latest trends in state mental health agencieslatest trends in state mental health agencies tim r....

LatestTrendsinStateMentalHealthAgencies

TimR.Kne*ler,MBA,CAE,NRIExecu8veDirector/CEOTedLu*erman,NRI

CarrieSlaton-Hodges,OklahomaRandallBurns,AlaskaVeraHollen,NRI

NASMHPDSummer2016CommissionersMee8ngAugust8,2016

Introduc7ons•  NRI

o  NASMHPD/NRIHistoryo  FederalProjects

‒  Profiles,URS-MH/CLD,FEPandothers

o  PerformanceandQualityImprovement‒  BHPMS,DataIntegrityReviewsandothers

o  NewIni8a8ves‒  NASMHPD/NRIJointAnnualConference–Fall,2017‒  NRIMentalHealth/CriminalJus8ceResearchCenter‒  SpecialStateProjects:CO,OH,TX,WAandothers

•  Presenta8onsandPresenters

National Association of State Mental Health Program Directors Research Institute Slide 2

Presenta7onOutline

© 2016 National Association of State Mental Health Program Directors Research Institute

•  TrendsinStateMentalHealthAgency(SMHA)ServicesandFinancingo SMHAapproachesinaddressingstatebudgetshorcalls‒ Oklahoma:CarrieSlaton-Hodges‒ Alaska:RandallBurns

•  UseandFundingofStatePsychiatricHospitalbeds•  Innova8veUsesofTechnologyToAddressTheNeedsOfJus8ce-InvolvedPersonsWithBehavioralHealthIssues

Slide 3

WhatweknowaboutSMHAServices

Through3majorFederalProjects,NRIcompilesinforma8onthatdescribes:1.  HowSMHAsareorganizedandstructured;andtheirmajor

policy,service,andfinancingissues(StateProfiles)2.  SMHAexpendituresandrevenuesformentalhealth(SMHA

Rev/ExpStudy)3.  WhoSMHAsserve:howmanypersonsareserved,by

demographics,employment,livingsitua8on,servicesegng,etc.(URS/CLD)

Plus,NRIconductsspecialStudiesforNASMHPD,States,SAMHSA,andOthers:Olmstead,StateBudgetShorcalls,PrematureMortality,Medicaid

© 2016 National Association of State Mental Health Program Directors Research Institute Slide 4

SummaryofSMHASystems:2016

SMHASystemsareorganizingthedeliveryofhighqualitymentalhealthservicestomoreconsumersthaneverbefore:•  Minori8esandchildrenareservedathighratesbySMHAs—rela8velyfewer

ElderlyservedbySMHAsystem•  LargeincreaseinthenumberofSMHAconsumerswithMedicaidpayingfor

someoralloftheircare•  AlmostallSMHAconsumersareservedincommunitysegngs.Statehospitals

serve2%ofclients,butatahighcost•  Compe88veEmploymentratesforSMHAconsumersincreasedakeralarge

dropduringtherecentrecession•  ThenumberofconsumersreceivingEBPs,suchasAsser8veCommunity

Treatment,DualDiagnosisTreatment,Mul8-SystemicTherapy,FirstEpisodePsychosis(FEP)

•  SMHABudgetsincreased—butares8llbelowpre-recessionlevelsininfla8onandpopula8onadjusteddollars(andFY2017islookingworseformanystates).


NumberandCharacteris7csofIndividualsServedbySMHAs:2015

Slide 6

7,448,380 consumers received mental health services from SMHA systems in 2015*

•  2.3% of the US population •  Range from 0.5% to 5.8% of state population

$41 billion of mental health expenditures was controlled by SMHAs in FY 2014 providing these services

•  SMHA budgets ranged from $60 million to $6.8 billion

* Based on 58 states and territories reporting URS data on mental health consumers served by SMHA systems in 2015

15.01 thru 25 (15 States) 25.01 thru 35 (9 States) 35.01 thru 60 (14 States)

4 thru 15 (13 States)

SMHAMHClientsServedPer1,000StatePopula7on,2015

Source: SMHA submissions to SAMHSA 2015 Uniform Reporting System, Table 2 Slide 7

DemographicCharacteris7csofClientsServed:2015URS

•  Slightlymorefemale(52%)thanmales(48%)•  Childrenwere28%ofclientsserved(16%werechildrenage0to12,and12%wereadolescentsage13to17)

•  Adultswere67%(10%wereyoungadultsage18to24,and57%wereadultsage25to65)

•  Olderadultswere4.8%(age65andolder)•  MajorityofclientsservedwereWhite(62%),followedbyBlack/African-Americans(20%)

Slide 9

AgeandGenderDistribu7onofClientsServedinCommunitySePngs:URS2014

Age 0-17 27.5%

Age 18-20 4.5%

Age 21-64 63.4%

Age 65 and Over

4.5%

Age NA 0.1%

Female, 51.90%

Male, 48%

NA, 0.10%

Slide 10

AgeandGenderDistribu7onofClientsServedinStatePsychiatricHospitals:URS2014

Female34%

Male66%

Gender NA0.0%

Age 0-177.5%

Age 18-204.3%

Age 21-6483.1%

Age 65 and Over5.1% Age

NA0.0%

Slide 11

U7liza7onRates(per1,000popula7on),byAgeandGender:2015URS

17

42

25 25

30

26

11

7

24

28

42

2522

2421

75

2323

42

2523

2724

19

9

23

0

5

10

15

20

25

30

35

40

45

0-12 13-17 18-20 21-24 25-44 45-64 65-74 75+ All

Utilizatio

nRateper1,000

Pop

ulation

AgeGroup

Female

Males

Total

Slide 12

Age Distribution of Mental Health Clients and U.S. Population: 2014 MH-CLD

.0%

.2%

.4%

.6%

.8%

1.0%

1.2%

1.4%

1.6%

1 3 5 7 9 1113151719212325272931333537394143454749515355575961636567697173757779818385

male

female

BasedonXstatesrepor8ngN(Total)=4,885,207Missing=4,887

Age of Clients

Perc

enta

ge

Slide 13

U7liza7onRates(per1,000popula7on),byGenderandRace:2015URS

21

5

37

1517

22

18

2325

5

32

1720

22

19

2423

5

34

1619

22

18

23

0

5

10

15

20

25

30

35

40

AmericanIndian/

AlaskaNative

Asian BlackorAfricanAmerican

NativeHawaiian/

PacificIslander

White MoreThanOneRace

Hispanic All

Utilizatio

nRa

teper1,000Pop

ulation

Males

Females

Total

Slide 14

Mental Health Diagnosis, Adults (18+) by Gender: 2015 MH-CLD

Slide 15

28%

17%15%

12% 11%

6%

3% 2% 2%1% 1% 0% 0%

33%

22%

7%

12%

16%

3% 3% 3%1% 0% 0% 0% 0%

0.00%

5.00%

10.00%

15.00%

20.00%

25.00%

30.00%

35.00%

Moo

dDisorder(b

ipolaror

depressio

n)

