
2Our VisionMental health is an essential part of health care. The Massachusetts Department of Mental Health, as the State Mental Health Authority, promotes mental health through early intervention, treatment, education, policy and regulation so that all residents of the Commonwealth may live full and productive lives.Our Vision: mental health is an essential part of health care. The Massachusetts Department of Mental Health promotes mental health through early intervention, treatment, education, policy and regulation so that all residents of the Commonwealth may live full and productive lives.
3Mission StatementThe Department of Mental Health, as the State Mental Health Authority, assures and provides access to services and supports to meet the mental health needs of individuals of all ages, enabling them to live, work and participate in their communities. The Department establishes standards to ensure effective and culturally competent care to promote recovery. The Department sets policy, promotes self-determination, protects human rights and supports mental health training and research. This critical mission is accomplished by working in partnership with other state agencies, individuals, families, providers and communities.Mission is to provide services for mental health for all, enabling people to live, work and participate in their communities. Done through establishing competent care to promote recovery. Recovery is the goal. Done through partnerships with other agencies, families, and individuals.
4Principles Value Excellence Innovation/CreativityExcellenceEfficiencyValueThe SMHA Value PropositionExcellence: Pursuing quality, adopting evidence based treatment practices and operating in a continuous quality improvement framework to produce accountable outcomesInnovation/Creativity: Adopting promising treatment practices that promote recovery and implementing best of breed administrative practices to support system operationsEfficiency: Ensuring cost effective, local services and supports that maximize outcomes.Value: Promoting effective care that has high value to consumers, citizens and our communities. Value is the product of excellence, efficiency and innovation.Principals: excellence, innovation/creativity, efficiency, and value. Department seeks to have superior care using evidence-based practice.Ensure high value treatment and supports to people with mental illnesses to empower personal growth and to promote an optimal and productive life in the community.
5National Context: New Freedom Commission In a Transformed Mental Health System:Americans understand that mental health is essential to overall healthMental health care is consumer and family driven and recovery orientedDisparities in mental health services are eliminatedEarly mental health screening, assessment, and referral to services are common practiceExcellent mental health care is delivered and research is acceleratedTechnology is used to access mental health care and informationCitation: President’s New Freedom CommissionNational context: new freedom commission. In a transformed mental health system, Americans understand mental health as essential.
6New Change ~ New Governance EOHHS Reorganization Leadership defined the focus of reorganization around coordinating services and programs while streamlining core administrative processes.EOHHS agencies: A common health and human services enterprise.Three new offices established: Children, Youth and Families; Health Services; Disabilities and Community Services. DMH is part of the Health Services cluster along with the Department of Public Health.Mental Health emerged as a critical lynchpin service provider that cuts across all EOHHS offices in a fundamental way.Through April 30April 1- June 30Incorporate Broader DMH and MHBH Staff Participation into Plan Specifications and Implementation StrategiesLeadership and Senior Management Develop Strategic FrameworkPhase III: Incorporate Other Agencies, Consumers, Advocates and Community LeadersMassachusetts felt it had an opportunity to do something new and effective. Mental Health was elevated as an objective in Massachusetts. Mental health services are part of the health department.
7DMH Mandate MGL, Chapter 19, Section 1: “The Department shall take cognizance of all matters affecting the mental health of the citizens of the Commonwealth.”The department of mental health is to be aware of all matters affecting mental health.
8DMH Overarching Principles 1. All services are consumer-centered and family-driven.2. Resiliency and recovery are the ultimate goals for all services and supports.3. Quality improvement principles must be embedded in everything we do.4. Services should be local.5. We must add value to our local communities.6. Effective behavioral health services are critical to the success of many other state agencies and we must actively partner with these organizations to achieve our common mission.Overarching principles: consumer-centered; seek recovery; quality; local services; add value to local communities; seek effective behavioral health services.
9What We DoThe Secretary of Health and Human Services has charged the DMH Commissioner with responsibility for coordinating mental health service issues across the EOHHS agencies, with particular attention to children and adolescents, and the homeless. Focusing on community care services, DMHprovides supportive clinical and rehabilitative services for adults with serious mental illness and children and adolescents with serious mental illness or serious emotional disturbanceintegrates public and private resources for optimal community-based care opportunitieshas oversight of the Behavioral Medicaid programs, including acute inpatient psychiatric services, emergency services, and other behavioral medicine services and programsWhat the department of mental health does: coordinate mental health services across all programs; provide supportive clinical/rehabilitative services; integrate public/private resources; and oversight of behavioral programs.
