1. DSHS COMMUNITY MENTAL HEALTH CRISIS SERVICES
IMPLEMENTATION OVERVIEW
MEETING
Thursday, August 2, 2007
9:30 a.m. – 4:00 p.m.

2. AGENDA Welcome and Introductions – Joe Vesowate 9:30 am
Opening Remarks – Dr. Lakey :45 am
Review of Committee’s Work – Joe Vesowate 10:00 am
Results of Legislature – Kirk Cole :30 am
Implementation Overview – Mike Maples 10:45 am
Break for Lunch :30 am
Committee Discussion – Implementation Overview 12:45 pm
Public Comment :15 pm
Final Comments – Committee Members :45 pm
*Adjourn :00 pm
*The adjournment time may be extended to 4:30 p.m. to allow
more time for public comment, if needed.

3. Please send comments to

4. OPENING
REMARKS

5. OVERVIEW OF
CRISIS REDESIGN
COMMITTEE

6. CRISIS REDESIGN COMMITTEE
Medical professionals (TSPP, Medical Directors of MH Centers)
Hospitals (THA, Hospital Districts)
Law enforcement (Sheriffs, Police)
Judges
Advocacy organizations (MHA, NAMI, Advocacy, Inc., et al)
Community MH centers
DSHS staff

7. CHARGE
Develop recommendations for a comprehensive array of specific services to meet the needs of Texans having a mental health and/or substance abuse crisis

8. WORK PROCESS Evaluation of existing services and data review
Review of biomedical and social services literature
Public testimony
Formation of four subcommittees
Clinical Design
Rural
Collaboration
Finance
Report

9. NEED FOR MENTAL HEALTH AND SUBSTANCE ABUSE
CRISIS REDESIGN

10. Projected Number of Persons Needing Crisis Services to Increase Dramatically Compared to that Expected from a General Population Increase
Note: Projected number of persons needing crisis services based on 13% increase in number receiving front-door crisis services from FY2005 to FY2006 projected forward each year, and 5% increase in number receiving community mental health services from FY2005 to FY2006 projected forward each year, 21% of whom receive community crisis services. Expected general population estimates based on 2.01% increase in Texas population (all ages) each year from 2005 to 2009.
Sources: DSHS Mental Retardation and Behavioral Health Outpatient Warehouse (MBOW); Texas Population Percent Change, All Ages, , Texas Data Center.

11. BACKGROUND
The committee was composed of more than 20 individuals representing local government, mental health professionals, hospitals, judges, law enforcement, advocacy organizations, local mental health authorities and DSHS staff.

12. COMMUNITY
SURVEYS

13. COMMUNITY SURVEYS 1600 surveys were mailed before September 1, 2005.
700 returned for overall return rate of 44%.
570 to Community Hospital Emergency Departments
258 were returned for a response rate of 45%
1030 to Law Enforcement, Sheriff Departments, Chiefs of Police
442 returned for a response rate of 43%

14. SURVEY RESULTS
Primary concerns of both Hospital/ER staff and Law Enforcement:
Timeliness of MHMR response
Use of “No Harm Contracts”
Issues related to requiring medical clearance
Need for improved communication and coordination
Law Enforcement also frequently mentioned:
Issues related to substance abuse
Need for more procedures and written agreements with LMHAs
All appeared to recognize the need for coordination to improve the system.

15. SITE VISITS AND HEARINGS
February 7, 2006 – San Antonio
February 15, 2006 – Austin
February 23, 2006 – Big Spring
February 27, Harlingen

16. CRISIS
THEMES

17. MAJOR ISSUES Information Attitude of providers
Specialists – competent, well-trained, appropriate attitude
No harm contracts
Standardized approach – assessment, services, etc.

18. MAJOR ISSUES
Training – crisis workers - assessment, suicide, substance abuse, law enforcement (CIT, MH Deputies), families
Integration with health
Medical evaluations/clearance – waiting time, consistency
Attention to families
Mobility orientation

19. MAJOR ISSUES
Types of services – crisis hotline, mobile outreach, 23 hr. evaluation, residential, trained law enforcement, etc.
Jail as an option – due to long waiting time, lack of options, unreceptiveness
Need for forensic system – individuals who may be dangerous
Courts – mental health and substance abuse

20. MAJOR ISSUES
Transportation – responsibility, availability, distance, cost, diversion of resources
Rural issues – distance, transportation, lack of professionals (MH/SA, healthcare, law enforcement), telemedicine
Involuntary status as admission criteria for state hospitals
Financial resources necessary

21. MAJOR ISSUES Children Data Cultural competency Collaboration
Outpatient services

22. SUBCOMMITTEES Clinical Services Rural Finance
Collaboration and Partnerships
* Special issue subcommittee - Transportation

23. CORE CRISIS SERVICES REPORT RECOMMENDATIONS
Crisis Hotline
23-48 Hour Observation
Crisis Outpatient Services
Community Crisis Residential Services
Mobile Outreach
Law Enforcement Crisis Intervention Team (CIT) and MH Deputy Programs

24. RESULTS OF
LEGISLATURE

25. FUNDING FOR MH CRISIS SERVICES REDESIGN
For the Years Ending
Aug. 31, Aug. 31, 2009
$27,317,890 $54,682,110

26. DSHS BUDGET RIDER
Use methodology that allocates a portion of the funds to achieve equity in state funding among local mental health authorities, a portion on a per capita basis, and a portion using a competitive process.
DSHS to submit allocation plan to Legislative Budget Board (LBB) and Governor prior to distribution of funding.
DSHS to report quarterly to LBB and governor on implementation of community mental health crisis services.

27. DSHS BUDGET RIDER
DSHS to develop performance measures for quarterly reporting, which may include:
Number of new psychiatric emergency 23/48 hour observation sites;
Number of persons receiving 23/48 observation, mobile outreach, and children’s crisis outpatient services;
Mental health relapse and hospitalization rates for clients receiving crisis services;

28. DSHS BUDGET RIDER
Number of DSHS-funded staff with hotline certification;
Percent of stakeholders satisfied with crisis services; and
Criminal justice recidivism rates for clients receiving crisis services.

29. DSHS BUDGET RIDER
DSHS to contract with independent entity for an evaluation of community mental health crisis services.
Evaluation to include analysis of the implementation of crisis services.
Evaluation to include analysis of the impact of crisis services on clients, local communities, mental health and health care providers, and law enforcement.

30. DSHS BUDGET RIDER
DSHS to submit evaluation to LBB, Governor, and standing committees of Senate and House of Representatives having primary jurisdiction over health and human services by January 1, 2009.