Depressiv

eDisorder

Schizoph

reniaandOther

Psycho

sis

Bipo

larD

isorder

AnxietyDisorder

SubstanceUseDiso

rder

Adjustmen

tDiso

rder

Person

ality

Diso

rder

A*en

8onDe

ficitDisorder

PervasiveDD

Diso

rder

Delirium/Dem

en8a

Disorder

Cond

uctD

isorder

Opp

osi8on

alDefi

ant

Disorder

male

female

Consumers can have up to 3 diagnoses N = 4,924,929

TotalNumberofClientsServed,byAge:2004–2015URS

Slide 16

0.0

0.5

1.0

1.5

2.0

2.5

3.0

3.5

4.0

4.5

5.0

2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

Num

ber

of C

lient

s Se

rved

, in

Mill

ions

Age 0 -17

Age 18 - 20

Age 21 - 64

Age 65+

URS Report Year

NumberandCharacteris7csofIndividualsServedbySMHAs:2015

•  98% of clients received community-based mental health services o  75% of FY 2014 SMHA Expenditures were for Community-Based

Mental Health

•  2% of clients received services in state psychiatric hospitals o  23% of FY 2014 SMHA Expenditures were for state psychiatric

hospital-inpatient services

•  4.5% of clients received services in other psychiatric inpatient settings (35 states reporting)

Note: Clients can be served in multiple settings during the year, thus percentages of consumers served are greater than 100%

Slide 17

0

1

2

3

4

5

6

7

8

2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

Num

ber o

f Per

sons

Ser

ved

by S

MHA

s, in

Mill

ions

URSReportYear

Community

StateHospitals

OtherPsychInpatient

TotalNumberofClientsServed,byServiceSePng:2004to2015URS

Slide 18

•  69%ofSMHAconsumershadMedicaidpayforsomeoralloftheirmentalhealthservices

•  22%ofAdultmentalhealthconsumerswerecompe88velyemployedduringtheyearo  6.6%ofconsumerswithadiagnosisofschizophreniawerecompe88velyemployed

•  3%ofAdultmentalhealthconsumerswerehomeless

2015 URS Summary Results

Slide 19

MedicaidStatusofSMHAConsumers:URS2015

Medicaid paid for some or all MH

services 69%

No Medicaid

31%

7,329,568 consumers served by SMHAs in 2015 •  7,108,742 consumers (97%) had known Medicaid status •  220,826 consumers (3%) were missing Medicaid status information

Note, this is the number of consumers receiving mental health services from SMHA systems that had Medicaid paying for some or all of their mental health services. It is not how much ($) Medicaid paid for these services

Slide 20

MedicaidStatusofSMHAConsumers:2005–2015URS

0

1

2

3

4

5

2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

Num

ber

of S

MH

A C

onsu

mer

s, in

Mill

ions

URS Report Year

With Medicaid No Medicaid Medicaid Status Not Available

Slide 21

ChangeinMedicaidStatusofSMHAConsumersSinceACA

SincestatesbeganexpandingMedicaid,thestatesthatexpandedMedicaidhaveseenanincreaseinthepercentoftheirconsumersservedwhohaveMedicaidpayingforsomeoralloftheirmentalhealthservices•  Inthe24statesthatExpandedMedicaidin2014,theyhad

anaverageincreaseof10.3%inthenumberofconsumerswithMedicaidcoverage.

•  Inthe4statesthatExpandedMedicaidin2015,theyhadanaverageincreaseof7.5%inconsumerswithMedicaid

•  The20statesthathadnotExpandedMedicaidhadnochange(0%).o  9stateshadanincreaseinthenumberofclientswithMedicaid,and10had

adecrease—anetUSaveragechangeof0%.Source:SAMHSA2015URS

Slide 22

Compe77veEmploymentStatusofAdultClients:URS2015withKnownEmploymentStatus

Employed,

21.6%

Not in Labor Force, 52.2%

Unemployed 26.1%

1,401,214 Adults with Employment Status Not Available Slide 23

PercentofSMHAAdult(age18andover)MentalHealthConsumersCompe77velyEmployed:2005–2015URS

20.7%21.6% 21.0% 21.4%

20.4%19.0%

18.1%16.9% 17.0%

17.9%

21.6%

0.0%

5.0%

10.0%

15.0%

20.0%

25.0%

2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

Percen

tofC

lientsE

mployed

URSReportYear

Total of Clients In 2015: 26% were unemployed 52% were not in labor force

Slide 24

Employment Status: By Diagnosis 2015, At Start of Reporting Period, Ages 18-64, 2015 MH-CLD

35%

23% 23%

9%6%

19%23% 22%

16%11%

20% 20%24% 26%

32% 32%

27%

20%16%

35% 34% 34%

20%

29% 29%

14%

41%

25%

33%

44%

50%

71%

79%

46%43% 44%

64%60%

52%

66%

35%

49%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

employed unemployed notinlaborforceSlide 25

Employment Change from within 2015 MH-CLD from T1 to T2 Clients with a valid employment update flag: Age 18-64

86.9%

7.3% 3.5% 6.2%

79.5%

5.7% 6.9%

13.2%

90.8%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Employed at T1 Unemployed at T1 Not In Labor Force at T1

Per

cent

Em

ploy

ed

employed at T2 unemployed at T2 not in labor force at T2

506,206 adults were NILF at T1 212,255 adults were employed at T1

269,980 adults were unemployed at T1

T1 = Admission for new clients and status at Start of Year for Continuing Clients T2 = End of Year status for Continuing Clients and Status at Discharge for discontinued Clients Slide 26

LivingSitua7onofAdultClients:2015URS

Crisis Residence 0.1%

Other 6.9%

Private Residence 65.1%

Not Available 16.1%

Jail (Correctional Facility)

1.7% Foster Home

0.7%

Institutional Setting 1.8%

Residential Treatment Center

0.2%

Homeless (Shelter) 3.5%

Residential Care 3.9%

Slide 27

PeopleLivinginShelters/Homeless,byRace:2015URS

3.4%

4.3%

2.0%

5.2%

3.7%

2.9%

1.9%

3.6%

0.0% 1.0% 2.0% 3.0% 4.0% 5.0% 6.0%

Total

American Indian

Asian

Black/ African American

Native Hawaiian

White

Hispanic/Latino

Multi-Racial

Slide 28

PercentofClientswhowereHomeless:URS2005to2015

0.0%

0.5%

1.0%

1.5%

2.0%

2.5%

3.0%

3.5%

4.0%

4.5%

5.0%

05 (44states)

06 (49states

07 (51states

08 (50states)

09 (53states)

10 (54states)

11 (53states)

12 (55states)

13 (53states)

14 (58states)

15 (54states)

Adults(18-64)

TotalSMHAConsumers

Children(0to17)

OlderAdults(65andover)