10What We DoThe Department of Mental Health provides an array of services from adult extended stay inpatient services and latency age and adolescent inpatient and intensive residential treatment facilities to a community-based services continuum.What we do, continued: provide an array of services in a variety of settings, for the complete range of patient/client.
11Key StatisticsDMH directly serves 26,000 individuals, including about 3,500 children and adolescents.With the integration of DMH and MassHealth Behavioral Health Programs, DMH has programmatic supervision of behavioral health services for 900,000 residents of the Commonwealth.Of the adult DMH clients, 78 percent receive Medicaid, 24 percent receive Medicare and 12 percent are uninsured.Key statistics; DMH (Department of Mental Health): serves 26,000 individuals; has programmatic supervision for 900,000 Massachusetts residents; and 78 percent of clients receive Medicaid, 24 percent Medicare, and 12 percent uninsured.
12Key StatisticsDMH operates 3 psychiatric hospitals, 8 community mental health centers, one contracted unit, and psychiatric units in two DPH operated hospitals with a total inpatient capacity of 996 adult beds and 48 adolescent continuing care beds.In FY2004, approximately 14,700 individuals, including children and adolescents, received statutory evaluations and/or other forensic services from DMH through the adult and juvenile court system.In FY2004, the DMH Forensic Transition Team planned the release and monitored the transition of 503 inmates with serious mental illness from incarceration to community mental health services.Since the early 1990s, DMH, working alone or with a formal partner or agent, has developed housing opportunities for more than 5,600 of our clients who previously lived in substandard housing or were homeless.Key statistics, continued; DMH: operates 3 psychiatric hospitals, 8 community mental health centers; gave 15,000 evaluations in 2004; transitioned 500 inmates to the community in 2004; has developed housing for 6,000 clients since early 1990’s.
13Initiative #1 Unified Behavioral Health System The Commonwealth is realizing the vision of a unified public behavioral health system since the Department of Mental Health and its Commissioner has been delegated oversight by the EOHHS Secretary of the MassHealth Behavioral Health Unit and its function.GoalsImprove access to and quality of servicesStandardize criteria for service entry, continuing care and dischargeEvidence based servicesEnsure high quality clinical decision makingProvide least restrictive settings to facilitate resiliency and recoveryInitiative #1, unified behavioral health system seeks to have unified system of care.
14Unified Behavioral Health System When fully implemented, the Unified Behavioral Health System will:DMH has articulated five high-level goals for the Unified Behavioral Health System. Together, these address the challenge of delivering adequate, efficient, and coordinated care.Deliver person and family-centered care and treatment that is evidence-based, recovery-oriented, and culturally competentSupport equitable access to the right treatment at the right time through coordination of benefits, administration and services across organizational entities and funding streamsProvide a forum where health and human service agencies will collaborate to improve access to services for special needs populations and for persons with conditions that are co-occurring with behavioral disordersPromote a flow of information and knowledge as the foundation for data supported decision making on standards of care, allocation of resources, and performance outcomesProduce results that are efficient, economical, and accountable to the citizens who use publicly funded behavioral health services and to the taxpayers who support the systemUnified behavioral health system when fully implemented provides unified care.
15Unified Behavioral Health System The Unified Behavioral Health System will coordinate services and administration across the DMH and MassHealth systems of care through different mechanisms:System Re-Design / Re-ProcurementRegulatory Change or WaiversContractual InfluenceUnified behavioral health system will coordinate care.
16Unified Behavioral Health System Successful design and implementation of the Unified Behavioral Health System require active participation from multiple entities.Active collaboration with MassHealth:The Steering Group charged with designing the Unified Behavioral Health System will include members from the Office of Medicaid, Office f Acute and Ambulatory Care, and other areas of MassHealth.MHBH program staff are now physically located at DMH and are an integral part of the core Unified System Steering GroupMHBH and DMH staff currently collaborate both on longer-term system design plans and on current management activitiesParticipation from other EOHHS Agencies:The Steering Group has established several statewide work groups (Service Planning and Design, Current State Analysis, Administrative and Financial Strategy) that will include participation from other state agenciesThe Steering Group and statewide work groups will pursue an inter-agency approach as they explores best practices and system needs, particularly as they relate to children and to people with disabilitiesActive public dialogue from stakeholders:The Steering Committee will release frequent Requests for Information (RFI) and will hold public meetings and focus groups with consumers, providers, advocates and other stakeholdersSuccessful design and implementation of the unified behavioral health system requires active participation from multiple entities.
