1. Mental Health and Substance Abuse Needs and Gaps FY 2013

2.   Provide legislators with information on behavioral health services in Idaho’s Region 2.  Demonstrate the effects of current funding for mental health and substance abuse services  Recommendations about services based on research data PURPOSE

3.   3 years of data collection  25 Stakeholders Responded  Treatment Providers  Schools  Hospitals  Justice System  Law enforcement  Prosecutors  Judicial system RESEARCH

4.   Suicide  6 th highest in U.S. - 49% higher than U.S. average  Nez Perce County - 21 suicides per 100,000  Nationally – 13.7 suicides per 100,000  $36 million - Cost of attempts per year in Idaho  $850,000 – Medical cost of completed suicides  Idaho Funding  $36.64 per capita expenditures for mental health  Lowest in U.S. Idaho Mental Health Facts

5.   Dedication and commitment of the Behavioral Health Providers and Regional Mental Health Board  Specialty Courts  Veterans Court established 2013  Currently 36 Mental Health Court participants  Graduates  20 Mental Health Court  43 DUI Court  77 Drug Court  CIT Training by Law Enforcement Region 2 Strengths

6. “Children’s Mental Health is Preventative Mental Health” Jennifer Griffis

7.  Percentage of Children Served with Mental Health Diagnoses  2011-12  10-80% of children served  2012-13  10-80% of children served  2013-14  10-85% of children served School Social Workers & Counselors – 8 districts

8.   More school-based services  More psychiatric and medication management services for children and youth  More community-based services for children and families  Accessible services for low-income families  Transportation  Easier access in rural areas  Local inpatient treatment for children & youth Needs and Gaps

9.  “Research has shown early intervention and effective treatment of children’s mental health needs have positive correlation to improved school performance, less involvement with juvenile justice system, and reduced cost for mental health treatment into adulthood.” Parent and Advocate To the Legislature

10.   FY 2010  35 children/youth  FY 2011  28 children/youth  FY 2012  38 children/youth  FY 2013  Unavailable Health and Welfare Crisis Response

11.   Youth in Idaho Juvenile Justice System with mental health diagnosis o 70.2%  Youth with Co-occurring Disorders o 39.2%  Youth with Substance Abuse Disorder o 59.6% Juvenile Justice System

13.  Hospitals - ER Visits Mental Health  2010  1532 Visits  2011  1649 Visits  2012  1584 Visits *  2013  Unavailable *estimate based on 1 st quarter statistics Drugs and Alcohol  2010  160 Visits  2011  158 Visits  2012  140 Visits*  2013  Unavailable

14.  Hospital Admissions Mental Health  2010  499 Admissions  2011  529 Admissions  2012  456 Admissions*  2013  734 Admissions Drug and Alcohol  2010  242 Admissions  2011  272 Admissions  2012  252 Admissions*  2013  Unavailable

15.   ER - Mental Health and Substance Abuse  2010 - $672,296  2011 - $877,190  2012 - $722,824*  Inpatient Mental Health  2013 -$429,000 Hospital Cost of Indigent Care

16.   Number of Medicaid clients served  2011 50-300 clients  2012 66-250 client  2013 86-250 clients  Percentage of clients covered by all types of government funding  60-100 % Private Providers 4 Agencies

17.   Excessive rules and regulations cost businesses and reduce patient care  Closing of rural Dept. of Health and Welfare Office left major gap in services  Need for Crisis Housing  Need for state-funded detox facility  Need for residential treatment for clients with substance use disorders Private Providers Needs and Gaps

18.  “We are the ones that have to look people in the eye and say ‘nope-sorry-can’t help you’… Ultimately the state will end up paying more for in-patient care, child protection, and incarceration but the lines never seem to be drawn from here to there.” Private Provider To the Legislators

20.   FY 2010  265 individuals  FY 2011  274 individuals  FY 2012  340 individuals  FY 2013  unavailable Region 2 Health and Welfare Crisis Response

22.  Prosecuting Attorneys 6 Prosecutors Mental Health  Cases involving Mental Health conditions  5-75%  2010-13: increase in cases involving mental health conditions appearing for court disposition Substance Abuse  Cases involving Alcohol and/or Drugs  5-90%  2010-13: increase in cases involving substance use disorders appearing for court disposition

23.   “ My primary concern is public safety…I believe a true financial analysis would show that the cost of handling the mentally ill as criminals (a system poorly suited to good outcomes for the mentally ill) is in the long run as or more expensive than providing treatment.” Prosecutor’s Concern

24.   Ability of defendants to pay for mental health services has decreased in the last three years.  Court costs of working with defendants with mental health needs are more than other cases.  Ability to find competent resources in the rural areas of district is decreasing. Needs and Gaps

25.   “While Mental Health Court is helpful for some, many of these people would not be committing crimes if their mental illness was being properly addressed.”  “Without the ability to address underlying mental health issues, the ability to treat substance abuse issues, and modify behaviors are significantly impaired. We lack something even as basic as an ACT team or an office for mental health professionals to meet defendants in our area.” To the Legislature

26.   “It is far less expensive to properly treat mental illness than incarcerate them as criminals -- not to mention the avoidable damage to the community by allowing their condition to deteriorate to where they are engaging in criminal conduct and victimizing others.”  “A person’s mental health needs, and a community’s response, are ongoing and need to be maintained with a large measure of certainty and consistency. Thus, random spurts of money are totally ineffective.” To the Legislature

27.  Law Enforcement - 1  Mental Health Holds 2012 – 3 2013 – 1  M H Transports 2012 – 3 2013 – 1 Average amount of officer time per transport: 3 hours  Attempted suicides 2012 – 7 2013 – 9  Completed suicides 2012 – 1 2013 – 0 Average amount of hours involved per attempt and per suicide: 5 hours

28.   Mental Health Transports  2011  38 transports  80 hours of officer time  $2800 personnel cost  2012  54 transports  110 hours of officer time  $3850 personnel cost Law Enforcement - 2

29.   Lowered response time for other concerns  Fewer officers available to respond  Increased cost of calling in off- duty officers  Training cost for officers on mental health issues Effect on Law Enforcement

30.   Officer Safety  Safety of emotionally disturbed person  Safety of citizens  Accurate identification of mental health issues by responding officer Law Enforcement’s Concerns

31.   “Law enforcement interaction with persons with mental health issues or emotionally disturbed persons (EDP) has increased over the past decade. The time and resources expended to address this problem is a resource and financial drain upon any law enforcement entity.” To the Legislature

32.  Court System Request for Mental Health Commitment Nez Perce County

33.   Reduce load on Justice System and increase funding for mental health & substance abuse services.  Greater regional control of funding allocation.  Increase access to services in rural and frontier areas.  Increase services in schools.  Increase community services for children and families.  Local detox unit and residential treatment for substance use disorders  Increase funding for prevention. Recommendations