Slide 29

HowStatesFinancetheirSMHAServices

TrendsinSMHA-controlledRevenuesandExpendituresforMentalHealthServices:

FY1981toFY2014



Trends in State Mental Health Agency Controlled Mental Health Spending, FY'81 to FY'14

$6.1 $7.1

$8.3 $9.3

$12.1

$14.2

$16.8

$23.1

$25.2

$26.4

$27.8

$29.4

$31.0

$34.0

$36.7 $37.6

$37.6

$39.0

$39.5

$39.2 $40.8

$6.1 $5.9 $6.1 $5.9

$6.2

$5.9

$6.0

$7.1

$7.3

$7.4

$7.5

$7.6

$7.7

$8.1 $8.4

$8.3

$8.1 $8.1 $7.9 $7.7 $7.8

$-

$5

$10

$15

$20

$25

$30

$35

$40

$45

SM

HA

-Con

trolle

d E

xpen

ditu

res

(In

Bill

ions

of D

olla

rs)

Current Dollars

Constant Dollars

Slide 32


Trend in Per Capita State Mental Health Agency Controlled Mental Health Spending, FY'1981 to FY'2014

Slide 33

$31 $35

$38

$49 $55

$63

$80 $86

$90 $94

$98 $103

$112

$120 $121

$121

$124 $125 $123 $127

$27 $25 $26 $25 $25 $23 $22 $25 $25 $25 $25 $25 $25 $27 $27 $27 $26 $26 $25 $24 $24

$0.00

$20.00

$40.00

$60.00

$80.00

$100.00

$120.00

$140.00

1981

1982

1983

1984

1985

1986

1987

1988

1989

1990

1991

1992

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

2005

2006

2007

2008

2009

2010

2011

2012

2013

2014

Per

Cap

ita

SMH

A-C

ontr

olle

d M

enta

l Hea

lth

Expe

ndit

ures

Current

Inflation-adjusted

Based on 50 States Reporting

TotalFY2014SMHA-ControlledPerCapitaMentalHealthExpenditures

Slide 34


SMHA-Controlled Expenditures for State Psychiatric Hospital Inpatient and Community-Based Services as a Percent of Total Expenditures: FY'81 to FY'14

Slide 35

33% 35% 36% 37%

43%

49%

58%

66% 67% 69% 70% 70% 70% 71% 72% 72% 73% 74% 74% 74% 75%

63% 60% 60% 59%

54%

48%

39%

32% 30% 29% 28% 27% 28% 26% 26% 26% 25% 24% 23% 24% 23%

0%

10%

20%

30%

40%

50%

60%

70%

80%

State Mental Hospital Inpatient

Community Mental Health

FundingSourcesofStateMentalHealthAgenciesforMentalHealthServices:FY2014

Slide 36

State General Funds, 40.4%

State Medicaid Match, 19.8%

Federal Medicaid, 29.0%

Medicare, 1.7%

MH Block Grant, 1.0%

All other Federal, 1.6% Local, 1.6%

First/Third Party, 1.5%

Other Funds, 3.6%

Total SMHA Revenues = $41.2 billion

FundingSourcesforStatePsychiatricHospitalsandCommunityMH:FY2014


State General Funds 30%

State Medicaid Match 24%

Federal Medicaid

35%

Medicare 1%

MH Block Grant 1%

All other Federal 2% Local

2%

First/Third Party 1%

Other Funds 4%

Community MH Revenues = $29.9 billion

StateGeneralFunds68%

StateMedicaidMatch9%

FederalMedicaid

13%

Medicare4%

MHBlockGrant0%

AllotherFederal1%

Local1%

First/ThirdParty2%

OtherFunds2%

State Psychaitric Hospital Revenues = $10.4 billion

Community Mental Health State Psychiatric Hospitals

Slide 37

SMHA-ControlledRevenuesforMentalHealthServices:FY1981toFY2014

State General Funds

State Medicaid

Match

$-

$5

$10

$15

$20

$25

$30

$35

$40

$45

SMH

A-C

ontro

lled

Fund

ing

in B

illio

ns

Other Funds

Other Federal

MH Block Grant

Federal Medicaid

State Medicaid Match

State General Funds Mental Health Block Grant

Slide 38

MedicaidReimbursementApproachesforMentalHealthServices,byState,2015

Combination (31)Fee for Service Only (13)Managed Care Only (4)No Response (3)

Slide 39

StateMentalHealthandSubstanceAbuseExpenditures

NRIhasbeenworkingwithNASADADinanexpandedsetofProfilestocombineinforma8ononSMHAexpendituresandfinancingwithSSAexpendituresandfinancing.•  CombinesNRIdataonSMHA-controlledRevenuesand

Expenditureswith•  SSAreportedExpendituresandRevenuessubmi*edto

SAMHSAaspartofSAPTBlockGrantRepor8ng

CombinedSMHAandSSAsystemscontrolledexpendituresof$46.25billionforbehavioralhealthservicesinFY2014


SSAandSMHAPerCapitaExpenditures:FY2014

AL

AK

AZ

AR

CA CO

CT

DE

DC

FL GA

HI

ID IL

IN

IA KS

KY

LA

MD

MA

MI

MN

MS

MO MT NE

NV

NH

NJ

NM

NY

NC

ND

OH

OK OR

PA

RI

SC

SD

TN

TX

UT

VT

VA

WA

WV

WI

WY

$0

$10

$20

$30

$40

$50

$60

$70

$80

$90

$0 $50 $100 $150 $200 $250 $300 $350

SSA

Per

Cap

ita E

xpen

ditu

res

SMHA Per Capita Expenditures

Slide 41

FundingSourcesofSSAsandSMHAs:FY2014

40%

49%

1%

10%

45%

16%

32%

6%

0%

10%

20%

30%

40%

50%

60%

State Funds (not including Medicaid

Match)

Medicaid (Federal & State Match)

SAMHSA Block Grants

All Other Funding Sources

Per

cent

of

SSA

or

SMH

A F

undi

ng f

rom

Sou

rce SMHA SSA

Slide 42

SSAandSMHAFunding:FY2008toFY2014

Funding Source

FY 2008 FY 2014 FY 2008 to FY 2014

Change

SSA SMHA SSA SMHA SSA SMHA

State Funds $2,192,412,306 $16,061,413,401 $2,265,508,240 $16,636,695,910 3.3% 3.6%

Medicaid $624,689,826 $17,019,598,135 $824,183,569 $20,108,153,479 31.9% 18.1% SAMHSA Block Grants $1,668,321,153 $405,537,084 $1,607,501,201 $405,238,235 -3.6% -0.1%

Other Federal $269,980,441 $1,204,671,508 $270,304,697 $1,326,019,586 0.1% 10.1%

Other Funds $158,903,291 $2,629,975,240 $62,265,220 $2,742,313,857 -60.8% 4.3%

Total $4,914,307,017 $37,321,195,368 $5,029,762,927 $41,218,421,066 2.3% 10.4%

•  State Funds have been flat for both SSAs and SMHAs •  Medicaid has been the major source of new funds for both SMHAs and SSAs, with