17Initiative #2 ~ Community Expansion, Inpatient Consolidation and a New Hospital The Department’s Inpatient Study Report of March 2004 outlines three basic issues: The limitations posed by two antiquated facilities; advanced standards of care and treatment of individuals with mental illness that have far outpaced our existing infrastructure; and the need to expand the DMH community service system in order to sustain client tenure in community placements.The Facility Feasibility Commission, established by section 364 of Chapter 149 of the Acts of 2004, is assessing the feasibility of building a state-of-the-art DMH psychiatric hospital in Central Massachusetts. The foundation of the Commission’s work is the imperative to provide community placements for those individuals in state hospitals who are entitled to live in less restrictive settings.Initiative #2 consistes of community expansion, inpatient consolidation and a new hospital.
18Community Expansion, Inpatient Consolidation and a New Hospital A major feature of the plan is a reduction of DMH’s statewide adult continuing care bed capacity from 900 to 740, including a reduction of the combined bed capacity of Worcester and Westborough State Hospitals from 354 beds to 260 and the consolidation of that capacity in a new state-of-the-art inpatient psychiatric facility.The Department enjoys a history of success in this arena. DMH closed Medfield State Hospital in 2003 and used the resulting savings to successfully place 255 clients from across the state in community settings, including 59 former patients from Medfield.Develop new community placements to serve 268 current DMH hospital residentsCompleted: 104 individuals placed into the community as of 03/09/05Planned: 164 continuing care patients placed by 12/31/05Community expansion, inpatient consolidation and a new hospital: increased capacity; sought efficiency and cost reductions; developed new community options.
19Initiative #3 Comprehensive Quality Improvement Plan GoalDevelop a customer-informed, data-driven infrastructure to continuously improve behavioral health services in the CommonwealthStrategiesUse reliable, transparent and accessible dataQuality will be defined by the needs of individuals, families and communitiesCommitment to evidence-based practices and the sharing of best practicesCommitment to innovation and creativityTechnologyProcessesProgramManagementPeopleInformationQualityBusinessQualityInitiative #3: comprehensive quality improvement plan using: reliable, transparent and accessible data.
20Comprehensive Quality Improvement Plan The meaning of the word “quality” is changingA comprehensive quality improvement plan evolved.There is momentum in the field to incorporate clinical outcomes with a broader emphasis on service excellence, increasing value and reducing waste.
21Restraint and Seclusion Reduction: A CQI Initiative DMH is committed to eliminating the use of restraint or seclusion in its facilities and programs. This goal is consistent with a mental health system that treats people with dignity, respect and mutuality, protects their rights, provides the best care possible, and assists them in their recovery.A recent grant award will support DMH efforts to coordinate a statewide R/S reduction, bolster current efforts, accelerating an already aggressive program.Evaluate the process and outcomes and consumer roles in a three-year project.Project will significantly improve mental health services in the 11 DMH facilities and, by example, help to improve mental health services across Massachusetts.Restraint and seclusion reductions was part of the quality initiative.
22Suicide Prevention: A CQI Initiative DMH collaborates with the Department of Public Health, and is active in statewide suicide prevention efforts through the Massachusetts Coalition for Suicide Prevention and the Statewide Strategic Plan for Suicide Prevention. Three priority goals of this effort are:Build broad support for suicide preventionReduce stigma associated with mental illnessTrainings to recognize suicidal behavior and risksDMH Commissioner Elizabeth Childs, M.D., co-chaired the EOHHS Suicide Prevention Task ForceDMH co-sponsors the annual statewide Suicide Prevention Conference in MayAnother dimension to the quality initiative was suicide prevention.
23Our Anti-Stigma WorkThe President’s New Freedom Commission identifies stigma as the main barrier to treatment. Mental illness is a public health problem that requires a public health approach. Historically, the Department of Mental Health has been in the forefront of efforts to increase awareness about mental illness and educate the public that mental illnesses, like cancer and diabetes, are treatable and that people can recover and live productively in their communities.In 1997, DMH, along with its advocacy partner, the Massachusetts Association for Mental Health (MAMH), launched the Changing Minds Campaign ― a pioneering effort in Massachusetts to remove the stigma of mental illness, the major barrier to treatment. Our latest anti-stigma work involves a federal mental illness awareness project called the Elimination of Barriers Initiative (EBI) and a SAMHSA National Anti-Stigma Campaign.Massachusetts is pursuing anti-stigma efforts since stigma is seen as the main barrier to treatment of mental illness.