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Department of Mental Health

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1 Department of Mental Health
Commonwealth of Massachusetts Presentation to the Citizens’ Health Care Working Group, Boston, MA, August 17, Department of Mental Health, Commonwealth of Massachusetts, Elizabeth Childs, MD, Commissioner. Elizabeth Childs, MD Commissioner

2 Our Vision Mental 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.

3 Mission Statement The 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.

4 Principles Value Excellence
Innovation/Creativity Excellence Efficiency Value The SMHA Value Proposition Excellence: Pursuing quality, adopting evidence based treatment practices and operating in a continuous quality improvement framework to produce accountable outcomes Innovation/Creativity: Adopting promising treatment practices that promote recovery and implementing best of breed administrative practices to support system operations Efficiency: 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.

5 National Context: New Freedom Commission
In a Transformed Mental Health System: Americans understand that mental health is essential to overall health Mental health care is consumer and family driven and recovery oriented Disparities in mental health services are eliminated Early mental health screening, assessment, and referral to services are common practice Excellent mental health care is delivered and research is accelerated Technology is used to access mental health care and information Citation: President’s New Freedom Commission National context: new freedom commission. In a transformed mental health system, Americans understand mental health as essential.

6 New 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 30 April 1- June 30 Incorporate Broader DMH and MHBH Staff Participation into Plan Specifications and Implementation Strategies Leadership and Senior Management Develop Strategic Framework Phase III: Incorporate Other Agencies, Consumers, Advocates and Community Leaders Massachusetts 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.

7 DMH 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.

8 DMH 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.

9 What We Do The 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, DMH provides supportive clinical and rehabilitative services for adults with serious mental illness and children and adolescents with serious mental illness or serious emotional disturbance integrates public and private resources for optimal community-based care opportunities has oversight of the Behavioral Medicaid programs, including acute inpatient psychiatric services, emergency services, and other behavioral medicine services and programs What 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.

10 What We Do The 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.

11 Key Statistics DMH 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.

12 Key Statistics DMH 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.

13 Initiative #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. Goals Improve access to and quality of services Standardize criteria for service entry, continuing care and discharge Evidence based services Ensure high quality clinical decision making Provide least restrictive settings to facilitate resiliency and recovery Initiative #1, unified behavioral health system seeks to have unified system of care.

14 Unified 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 competent Support equitable access to the right treatment at the right time through coordination of benefits, administration and services across organizational entities and funding streams Provide 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 disorders Promote a flow of information and knowledge as the foundation for data supported decision making on standards of care, allocation of resources, and performance outcomes Produce results that are efficient, economical, and accountable to the citizens who use publicly funded behavioral health services and to the taxpayers who support the system Unified behavioral health system when fully implemented provides unified care.

15 Unified 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-Procurement Regulatory Change or Waivers Contractual Influence Unified behavioral health system will coordinate care.

16 Unified 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 Group MHBH and DMH staff currently collaborate both on longer-term system design plans and on current management activities Participation 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 agencies The 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 disabilities Active 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 stakeholders Successful design and implementation of the unified behavioral health system requires active participation from multiple entities.

17 Initiative #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.

18 Community 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 residents Completed: 104 individuals placed into the community as of 03/09/05 Planned: 164 continuing care patients placed by 12/31/05 Community expansion, inpatient consolidation and a new hospital: increased capacity; sought efficiency and cost reductions; developed new community options.

19 Initiative #3 Comprehensive Quality Improvement Plan
Goal Develop a customer-informed, data-driven infrastructure to continuously improve behavioral health services in the Commonwealth Strategies Use reliable, transparent and accessible data Quality will be defined by the needs of individuals, families and communities Commitment to evidence-based practices and the sharing of best practices Commitment to innovation and creativity Technology Processes Program Management People Information Quality Business Quality Initiative #3: comprehensive quality improvement plan using: reliable, transparent and accessible data.

20 Comprehensive Quality Improvement Plan
The meaning of the word “quality” is changing A 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.

21 Restraint 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.

22 Suicide 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 prevention Reduce stigma associated with mental illness Trainings to recognize suicidal behavior and risks DMH Commissioner Elizabeth Childs, M.D., co-chaired the EOHHS Suicide Prevention Task Force DMH co-sponsors the annual statewide Suicide Prevention Conference in May Another dimension to the quality initiative was suicide prevention.

23 Our Anti-Stigma Work The 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.

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