SSAs having a larger percent increase (but starting at a much lower base)

Slide 43

Impactofthe2009-2011RecessiononSMHASystemsandCurrentStateBudgetSitua7ons

•  Therecessionthatoccurredduringthelate2000simpactedstategovernmentbudgetsformanyyears.o  TheNa8onalGovernor’sAssocia8oniden8fieditastheworstprolongedreduc8oninstategovernmentrevenuessincetheGreatDepressionofthe1930s

•  NRIworkedwithNASMHPDtotracktheimpactofstatebudgetreduc8onsonpublicmentalhealthsystemsduringtherecession

•  Unfortunately,anumberofstatesarenowexperiencingnewbudgetshorcallsandreducedstaterevenues


StateMentalHealthSystemswereAffectedBy2009to2012StateBudgetShorcalls

From FY2009 to FY2012 SMHAs Had Total MH cuts of $4.35 Billion*

Year Total FY 2009

(39 states had MH Cuts out of 44 responding) $1,216,020,843

FY 2010 (38 states had MH Cuts out of 45 Responding) $1,019,325,136

FY 2011 (36 states had MH Cuts out of 47 responding) $1,270,618,291

FY 2012 (31 states had MH Cuts out of 41 Responding) $842,236,221

Slide 45

ClosingStatePsychiatricHospitals&HospitalBeds(2009-2012)

Results based on 41 SMHAs Reporting Winter 2011-2012

•  12Statesclosed15statepsychiatrichospitals•  29Statesclosedover4,400beds

o Over 9% of state psychiatric hospital bed capacity was closed

o Acute civil status beds were most likely to be closed. Few forensic beds were closed.

Slide 46

NASBOSpring2016FiscalSurveyofStates


“State General Fund Budgets Finally Surpass Pre-Recession Levels after Adjusting for Inflation”

Slide 47

State Budget Officers Association: July 29, 2016 Update “a majority of states…showed revenues below their most recent projections” “It is likely that the slow revenue growth will continue into fiscal 2017”

Slide 48

RecentStateHeadlines


OklahomaDepartmentofMentalHealthandSubstanceAbuseServices

Na7onalAssocia7onofStateMentalHealthProgramDirectorsAug.8,2016

CarrieSlaeon-Hodges,DeputyCommissioner

Oklahoma’sSystemtoAddressBrainHealth:Impac7ngOurState’sFuture

OklahomaHasSomeoftheHighestRatesforMentalIllnessandSubstanceUseDisorders

51

•  ODMHSASisresponsibleforOklahoma’spublicbehavioralhealthsystem,anarrayoftreatmentservices,astatewidepreven8onnetwork,cer8fica8on,policyandotherrelatedprograms/ini8a8vesalongwithadministra8onandoversightoftheState’sbehavioralhealthMedicaidprogram.

•  Thedepartmentservesapproximately195,000Oklahomansannually(thisincludesMedicaideligibleclients).

•  Oklahomaconsistentlyranksashavingamongthehighestratesofmentalillnessinthecountryanddispropor8onatelyhighratesofnega8veconsequences/factorsrelatedtosubstanceabuse.

•  VariousreportsrankOklahomabetween46-49thpercapitaformentalhealthspending,at$53.05percapita,comparedtoana8onalaverageof$120.56.

52

RecoveryDoesHappenWhenPeopleAccessAppropriateCare

•  ODMHSASfundsandoperatesastatewidenetworkofbehavioralhealthtreatmentservicesthatincludes:o  Fundingmorethan300contractedcommunitybehavioralhealthproviders

thatactasthestatewidesafetynetforservices,inaddi8ontostate-operatedservices.

o  Opera8ng/managingOklahoma’sBehavioralHealthMedicaidSystem(1,262Medicaidcontractedproviders;394agenciesand868independents).

o  Overseeing/managingastatewidenetworkofcourtdiversionservices…programsthathavewonna7onalawardsandareconstantlyinthenews.

•  Thedepartmentprovidesoutpa8entservices,urgentandcrisiscare,hospitalcare,anarrayofsubstanceabusetreatmentop8ons,courtrelatedservicesandjaildiversion,servicesthatimpactchildrenandfamiliesintheDHSsystem,servicesthatsupporttheeduca8onsystem,forensicservices,preven8onservices,cer8fica8onandtraining,specializedhousingneeds,transi8onalcare…EVERYTHINGTHATISESSENTIALTORECOVERY!

Factors that limit publicly assisted services…including stagnant investment

•  Lackofinvestmenthasresultedintheimplementa8onofa7eredservicedeliverysystembasedonacuity/availableresources.

•  Thedepartmentiscommi*edtothedeliveryofevidence-basedservices/programs(be*ercareandbe*eru8liza8onoffunding).

•  ODMHSAShasalsodoneanexcellentjobofcompe7ngforandwinningcompe77vegrantsforinnova7veprograms.

LackofNeededInvestmentMeansthattheDoortoServicesisNarrow

54

•  Theprimarysourceoffundingis$324millioninstateappropria7onsthatincludesOklahoma’sbehavioralhealthMedicaidprogrammatch(Oklahomaisoneof19statesthatisnotaMedicaidexpansionstate).

•  Thisfundingisfarshortofwhatisrequiredtomeettreatmentneed(theseserviceshaveneverbeenfundedtomeetdemand),andinfactissignificantlyreducedfromwherewewerejustoneyearago.

•  ODMHSASstateappropria7onshavebeencutby$23millionsinceJanuary2016(over73,000Oklahomansimpactedandsignificantproviderbillingloss).

Ac7onTakentoDetermineHowtoBestDistributeCuts

55

•  Thedepartmentfollowsathoroughdecision-makingprocessregardingsuchchallengesandseekstoreducethenega8veimpactofservicechanges;thegoalistoimpactthefewestnumberofseriouslyillclientsaspossible.

•  Oken,thismeanschoicesthataretheleastterribleofnothingbutterriblechoices.

•  Itisimportanttobeengagedwithsystempartnerswhenmakingthesetoughdecisions:

o  MentalHealthPlanningCommi*eemee8ngs;

o  BehavioralHealthAdvisoryCommi*eemee8ngs;

o  Mee8ngswithCommunityMentalHealthCenterandSubstanceAbuseCenterfacilitydirectors;

o  Mee8ngswithcommunityprovidersandMedicaidcontractors,andothersofinterest.

