“It’s Time for a Revolution”
State Mental Health System Reorganization
NAMI National ConventionJune 20, 2005
“It’s Time for Systems Change”
“……..Systems changeSystems change is a complex and multi-faceted construct that may be approached in a variety of
fashions.
….EvolutionEvolution views the transformation of systems as a necessarily slow and ongoing process that requires
consensus among all levels of stakeholders about changes in attitude and behavior.
…..RevolutionRevolution reflects stakeholder impatience with slow change seeking to replace tortuous evolutions with more immediate and dramatic modifications in
status quo.” Patrick Corrigan, University of Chicago Center for Psychiatric
Rehabilitation
THE MENTAL HEALTH SERVICE SYSTEM IS IN DISARRAY
The Commission is united in the belief that the mental health service delivery system needs dramatic reform. It is becoming clear that the mental health services system does not adequately serve millions of people who need care.New Freedom Commission, Interim Report 10/29/02
2003 NAMI TRIAD REPORT:SHATTERED LIVES
3,400 individuals/families with SMI – 50 states responded
62% never married – 80% dependent on disability and support from others – ½ with diagnosis of schizophrenia – 44% - criminal justice contact -60% had more than 1 diagnosis.
99% received medication – 85% hospitalized
Less than 1/3rd had access to effective & valued interventions
Flowchart For Problem Resolution
Don’t Mess With It!
YES NO
YES
YOU IDIOT!
NO
Will it Blow UpIn Your Hands?
NO
Look The Other Way
Anyone ElseKnows? You’re SCREWED!
YESYES
NO
Hide ItCan You Blame Someone Else?
NO
NO PROBLEM!
Yes
Is It Working?
Did You Mess With It?
BOIL IT ALL DOWN?
“If you ran your business the way the state ran its mental health system you’d be out of business.”
Texas RevolutionHB 2292
Consolidation of Health & Human Services Agencies
Reprioritize Existing Resources Implement Disease Management & Jail
Diversion Strategies Supplemental Rebates, Preferred Drug List
(No Carve outs)
HB 2292 - TRANSFORMATION OF HEALTH & HUMAN
SERVICES
Consolidation of 12 to 5 Department of State Health Services includes
physical health, mental health and substance abuse (3 agencies to 1)
Transformation into a customer-focused health and human services “enterprise”
Operate like GE – Jack Welch Departments will focus on client needs and
program delivery Performance goals and successful outcomes
HB 2292 Sec. 533.0354
Redefined our Priority Population to serve:
1. Schizophrenia2. Bipolar Disorder3. Severe Clinical Depression4. Children with serious emotional
disturbances
Implements Disease Management for each illness
Prevalence, Severity, and Unmet Need – Prevalence & Severity of Mental Disorders, 6/2/2004
www.jama.ama-assn.org/cgi/content/full/291/21/2581
Sec. 533.0354 (Cont’d) Recovery Based
Old system – programs decided what services to offer & person was expected to fit into the available services
Person only guaranteed to get crisis, hospital & medications
Disease Management is based on specific diagnosis and level of need
The service system is arrayed to deliver the services matched to what the person needs
Focused on a process of recovery
Sec. 533.0354 (Cont’d) Accountable Care System
Guidelines for consistent levels of care across the system – hospital and community services
Utilizing sound business practices Performance-based contracting Fee for Service The delivery system WILL BE HELD
ACCOUNTABLE www.dshs.state.tx.us/mhprograms/
FinalRDMReport.pdf
Sec. 533.0354 & SB 1145 CIVIL SIDE JAIL DIVERSION
Targets appropriate services for individuals with schizophrenia and bipolar disorder – as in disease management – plus collaboration with TCOOMMI, CIT Training, Mental Health Courts
Allows an urban area to prioritize its available funding for programs designed to divert persons with mental illness from jail
Texas Correctional Office on Offenders with Medical and Mental Impairments (TCOOMMI) An agency created by the legislature to work with adult and juvenile offenders with mental impairments in the criminal justice system to place them on separate paths from regular offenders.www.tdcj.state.tx.us/tcomi/tcomi-home.htm
Sec. 531.069, Preferred Drug List
Supplemental Rebates, PDL & PA required of all drugs (No Carve Out for Behavioral Health)
P & T Committee must exercise clinical judgment
Option to place supplemental rebate into Alternate Benefit Program
Results – Open Access Redefined PA Protocol - Texas Medication Algorithm www.hhsc.state.tx.us/HCF/vdp/PT/PT.html
