1. Access Task Force Report Presentation to House Health, Welfare and Institutions General Assembly Building September 6, 2007

2. Report to HWI – September 2007 2 What the system looks like now... TRIAGE Crisis response/Resolution & Referral JAIL Crisis Stabilization & Referral Non-emergency & clinical support services

3. Report to HWI – September 2007 3 Jail TRIAGE Crisis response/Resolution & Referral Crisis Stabilization & Referral Non-emergency & clinical support services Inpatient/ State Facility What it should look like Emergency Psychiatric Services Center Anytown, Virginia

4. Report to HWI – September 2007 4 Background Inability to access community based, private and public mental health services –Large volume of Temporary Detention Order (TDO) hearings –Unnecessary arrest and incarceration of individuals affected by psychiatric illness –Inappropriate use of hospital emergency rooms –Untreated individuals in distress or at risk

5. Four Decades of Study… Previous Commissions have studied and recommended changes for the Commonwealth’s Mental Health System

6. Report Recommendation Gov. Tuck 1949 Willey 1962 Comm. MH/MR 1965 Hirst Comm. 1970-72 JLARC 1979 Bagley Comm. 1980 Emick Comm. 1985 JLARC 1986 JLARC 1995 Comm. MH/MR 1997 Hall- Gartlan 1998 Hammond Comm, 1998 Hall- Gartlan 2000 Need for Availability of Community Services Statewide to Prevent/Reduce Hospitalizations Need for Services/Core Services, Prevention/Early diagnosis, Treatment/care, Housing/day treatment, Emergency interventions Single System of Care, Continuum of Services. and Continuity of Care Individualized Services in Least Restrictive Environment Discharge Planning by CSBs Funding Needed for Community Services Maximize Medicaid Reinvest Funding from Facilities/Downsizing Define Eligible/Priority Populations Barriers to Community Services Lack of Resources Lack of Even, Standardized Services Statewide Consensus Recommendations from MHMRSAS Legislative Studies (1949-2000)

7. Report to HWI – September 2007 7 Solutions will be found in … Resources Law Reform Service Capacity

8. Report to HWI – September 2007 8 The Three Legged Stool Law Reform –the statutory framework for delivering mental health services –State and local policies governing care provided by public and private agencies and providers Service Capacity –the continuing need for private and public community- based services accessible by all Virginians Resources –funding (SGF, local funds, Medicaid/Medicare and other insurance, SSDI, Auxiliary Grant support, etc.)

9. Report to HWI – September 2007 9 Conceptual Model Capacity Components necessary to improve access to other private and public community based services Early Intervention and Treatment services Crisis Response Services Intensive Support Services

10. Report to HWI – September 2007 10 Early Intervention and Treatment services (Crisis Avoidance) Outpatient Counseling Outpatient Psychiatry Open referral to one # for all services Education Advance Directives In-home or community respite Linkages with other agencies Capacity Components

11. Report to HWI – September 2007 11 Crisis Response Services Crisis Intervention Crisis Stabilization Inpatient Acute Care Urgent care Crisis Intervention Teams (CIT) Non criminal justice transportation Peer and natural supports Capacity Components

12. Report to HWI – September 2007 12 DISPOSITION INTERVENTION STABILIZATION REFERRAL EMERGENCY MENTAL HEALTH CONTINUUM CRISIS, ACCESS & RECOVERY ASSESSMENT ARRAY OF COMMUNITY RELEVANT SERVICES AND CENTERS POLICE/SHERIFFS MAGISTRATES EMS ER MH-ES HOTLINE URGENT APPOINTMENTS QUICK MED VISITS MED AVAILABILITY DAY PROGRAMS CRISIS STAB PROGRAMS CONSUMER RUN SUPPORTS CRISIS CASE MGMT CRIMIINAL JUSTICE LIAISON JAIL DIVERSION JAIL MH SERVICES QUICK BENEFITS MEDICAL CARE BLENDED SERVICES SA TREATMENT LOCAL HOSPITAL BEDS SPECIAL JUSTICES RESIDENTIAL SUPPORTS HOUSING COMPETENT SYSTEM: ATTITUDEKNOWLEDGESKILL

13. Report to HWI – September 2007 13 Intensive Support Services Case Management Psychiatry/Medication and treatment Intensive Outpatient In Home Crisis Management Aggressive Engagement Services (PACT/ICT/ICM) Day Treatment/Psychosocial Capacity Components

14. Report to HWI – September 2007 14 Intensive Support Services (cont.) Job Training and placement Aggressive linkage with SUD services Intensive Home Based services (MH supports) Housing supports Peer Support services Capacity Components

15. Report to HWI – September 2007 15 Proposed Mandated Services – All C&A Inpatient/ Acute Care Both Adult

16. Report to HWI – September 2007 16 Va. Code Ann. § 37.2-500 Purpose; community services board; services to be provided –The core of services provided by community services boards within the cities and counties that they serve shall include emergency services and, subject to the availability of funds appropriated for them, case management services. The core of services may include…

17. Report to HWI – September 2007 17 Proposed Revisions Purpose; community services board; services to be provided –The core of services provided by community services boards within the cities and counties that they serve shall include emergency, crisis stabilization, case management, outpatient, respite, in-home, residential and housing support services. The core of services may include a comprehensive system of inpatient, prevention, early intervention, and other appropriate mental health, mental retardation, and substance abuse services necessary to provide individualized services and supports to persons with mental illnesses, mental retardation, or substance abuse.

18. Report to HWI – September 2007 18 Policy and Resource Issues Health care insurance –Private and public –Benefits and reimbursement parity Medicaid Eligibility –80% of FPL versus 100% of FPL Role of DMHMRSAS –Facilities versus communities

19. Report to HWI – September 2007 19 Action Plan Phase One FY 2009Phase Two FY 2010 Goal : Initiate a full array of crisis response services Establish 29 crisis stabilization facilitiesEstablish 9 additional crisis stabilization facilities Goal : Revise § 37.2-500 of the Code of Virginia Expand mandated core services n/a Goal : Expand capacity of CSB targeted Case Management Dedicated resources to increase CSB Case Management by 125 FTEs Dedicated resources to increase CSB Case Management by 175 FTES

20. Report to HWI – September 2007 20 Action Plan (cont.) Phase One FY 2009Phase Two FY 2010 Goal : Implementation of CIT in each law enforcement jurisdiction One third of all law enforcement jurisdictions implement CIT Additional third of all law enforcement jurisdictions implement CIT Goal : Expand access to Community Mental Health Outpatient Psychiatry (Public and Private) DMHMRSAS comprehensive study of community psychiatry capability Dedicated resources to expand community mental health outpatient psychiatry by 100 FTEs Goal : Expansion of Medicaid eligibility Change from 80% to 100% - $40 million Sustaining expansion - $60 million

21. Report to HWI – September 2007 21 Action Plan (cont.) Phase One FY 2009Phase Two FY 2010 Goal : Expansion of Intensive Community Treatment Program/PACT Funding for additional 18 TeamsFunding for additional 9 Teams Goal : Improved access to permanent housing Creation of Portable Auxiliary Grantsn/a

22. Questions ? Contact Info: Charles A. Hall, Executive Director Hampton-Newport CSB chall@hnncsb.org Phone: (757) 245-0217