And,theDoorisNarrowingEvenMore!ODMHSASWasForcedtoCutServicesinFY16/17

56

FirstRevenueFailure•  $4.4million–CutstoODMHSASAdministra8on/Opera8ons•  $1.5million–CutstoMentalHealthCourtExpansion•  $1.3million–CuttoSafetyNetServices•  $1million–PostponedSOCExpansion•  $400,000–CutstoPreven8onServicesSecondRevenueFailure•  $7million–CuttoPrivateCommunity-BasedProviders•  $4.1million–DelayofFinalReimbursementClaimsforContractedProviders•  $1.8million–RateCutsforPrivateProviders(FY17-$10.5million)

o  3%cuttoacuteinpa8entreimbursementrate($22,333)o  15%cuttopsychiatricresiden8altreatmentservicesrate($875,000)o  10%cuttoreimbursementrateforanLBHPUnderSupervision($537,419)o  30%cuttoindividualLBHservices($346,802)

•  $1.3million–CappedDeliveryofPsychotherapyServices(FY17-$15.6million)•  $48,000–CutstoTreatmentPlanUpdates(FY17-$580,000)

57

OklahomaDepartmentofMentalHealthandSubstanceAbuseServices1200NE13thStreet

OklahomaCity,Oklahoma

TerriWhite,MSWCommissioner

Website:www.odmhsas.org

Facebook:www.facebook.com/ODMHSAS

Departmenttwieer:@ODMHSASINFO

CommissionerWhitetwieer:@terriwhiteok

HowAlaskaAddresseda$5.8MillionReductioninBehavioralHealthTreatmentGrants:

ANASMHPDPresentation–August,2016 RandallP.Burns,Director,DivisionofBehavioralHealthAlaskaDepartmentofHealth&SocialServices

HowtheReductionCametoBe•  ThetotalamountoftheReduc8on($5.8Million)totheDivision’sbehavioralhealthgrantslinewascontainedinGovernorWalker’soriginalFY17BudgetProposal

•  Thereduc8onwasinUndesignatedGeneralFunds(UGF),atruereduc8oninstatespending

•  Thereduc8onforFY17–andaddi8onalcommitmentsuptofiveyearsout–wasproposedduringtheprevious(CY2015)legisla8vesessionasanen8cementtotheRepublican-ledLegislaturetoadopttheMedicaidExpansionprovisionsoftheACAbeginninginFY16

HowtheReductionCametoBe•  Despitetheen8cements,theLegislaturerefusedtopassMedicaidExpansionbeginninginFY16

•  ThiswasbutoneofmanyeffortsputforthbytheGovernortorespondtoAlaska’sdeepfinancialtroubles,includingproposalstotheLegislatureforanincometax,acapontheAlaskaPermanentFundDividend,savingsfromreduc8onsto/increasesinoilcompanyrebates/taxes,etc.

•  Giventhesubstan8vesavingsthatwouldaccruetotheStatefromtheadop8onofMedicaidExpansion,GovernorWalkerlastsummer(2015)gaveno8cetotheLegislatureofhisintenttomoveforwardwithMedicaidExpansionunderhisExecu8veAuthority

•  AlaskabeganenrollingadultseligibleunderExpansionforMedicaidcoverageonSeptember1st

•  TheLegislaturefiledsuitagainsttheGovernor’sac8onsshortlythereaker

ReductionComplexities Thepresentsystemofawardingfundsviaindividualgrantsmakesfindingawaytofairlydistributethereduc8onsverycomplex:

•  AlaskadoesnotawarditsgrantstoaBHagency,itdistributesfundingviaindividualgrantsthatprescribeservicedeliveryexpecta8ons/requirementsacrossalmosttwenty(20)dis8nctprovidertypes(SMIadults,SEDchildren,SEDchildrenandparents,SUDdetox,SUDresiden8alforadults,SUDresiden8altreatmentforwomenwithchildren,SUDIOP,etc.)

•  Therefore,mostagencieshavemul8plegrantsthatcoverarangeofBHservicesthattheagencymayprovidetoresidentswithinitscommunityorregion

•  Further,thereareuptosix(6)possiblefundingsourcesfromwhichDBHmakeseachindividualgrantaward(with–inmanycases–atleasttwoofthosesixsourcesfundinganindividualgrant)

•  Allthese“partswithinparts”makesfindingawaytofairlybalancethegrantreduc8onsverycomplex

Issue:Reductions=Expansion•  Tosomedegree,thera8onaleforthereduc8onstothegrantslinewasbasedontheunderstandingthatunderMedicaidExpansion,manyformerlyun-orunder-resourcedclientswouldnowbeeligibleforMedicaidreimbursement

•  Therefore,theStatecouldreducethegrantslinebecausethatformerlytotalUGFprogramcouldnowbe,replaced,inpart,byMedicaiddollarsthatwereeligiblefor100%/then90%federalmatchfortheadultMedicaidExpansionpopula8on

•  InCY2015,AKDHSSes8matedthatitcouldreplaceupto$7MillioningrantfundingwiththefundingthatwouldcomeintotheBehavioralHealthMedicaidSystemviathenoweligibleadultExpansionpopula8on

MedicaidinAlaskaDashboard

What9monthsofdatatoldus•  EnrollmentbeganSeptember1,2015,underAlaska’sMedicaidExpansionProgram

•  DHSSexpected21,000AlaskanstosignupforMedicaidinthefirstyearofExpansion

•  AttheendofMay,2016,following9monthsofexperienceunderExpansion,justunder$7MillioninMedicaidExpansionPopula8onpaymentsweremadeforBHservices

•  So,BHProvidershadindeedbroughtinmorethantheamountofthegrantsreduc8on($5.8M),butthedistribu8onofthat“new”moneywasfarfromevenlydistributedacrossallBHgranteeswhohadaccesstotheMedicaidExpansionpopula8on

MedicaidExpansionandGrantees •  Thereare82agenciespresentlyreceivingbehavioralhealthgrantsfromtheDivision

•  Ofthose,only39actuallyhadtakeninanybehavioralhealthrelatedExpansiondollarsinthe9monthsbetween9/1/15and5/31/16,totaling$6,997,523.

•  Ofthattotal,$3,908,746camefrom9tribalorganiza8ons,withtwoofthembringingin56%ofthattotalamount($1,436,413and$769,264,respec8vely).

•  Another$1,940,870inBHExpansiondollarscamefrom8non-tribalgranteeagencies:3larger“comprehensive”BHcenters($582,543)and5SUDresiden8al/IOP/OTPtreatmentprograms($1,940,870)

•  Theremaining$1,147,907inExpansionrevenuewasspreadacross22grantees,alltakinginlessthan$100,000each

Howtodistributethereductions•  BasedonthebehavioralhealthMedicaidExpansiondataoverthefirst9months,anysugges8onthattheen8re$5.8MinDivisiongrantreduc8onscouldbefairlydistributedbyspreadingthatreduc8onacrossonlythosegranteeswhowereabletoaccesstheExpansionpopula8onwasclearlynotgoingtobepossible

•  Therefore,wehadtodeterminehowbesttoa*empttospreadthereduc8onsinawaythatdidnotpenalizeanyagencyprogramtoosignificantly

•  Akerweeksofdebate,wedeterminedtoessen8ally“splitthebaby”

SplittingtheBaby:

SFY2017BehavioralHealthTreatment&RecoveryGrantsQuickReferenceGuidetotheGrantReduc7onAlloca7onProcess

•  TheSFY2017DivisionofBehavioralHealth(DBH)ComprehensiveBehavioral

HealthTreatmentgrantawardswerereducedby$5,779,653incompliancewiththeSFY17budgetac8onsbytheOfficeoftheGovernorandtheLegislatureandinresponsetotheState’sadop8onofMedicaidExpansionundertheACA.

