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Senate Health and Human Services
Committee
Interim Charge #1
August 23, 2006
The Mental Health of Texans is
Everyone’s Responsibility
• DSHS’s Mental Health and Substance Abuse Services
– Community-based services
• 39 Local Mental Health Authorities
• Dallas Area NorthSTAR Authority
• 180 Substance Abuse contracts
– 10 State Hospitals
• Public Mental Health System
– DSHS mental health services are only part of the public
mental health system in Texas
– Law enforcement, education, Medicaid, CHIP, the criminal
justice system, hospitals and other entities all play major
roles in treating Texans with mental illnesses
Senate Health and Human Services Committee  DSHS Presentation  August 23, 2006
2
Number of Adults and Children (and Total) Served at DSHS
Community Mental Health Centers
from FY2003 to FY2006 Year-to-Date
Children
Adults
Total
150,000
135,743
110,491
131,344
129,744
107,558
105,131
129,400
103,659
100,000
50,000
25,622
22,499
26,213
25,741
0
FY2003
FY2004
FY2005
FY2006 Year-to-Date
(September-June)
Source: FY2003 = CARE Report HC028488, TDMHMR MH Priority Population Counts by Month for 09-01-02 through 08-31-03, prepared on 09/20/03, total is
unduplicated; FY2004 = CARE Report HC028488, TDMHMR MH Priority Population Counts by Month for 09-01-03 through 08-31-04, prepared on 09/18/04, total is
unduplicated; FY2005 = DSHS Mental Retardation and Behavioral Health Outpatient Warehouse, Business Objects Corporate Report, LBB RDM Served for FY2005,
08/01/06, used for LBB reporting for number of adults and children receiving community mental health services per year (i.e., number who received a full RDM service
package); FY2006 Year-to-Date = DSHS Mental Retardation and Behavioral Health Outpatient Warehouse, Business Objects Corporate Report, LBB RDM Served for
FY2006 September-June, 08/03/06, used for LBB reporting for number of adults and children receiving community mental health services per year (i.e., number who
received a full RDM service package).
Senate Health and Human Services Committee  DSHS Presentation  August 23, 2006
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Number of Texans who Participated in
Substance Abuse Prevention and
Intervention Services in FY2005
119,920
46,186
331,016
989,569
Youth Prevention
Youth Intervention
Adult Prevention
Adult Intervention
Senate Health and Human Services Committee  DSHS Presentation  August 23, 2006
4
53,420 Texans Accessed Substance
Abuse Treatment in FY2005
7,360
8,887
23,144
32,800
Youth
Male
Female
Priority Female
Estimated number in need of treatment
is 1.6 million Texans
Senate Health and Human Services Committee  DSHS Presentation  August 23, 2006
5
Resiliency and Disease Management
(RDM)
• Evidence-based
• Intended to better match services to Mental Health
consumers’ needs, and to use limited resources most
effectively by providing the right service to the right
person in the right amount to have the best outcomes.
• Includes medication management, case management, skills
training, family training, supports and partners,
psychosocial rehabilitation, individual and group
counseling, supported employment, supported housing,
and Assertive Community Treatment (ACT)
Senate Health and Human Services Committee  DSHS Presentation  August 23, 2006
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RDM Key Components
• Uniform Assessment
• Standard Service Packages
• Utilization Management
• Data Analysis and Performance Evaluation
• Jail Diversion
Senate Health and Human Services Committee  DSHS Presentation  August 23, 2006
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Percent of Adults and Children Served with RDM
Receiving the Minimum Number of
Recommended Monthly Service Hours
100%
85%
75%
80%
60%
71%
38%
40%
20%
83%
48%
60%
50%
29%
Target = 85%
66%
57%
37%
Adults
Children
0%
FY2005 FY2005 FY2005 FY2005 FY2006 FY2006
Quarter Quarter Quarter Quarter Quarter Quarter
1
2
3
4
1
2
Source: DSHS, Mental Retardation and Behavioral Health Outpatient
Warehouse (MBOW), PM Service Package Minimum Hours. For methodology,
see Fiscal Year 2006 Performance Contract with Local Mental Health
Authorities, Information Item C.
