Maggie Labarta, PhD President/CEO April 27, 2011

Among the most prevalent disorders

 Brain disorders, highly treatable  60-80% improvement, compared to 40-60% for heart disease  Mental illnesses cause more premature death and disability than most other conditions, second only to heart disease  Account for 25% of disability recipients  Cost over $317 billion annually for lost productivity, health care and disability payments  Impact of mental health and substance abuse in Alachua County  One in four are affected by a mental illness = 61,750  One in 17 has a serious, potentially disabling illness = 22,230

 The system of care capacity is inadequate  Florida ranks 49 th in funding for behavioral health, 35 th for substance abuse  Un-met need:  58% of adult mental health  82% children’s mental health  85% children’s substance abuse  93% adult substance abuse of disorders Only 46% of the care being provided is covered through private insurance  Last year, Meridian provided $1.6 million in uncompensated care and still had to turn away 815 from all catchment areas, 309 in Alachua County who requested treatment because no payment source was available

 Return on investment Community TreatmentWithout Community Treatment Crisis Stabilization per Day $300 Emergency Room visit $2,887 Detox per day $274 Hospital per day $2,000 Average annual cost – substance abuse treatment $2,400 Average Annual prison Cost $55,000 Average annual cost – mental health treatment $1,551 Average State hospital bed $112,000 per year $28,000 for 3-month admission

 Meridian is a non-profit community mental health and substance abuse treatment provider  Part of the safety net providing  Emergency and crisis support services  The region’s only public receiving facility  Collaborative solutions to community problems  Emergency room and hospital overutilization  Jail diversion  Homeless services  Services to the uninsured

 Part of the area’s high quality healthcare system  Accredited  Council on Accreditation of Rehabilitation Facilities  American Association of Suicidology  Licensed  Agency for Healthcare Administration  Department of Children and Families  Drug Enforcement Agency

 Served almost 30,000 across ten counties  14,574 in treatment programs  16,000 through outreach and prevention services  Part of the area’s economy  Employ over 500 individuals, 387 in Alachua County  Provide $22 million in salaries and benefits  Purchase goods and services totaling $8.3 million in the local communities

p Jail Diversion Homeless Educational Success Uninsured Employment

Forensic Services

Effective use of resources

 4,569 seen year to date  Comparable to 4,554 at the same point in FYE2010  Most prevalent problems  Mood disorders (depression, bi-polar) – 2,335  Psychotic Disorders – 567  Substance Use Disorders  PTSD/Anxiety – 304  ADHD  Turned away 100 due to lack of capacity or lack of payor source  Typically increases in last quarter as state funds are depleted  84% are at or below Federal Poverty  98% are at or below 300% Federal Poverty and receive discounted services

Ability to braid funds maximizes county, state, federal and private revenues Each piece is essential to maintaining the whole Federal State Insurance Client Fees Donations Medicaid Medicare Contracts

 Medicare  Psychiatric Treatment  Counseling  Commercial Insurance  Psychiatric Treatment  Counseling  CSU – some companies only  Detox seldom  Medicaid  Psychiatric Treatment  Counseling  CSU – some companies only  Rehabilitation  Case Management  Peer Supports  State and County  Psychiatric Treatment  Counseling  CSU – some companies only  Rehabilitation  Case Management  Vocational  Peer Supports  Housing

 Most clients need more than one service, often not all allowed by the primary payor  Once a client is admitted, they are offered all medically necessary services  regardless of availability of funding  Typically results $1.6- $3 million per year in uncompensated care Medical HousingRehab

Fees/ Insurance/ Medicaid/ Medicare StateCounty Comprehensive Care

 State and federal funds require local match  Meridian’s match amount is specified within contract with DCF  Varies year-to-year depending on how state and federal dollars are allocated to us from DCF  “Local match”  Local fee and county funds  Counties responsible

Apportion required match Calculate catchment area population Calculate each county’s percent Distribute share of match accordingly Project funds from all eligible sources = “earned match" Client fees Insurance Contracts County special service contracts School contracts Request County Commission funding Match required less earned match Remaining amount to be asked of county BOCC

 2010 required match: $2,638,678 or $5.06 per capita  Alachua County  50% of catchment area, $1,301,640 in match  Current match eligible contribution  $795,561 BOCC contract  $430,000 Court Services Contracts (estimated current year)  Match deficit $76,000

Alachua County Fiscal YearNumber Served % changePer Capita Funding Total Funding Value of Services Cost Per Person Served County Per Person Served FYE 20075,042 $3.62$899,383$13,111,15 8 $2,600$178 FYE 20085, %$3.58$904,929 $13,758,791 $2,508$165 FYE20095, %$3.54$883,956$14,043,82 5 $2,453$154 FYE20105, %$ ,561$11,064,88 4 $1,920$138 FYE2011 Estimate* 5, % $3.09 $695,561 GR /$100,000 (CHOICES) $134 5% Reduction $2.93$755,783

Focus on Evidence Based Practices

 Co-occurring treatment  Evidence based assessment – GAIN  Solution focused therapy  Group treatment  Trauma informed care  Wellness  Prevention

 Mental Health MeridianRegionState AdultDays in Community Days of Work (SMI) Days in Community (Forensic) ChildSED Days in Community SED School Attendance91.61%92.49%91.49% ED Days in Community

 Substance Abuse MeridianRegionState AdultSuccessful Completion57.14% 61.54% %Change in Employment 7%9%15% ChildSuccessful Completion46.67%52.93%69.11% Stable Housing100%92%96%

 Forensic Services – Forensic Specialist Team (MIWG)  Arrests went from 1.93 to.75, on average in the first year and jail days from 117 to 53 jail days.  In year 2, arrests remained lower,.70 on average and jail days to 48, on average.

 Forensic Diversion Team (CJMHSAG) – The number of arrests and incarcerations decreased for all groups, though it was the most significant for the clients who successfully completed treatment (42% decrease in arrests and 51% decrease in incarcerations). The number of jail days significantly increased by 86% for the non-engaged group of clients) -

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