•  TheSFY2017grantfundingreduc8onswereallocatedu8lizingatwo-stepprocess:

Step1:Applya“SystemPropor8onalReduc8on”Step2:Applya“MedicaidExpansionReduc8on”

•  GrantamountsfundedwithGeneralFund(GF),GeneralFund/MentalHealth(GF/MH),orAlcohol&OtherDrugAbuseTreatmentandPreven7onFund(ADTP)dollarsweresubjectto(i.e.,eligiblefor)reduc7on,unlesstheywereexcludedfromreduc7onunder“GrantTypesHeldHarmless”(seedescrip7onsbelow).

•  GrantamountsfundedthroughInteragencyReceipts(IA),Federalgrants,RSAs(ReimbursableServiceAgreements),andtheAlaskaMentalHealthTrustAuthorityAuthorizedReceipts(MHTAAR)wereheldharmlessfrombothreduc7onsteps.

Step1Reductions•  Step1:SystemPropor,onalReduc,on:

•  ActualAmountReducedwas$3,066,237ofthe$5,779,653(Step1accountsfor53%ofthetotalDBHreduc8on)

•  Inaddi8ontothegrantamountsfundedthroughIAReceipts,Federalgrants,ReimbursableServiceAgreements,andMHTAAR,thefollowinggrant“types”wereheldharmlessfrom(i.e.,noteligiblefor)aStep1Reduc8on:•  $100grants(allowproviderstobillMedicaid)•  PsychiatricEmergencyServices

•  AgencygrantfundseligiblefortheStep1reduc8onprocesswerereducedbasedonthepropor8ontheycomprisedofthetotalStep1eligiblegrantfundsacrossallagencies.Thispropor8onwasappliedtothetotalSystemPropor8onalReduc8ontodeterminetheamountofreduc8ontoeachgrant.

Step2Reductions•  Step2:MedicaidExpansionReduc,on:•  ActualAmountReducedwas$2,713,416ofthe$5,779,653

(Step2accountsfor47%ofthetotalDBHreduc8on)•  Inaddi8ontothegrantamountsfundedthroughIA,Federalgrants,RSAs,and

MHTAAR,thefollowinggrant“types”wereheldharmlessfrom(i.e.,noteligiblefor)aStep2Reduc8on:

•  1)$100grants;2)PsychiatricEmergencyServices;3)SeverelyEmo8onally

DisturbedYouth;4)Non-DirectServices;5)Peer&ConsumerSupportServices;6)SupportedEmployment;7)AdultResiden8alSubstanceAbuseTreatmentandDetoxServices[duetotheMedicaidIMDExclusion];and8)GrantswithaTotalAwardamountof$75,000orless

•  AgencygrantfundseligiblefortheStep2reduc8onprocesswerereducedbasedontheAgencypropor8onofthetotalMedicaidexpansionpaymentsreceivedacrossallagencies.Thispropor8onwasappliedtothetotaltargetedMedicaidExpansionReduc8ontodeterminetheamountofreduc8ontoeachagency.Ifanagencyhadmorethanonegrant,thecutwasspreadpropor@onallyacrosstheagency’sgrantsthathadfundseligiblefortheStep2reduc@on.AgenciesthatreceivedMedicaidexpansionpaymentsbutdidnothavegrantfundseligiblefortheStep2reduc8onprocesswereexcludedfromreceivingaMedicaidExpansionReduc8on.

CommunicationsPlanBehavioralHealthGrantReduc7onsintheFY17BudgetCOMMUNICATIONPLAN

August5,2016

ISSUESTATEMENT:TheDivisionofBehavioralHealth(DBH)receiveda$5,779,653reduc7ontoits$61,041,539ComprehensiveBehavioralHealthTreatmentandRecoverybudgetcomponentforFY2017(equaltoanoverall9.5%reduc7ontothatcomponent).Thisreduc7onreflectstheState’seffortstobeginshiuingfromarelianceongrantsfundedbyGeneralFund(GF)dollarstoprogramfundingviaMedicaiddollars.Thisbecomesmorepossibleasaddi7onalclientsgainaccesstohealthcoveragethroughMedicaidExpansionundertheAffordableCareAct(ACA).

Thefundstargetedforthereduc7onincludeGF,GeneralFundMentalHealth(GF/MH)andAlcohol&DrugAbuseTreatment&Preven7on(ADTP)dollars.

Thetotalreduc7onwasmadeapplyingthefollowingtwoscenarios:

Ø  Thefirstwasapropor7onalreduc7ontoalleligiblegrants,withtheintentofmaintainingcon7nuityofservicesandapplyingaconsistentalloca7onformulatothemajorityofgrantsfundedbytheTreatmentandRecoverycomponent.

Ø  Thesecondwasanaddi7onalreduc7ontothosebehavioralhealthagenciesthathavebeenabletobenefitfromaccesstonewrevenueviaMedicaidExpansionpaymentsreceived

betweenSeptember,2015andtheendofMay,2016.

Thereduc7ontothegranteeswill–onaverage–equal9.5%ofthegrantsagenciesreceivedinFY2016.However,whereagencieshavebeenverysuccessfulinimplemen7ngservicesbenefiPngthenewMedicaidExpansionpopula7on,thereduc7onsmaybesignificantlylarger.

LEADAGENCY:DivisionofBehavioralHealthCONTRIBUTINGSTAFF:BritaBishop,AmyBurke,LindaBrazak,KathleenCarls,StacyToner,DarlaMaddenSPOKESPERSON:RandallBurnsPUBLICINFORMATIONCONTACT:SaranaSchell

ADVANCENOTICELIST:AssistantCommissioner,DeputyCommissioners,Commissioner,Legislators,Governor

MEDIARESPONSE:☐StatementOnly☒AvailableforPressCalls/Interviews☐PressRelease☐PressAvailability/Conference

OfficialMediaStatement:OfficialMediaStatement:“TheAlaskaDepartmentofHealthandSocialServicesisalloca7ngreduc7onstoDivisionofBehavioralHealthtreatmentandrecoverygranteesthattotal$5.8Million.Thisisa9.5%reduc7ontothebudgetcomponentthatfundstheDivision’svariousmentalhealthandsubstanceabusetreatmentprograms.Thisreduc7onisincompliancewiththeSFY17budgetac7onsbytheOfficeoftheGovernorandtheLegislatureandinresponsetotheState’sadop7onofMedicaidExpansionundertheACA.”