Senate Health and Human Services Committee  DSHS Presentation  August 23, 2006
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RDM Outcomes
• Outcomes for Adults in FY 2005:





78% with improved or stabilized functioning
88% with improved or stabilized risk of harm
82% with improved or stabilized housing
86% with improved or stabilized employment
91% with improved or stabilized criminal justice
involvement
 97% of adults who received the full benefits indicated
avoided spending time in crisis (i.e., avoided being
placed in 23-hour observation in a hospital setting,
crisis counseling, etc.).
Senate Health and Human Services Committee  DSHS Presentation  August 23, 2006
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RDM Outcomes
• Outcomes for Children in FY 2005:




80% with improved or stabilized functioning
92% with improved or stabilized risk of harm
92% with improved or stabilized school behavior
84% with improved or stabilized severe aggressive
behavior
 89% who avoided re-arrest
 98% of children who received the full benefits
indicated avoided spending time in crisis (i.e., avoided
being placed in 23-hour observation in a hospital
setting, crisis counseling, etc.).
Senate Health and Human Services Committee  DSHS Presentation  August 23, 2006
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FY2005 Texas Monthly Hospital Emergency Room (ER)
Costs 31 Percent Lower for Medicaid Clients with Mental
Illness or Substance Abuse Receiving DSHS Behavioral
Health Treatment
$115
ER Costs
per Medicaid
Client
per Month
Untreated
$115
ER COST OFFSET
- $36
Average per Client per Month
31%
REDUCTION
Treated
$79
$0
Source: Prepared by Research Team, Strategic Decision Support, HHSC, 3/23/2006. Average of ER costs per month for Medicaid clients not
receiving needed DSHS Mental Health and Substance Abuse services (Untreated) vs. average of ER costs per month for Medicaid clients
receiving needed DSHS Mental Health and Substance Abuse services (Treated).
Senate Health and Human Services Committee  DSHS Presentation  August 23, 2006
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Crisis Services Redesign
• February 2006, DSHS established the Crisis Services Redesign
Committee to develop recommendations for a comprehensive
array of crisis services.
• Members of the committee include medical experts, citizen
stakeholder groups, law enforcement representatives, county
probate court judge representation, and county representatives,
as well as individuals from professional organizations and
provider groups.
• A redesign of crisis services will build on, and is a part of, the
service improvements made by the evidence-based Resiliency
and Disease Management program.
• A thorough review of the current crisis system was conducted,
including holding public hearings around the state, reviewing
current research and consultation with experts.
Senate Health and Human Services Committee  DSHS Presentation  August 23, 2006
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Crisis Services Redesign
• The committee is considering a range of effective
community-based interventions designed to intervene in
and avoid crisis and the need for hospitalization, including:
– 24-hour hotline
– Mobile outreach
– 23 to 48-hour hold capacity
– On-call psychiatric services
– Crisis residential services
– Respite
– In-home crisis resolution
• Special Issues
– Children’s issues
– Forensic issues
– Transportation
Senate Health and Human Services Committee  DSHS Presentation  August 23, 2006
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Behavioral Health Issues Impact
Other Systems
• 75% of children placed in foster care have parents with
behavioral health problems
• 75% of kids in the juvenile justice system have behavioral
health problems
• 30% of kids in the juvenile justice system will end up in
the adult justice system
• 46% of all ER visits have behavioral health issues as a
basic or contributing factor
• 30% of all truancy is related to behavioral health problems
Senate Health and Human Services Committee  DSHS Presentation  August 23, 2006
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Mental Health Transformation
• Overarching goal is to improve the mental health of all Texans
and support the development of state infrastructure for
implementing the President’s New Freedom Commission goals.
• New Freedom Commission Goals are shared by the 14 state
agencies, client and family member representatives, and
legislators participating on the Transformation Working Group,
including:
– The Governor’s Office; Dept of State Health Services; Texas
Health and Human Services Commission; Dept of Family
and Protective Services; Dept of Criminal Justice; Texas
Juvenile Probation Commission; Texas Youth Commission;
Consumers; Family Members; Texas Education Agency;
Dept of Aging and Disability Services; Dept of Assistive and
Rehabilitative Services; Workforce Commission; Veteran’s
Administration; Housing and Community Affairs.