ReactiontotheProcess •  Onlyoneappeal!•  Generalapprecia8onexpressedforthe8me,effort,andthoughtappliedtotheprocess

•  Nocomment,asyet,fromthetribalcommunity•  NocallsfromLegislators•  NocallstotheDepartmentCommissioner’sOffice

ThankYou!RandallP.Burns

DirectorDivisionofBehavioralHealth

AlaskaDepartmentofHealth&SocialServices3601CStreet,Suite878Anchorage,AK99503

907.269.5948(directoffice)

907.310.4348(cell)

TrendsinStatePsychiatricHospitals

Slide 74

Source: NRI 2015 State Mental Health Agency Profiling System

Number of State Psychiatric Hospitals, 2015

1 SPH (16)2 SPHs (9)3 SPHs (5)4 SPHs (7)5 to 7 SPHs (10)8 or more SPHs (4)

Slide 76

StatePsychiatricHospitalResidentsPer100,000StatePopula7on,2014

Slide 77

Residents per 100,000

0 to 8.71 (13)8.7 to 12.72 (12)12.72 to 18.07 (13)Over 18.07 (13)

NumberofStatePsychiatricHospitals&ResidentPa7entsattheEndofYear:1950to2015

322

280

315

276 281

230217 213 207

195188 188

0

50

100

150

200

250

300

350

1950 1960 1970 1980 1990 2000 2010 2011 2012 2013 2014 2015

Num

ber o

f Sta

te P

sych

iatri

c Ho

spita

ls

0

100,000

200,000

300,000

400,000

500,000

600,000

Num

ber o

f Res

iden

ts in

Sta

te P

sych

iatri

c Ho

spita

ls

Hospitals

Residents

Sources: CMHS Additions and Resident Patients at End of Year, State and County Mental Hospitals, by Age and Diagnosis, by State, United States, 2002, and 2015 State MH Agency Profiles System

Slide 78

StatePsychiatricHospitalAdmissionsandResidents:2008to2015

0

20,000

40,000

60,000

80,000

100,000

120,000

140,000

160,000

180,000

200,000

2008 2009 2010 2011 2012 2013 2014 2015

Num

ber

of S

tate

Hos

pita

l Pat

ient

s

Fiscal Year

Residents Additions

The number of Residents in state psychiatric hospitals on the first day of each year declined by 5,965 from 2008 to 2015 (13% decrease)


Source: SAMHSA Uniform Reporting System: 2008 to 2015 Slide 79

SMHAControlledExpendituresforStatePsychiatricHospitalInpa7entServices,FY1981-FY2010inCurrent&Constant"1981"Dollars


$3.9

$4.3

$5.0

$5.5

$6.5 $6.9

$6.6

$7.3 $7.6 $7.6 $7.7

$8.1

$8.5 $9.0

$9.6 $9.8 $9.4 $9.3 $9.3 $9.4 $9.4

$3.9 $3.6 $3.7 $3.5

$3.3

$2.8

$2.3 $2.2 $2.2 $2.1 $2.1 $2.1 $2.1 $2.1 $2.2 $2.2 $2.0 $1.9 $1.9 $1.8 $1.8

$0

$2

$4

$6

$8

$10

$12

Expe

nditu

res i

n B

illio

ns

State Mental Hospitals Current Dollars

State Mental Hospitals Constant Dollars

Constant Dollars calculated using Medical Component of the Consumer Price Index

Slide 80

IntendedUseofStatePsychiatricHospitals:2015

13

18

41

39

35

14

21

44

42

39

10

15

43

42

41

0 10 20 30 40 50

Children

Adolescents

Adults

Elderly

Forensic

Number of States

Long-Term Care (more than 90 days)

Intermediate Care (30-90 days)

Acute Care (less than 30 days)

Slide 81

StatePsychiatricHospitalU7liza7onbyPa7entDay:2005to2014


Year Forensic Patients Sex Offenders Children Adults Total Patient

Days Patient Days Percent Patient Days Percent Patient Days Percent Patient Days Percent

2005 5,653,891 33% 995,444 6% 715,098 4% 9,984,066 58% 17,348,499

2006 5,531,851 32% 1,102,346 6% 671,758 4% 10,109,656 58% 17,415,611

2007 5,742,751 33% 1,243,028 7% 652,735 4% 9,752,858 56% 17,391,372

2008 5,895,691 34% 1,369,403 8% 648,843 4% 9,605,169 55% 17,519,106

2009 5,905,327 34% 1,490,156 9% 617,698 4% 9,197,320 53% 17,210,501

2010 5,956,987 36% 1,440,118 9% 550,311 3% 8,722,005 52% 16,669,421

2011 5,601,736 36% 1,494,353 10% 533,711 3% 7,992,605 51% 15,622,405

2012 5,627,805 37% 1,574,339 10% 521,884 3% 7,650,164 50% 15,374,192

2013 5,267,956 38% 1,366,919 10% 491,567 4% 6,584,330 48% 13,710,772

2014 5,725,286 39% 1,587,424 11% 471,802 3% 6,813,699 47% 14,598,211

Slide 82

AverageandMedianStatePsychiatricHospitalInpa7entExpendituresperPa7entDay,byPa7entType:FY2014

$894$812

$766

$388

$767$787$687

$607

$334

$635

$0$100$200$300$400$500$600$700$800$900

$1,000

CivilStatusChildrenandAdolescents

CivilStatusAdults

ForensicPa8ents

SexOffenders

TotalStatePsychiatricHospital

Expe

nditu

resP

erPa7

entD

ay Average

Median


SMHA-ControlledForensicandSexOffenderMentalHealthExpendituresAsaPercentageofStatePsychiatricHospitalExpenditures,FY'83toFY'14

Slide 84

StateHospitalAdmissionLegalStatus:2015SHRDataSet

N=90,228 admissions with known legal status (94%); Not Reported = 5,550 (6%)

Voluntary-Others 4.9%

Involuntary-Civil

69.8%

Involuntary-Criminal 24.1%

Involuntary-Juvenile Justice

0.5%

Involuntary-Civil-Sexual

0.8%

Slide 85

ReadmissionRatesWithin30Days:ByDiagnosisandLegalStatus2015SHRDataSet,Firstdischargerecordsonly

Total N= 95,778 discharges in 2015

0% 2% 4% 6% 8%

10% 12% 14% 16%

Perc

ent

of 3

0 D

ay R

eadm

issi

ons

with

Dia

gnos

is

All 30 Day Readmission Civil Status Forensic Status

Slide 86

DaysUn7lReadmission2015SHRDataSet,FirstdischargerecordsonlyClientsDischargedduetoDeathorforAcuteMedicalCareareExcluded

N=78,108 discharges during year •  290 discharges excluded due to death •  731 discharges for Acute Medical Treatment excluded

0%

5%

10%

15%

20%

25%

30%

0 30 60 90 120 150 180 210 240 270 300 330 360 390 420 450 481 514 579

Days Since Discharge

30 Days 6.1% Readmitted

180 Days 14.4% Readmitted

Slide 87

DaysUn7lStateHospitalReadmissionPa7entswithSchizophreniaandwithSchizophreniaandaSubstanceAbuseProblem2015SHRDataSet

N=78,108 discharges during year •  290 discharges excluded due to death •  731 discharges for Acute Medical Treatment excluded

0%

5%

10%

15%

20%

25%

30%

0 30 60 90 120 150 180 210 240 270 300 330 360 390 420 450 481 514 579

Days Since Discharge

All Readmissions

Schizophrenia

Schizophrenia and Substance Abuse

First discharge records only Clients Discharged due for Acute Medical Care or Death Excluded Slide 88


Estimating the Total Psychiatric Inpatient Capacity

SAMHSAperiodicallysurveysprivatepsychiatrichospitalsandgeneralhospitalswithseparatepsychiatricunits.Currently2010isthemostrecentdataavailable,but2014informa8onshouldbeavailablesoon.