Senate Health and Human Services Committee  DSHS Presentation  August 23, 2006
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Mental Health Transformation
• The 2 primary areas of focus:
– Developing and supporting local behavioral health
collaboratives
– Using cutting edge technology to change work
processes across agencies
• Improvement of the system will be targeted to the
following principles:
– Apply evidence to health care delivery
– Use information technology
– Encourage continuous improvement
– Prepare the workforce
Senate Health and Human Services Committee  DSHS Presentation  August 23, 2006
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Behavioral Health Integrated Provider
System (BHIPS)
• First statewide development of an electronic health record in the
United States.
• BHIPS is an Internet-based, non-proprietary computer system for
behavioral health providers that supports a comprehensive service
delivery system.
• BHIPS offers tools for clinicians to ensure provision of consistent,
quality services.
• Using BHIPS, providers can easily meet state and federal requirements
for reporting, including capturing required client and billing data.
• Provider focus groups were used to gather input for the design of
BHIPS to ensure that the system works in a clinical setting.
• Security and privacy of information ensured by allowing a provider
access only to data that they enter or have been allowed to access
through the consent of the client.
• BHIPS is the basis for other states’ use of Electronic Health Records.
Senate Health and Human Services Committee  DSHS Presentation  August 23, 2006
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Drug Demand Reduction Advisory
Committee (DDRAC)
• The 77th Texas Legislature passed Senate Bill 558, establishing the
Drug Demand Reduction Advisory Committee (DDRAC) with a
mandate to develop and coordinate a statewide strategy to reduce drug
demand in Texas.
• The DDRAC, with input from the public and private sectors, is to:
– Serve as a single source of information for the Governor, the
Legislature and the public about issues relating to reducing drug
demand, including available prevention programs and services;
– Develop a statewide strategy to reduce drug demand;
– Identify lead or contributing agencies or offices to implement the
strategy; and,
– Coordinate the implementation of the strategy by those agencies or
offices.
Senate Health and Human Services Committee  DSHS Presentation  August 23, 2006
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Drug Demand Reduction Advisory
Committee (DDRAC)
• Agencies participating in the effort include:
– Office of the Governor, Criminal Justice Division (CJD);
Department of /Public Safety (DPS); Health and Human Services
Commission (HHSC); Texas Alcoholic Beverage Commission
(TABC); Texas Department of State Health Services (DSHS);
Texas Correctional Office on Offenders with Medical and Mental
Impairments (TCOOMMI); Texas Department of Criminal Justice
(TDCJ); Texas Department of Aging and Disability Services
(DADS); Texas Department of Family and Protective Services
(DFPS); Texas Education Agency (TEA); Texas Juvenile Probation
Commission (TJPC); Texas Youth Commission (TYC); Texas
Department of Transportation (TxDOT)
Senate Health and Human Services Committee  DSHS Presentation  August 23, 2006
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Drug Demand Reduction Advisory
Committee (DDRAC)
• Enabling legislation requires DDRAC to make
recommendations to the Legislature. This year DDRAC
recommendations will address issues including:
– Reducing the risks of underage drinking
– Reducing the risks associated with driving under the
influence
– Uniform Accident and Sickness Policy Provision Law
(UPPL)/prevention of insurance exclusion for patients under
the influence
– Using SBIRT model in healthcare and social service settings
• Collaborative concepts and action plans for DDRAC include:
– Motivational interviewing training across agencies
– Development of joint DSHS/Criminal Justice screening,
assessment and placement protocols for adults and children
Senate Health and Human Services Committee  DSHS Presentation  August 23, 2006
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Integration of Behavioral Health and
Primary Care: Project InSight
Project InSight provides screening, brief intervention,
and referral to treatment (SBIRT) as part of routine
medical care in the Harris County Hospital District.
• Findings:
– One in five patients screen positive for substance
abuse issues
– Total cost savings after one year has been more
than $4 million due to reduced utilization of
emergency and inpatient services
Senate Health and Human Services Committee  DSHS Presentation  August 23, 2006
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