NRIcombined2012URSdataonStatePsychiatricHospitalswithdataonprivatepsychiatrichospitalsandnon-Federalgeneralhospitalswithseparatepsychiatricunits(fromSAMHSA’s2010Na8onalMentalHealthServicesSurvey(N-MHSS))

Type of Psychiatric Facility Number of Facilities

Number of Beds/

Residents

State Psychiatric Hospitals (2012) 195 41,821

Non-Federal General Hospitals with Separate Psychiatric Units (2010) 1,157 35,351

Private Psychiatric Hospitals (2010) 374 24,919

Total Psychiatric Inpatient Capacity 1,726 102,091

Slide 89

TrendinAllPsychiatricBeds:ByTypeofHospital,1970to2015

0

50,000

100,000

150,000

200,000

250,000

300,000

350,000

400,000

450,000

500,000

550,000

1970 1975 1980 1985 1990 1995 2000 2005 2010 2015

State Hospitals Private Psychiatric Hospitasl VA Psychaitric Services General Hospitals Total Psych Beds

Slide 90

NumberofPublicandPrivatePsychiatricBedsper100,000StatePopula7on:2010es7mate

State Psychiatric Hospital data are residents in state hospitals on the first day of 2012. Private psychiatric bed counts represent separate psychiatric units in general hospitals and private psychiatric hospitals from SAMHSA's 2010 Survey

Psychiatric Bed Rates per 100,000 population

13.2 to 23.29 (13)26.3 to 33.49 (13)33.5 to 42.99 (13)43 to 81.5 (12)

Slide 91

ResidentsinStatePsychiatricHospitals,Jails,andPrisons,1950to2014

0

200,000

400,000

600,000

800,000

1,000,000

1,200,000

1,400,000

1,600,000

1,800,000

1950

19

53

1956

19

59

1962

19

65

1968

19

71

1974

19

77

1980

19

83

1986

19

89

1992

19

95

1998

20

01

2004

20

07

2010

20

13

State Psychiatric Hospital Residents

Jail

Prison

Slide 92

KeyMessages•  Statepsychiatrichospitalsareavitalpartofthecon8nuumof

careandshouldberecovery-orientedandintegratedwitharobustsetofcommunityservices.

•  Allpeopleservedinstatepsychiatrichospitalsshouldbeconsideredtobeintheprocessofrecovery.

•  Changingthecultureandenvironmentofstatepsychiatrichospitalsarekeystoprovidingeffec8vecare.Culturesshouldberecovery-oriented;trauma-informed;culturallyandlinguis8callycompetent;andaddresshealthandwellness.

•  Peersupportservicesareanintegralpartofassis8ngwithpeople’srecoveryprocessandshouldbemadeavailabletoallservicerecipientsinstatepsychiatrichospitals.Peersupportspecialistsshouldbemadeanequalmemberofthetreatmentteam.

Slide 94

KeyMessages(cont.)

•  Servicerecipientsshouldbeservedinthemostintegratedandleastrestric8veenvironmentpossible.

•  Astatepsychiatrichospitalisnotaperson’shome.Statepsychiatrichospitalsshouldbefocusedonservicerecipientsreturningtothecommunityquicklywhentheynolongermeetinpa8entcriteria.

•  Statepsychiatrichospitalstaff,inpartnershipwiththeservicerecipient,shouldworkdirectlywithcommunityprovidersonadischargeplanthatincludeswhatcommunityserviceswouldbemosthelpfulfortheservicerecipient.

Slide 95

KeyMessages(cont.)•  Forforensicservicerecipients,sexoffenders,andinmanystates

involuntarilycommi*edservicerecipients,decisionsforadmissionanddischargearemadebycourtsandnotbythestatepsychiatrichospital.

•  Statepsychiatrichospitalsincludepeoplewithmentalillness,

peoplewithcriminalbehaviordrivenbymentalillness,andpeoplewithcriminalandpredatorybehaviorwithnomentalillness.Thesepopula8onsshouldbeservedindiscreteloca8ons.

•  Itisthedutyofthestatepsychiatrichospitaltomake

reasonableeffortstocreateenvironmentsinwhichservicerecipientsandstaffareassafeaspossible.Addressingsafetyneedsshouldbetrauma-informed.

•  Leadershipandawell-trained,professionaland

paraprofessionalworkforceareparamountinensuringqualitycare.

Slide 96

Innova7veUsesofTechnologytoAddresstheNeedsofJus7ce-

InvolvedPersonswithBehavioralHealthIssues

Slide 98

•  PaperfortheNASMHPDTechnicalAssistanceCoali8on(TAC)•  FundedbySAMHSA•  AvailableonNASMHPD’swebsiteakerSAMHSAclearance•  ConceptualizedwiththehelpofNASMHPD’SForensic

Commi*ee.Specialthanksto:BetsyNeighbors,Ph.D.,ABPP(Nevada)JulietBri*on,J.D(Oregon)Li-WenGraceLee(NewYork)

•  AuthoredbyVeraHollen,GlorimarOr8z,LucilleSchacht


Sequen7alInterceptforChange:CriminalJus7ce-MentalHealthPartnerships


IntegratedDatasets


Camden New Jersey ARISE person-level linked datasets

Data Set: Type of information:

Camden Coalition Static hospital claims data from area hospitals

Camden County Policy Department Arrest, calls for service, overdose, and crime incident data

New Jersey State Prison Inmate data

Camden County Schools Student attendance and demographic information

CamConnect Identifies addresses that are vacant (used as a proxy for homelessness)

South Jersey Perinatal Cooperative Data on pregnant women

Slide 101

BedRegistries


Virginia Oregon

Slide 102

Person-levelDataLinkages


IllinoisJailDataLinkSystem


VideoTechnology-Nevada


ForAddi7onalInforma7on

NRI TimKne*ler703-738-8161Tim.kne*[email protected]*erman703-738-8164Ted.lu*[email protected]@nri-inc.org

Oklahoma [email protected]

Alaska [email protected]

Slide 106

latest trends in state mental health agencieslatest trends in state mental health agencies tim r....

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