We Can Solve This!

The Practicality, Possibility, & Inevitability of Change

Anthony M. Zipple. Sc.D., MBASeven Counties Services

azipple@sevencounties.org

4 of the 10 leading causes of disability are mental illnesses

~6% of the population has a severe and disabling mental illness at some point

There are over 500 suicides annually in KY alone (11th most common cause of death)

Social Security makes $32 billion in mental illness disability payments annually. Medicaid costs are even higher.

Severe Mental Illness Is A Common Disorder… And Expensive for Us All

15% of corrections population

25-40% of homeless population

85-90% unemployment rate

Large majority live in poverty

Average life expectancy of 53-55 years (same as Republic of the Cameroon, lower than Haiti)

Nationally, We Are Failing People With Severe Mental Illnesses

KY received a grade of “F” from NAMI In 2008 we spent only $54/capita on mental health

(national average was $121) State Medicaid plan does not cover essential

services: community support, ACT, supported employment, supportive housing, etc.

Medicaid rate is based on 1998 data Non-Medicaid revenue flat since 1998 6,400 people in personal care homes & more in

nursing homes Lots of people with severe MI in jail and prison 59% of resources spent on institutional care

Kentucky Reflects These National Challenges

Poor Homeless Incarcerated Underserved Unemployed Unhealthy Dead

This is not the ideal model for a recovery oriented mental health system.

We Talk About Recovery, But Do We Act Like We Believe It?

We have great evidence based practices like ACT, IDDT, WMR, supported employment, etc. that really work

We have great emerging practices like supportive housing, WRAP, peer support, etc. that have great bases of successful experience

We know how to help people with serious mental illnesses live longer & healthier lives

We have robust research, training and demonstration ability

We have great consumer & family advocacy We have multiple examples of state and local

systems that work pretty well

We Know How To Do Better

An Example of a Recovery Services Organization

Thresholds: Chicago Illinois

Thresholds…. Opened in 1959 and became a long time national

leader in the psychiatric rehab/community support movement

Their only mission for over 50 years: A good life in the community for those with most severe mental illnesses

One of a small handful of places that can make some claim to having “invented” psychiatric rehabilitation

Long history of innovation

Thresholds Mission

Thresholds inspires people with severe mental illnesses to reclaim their lives by providing skills, support, and respectful encouragement to achieve successful and hopeful futures.

Thresholds’ Goals For Each Member Are Simple, Even If The Work Is Complicated

A real home A real job A chance to learn and go to school Friends & family Good health services Less hospital and crisis time

Thresholds By The Numbers 850 staff Budget of ~$50,000,000 More than 25 program locations ~60 residential locations (more than 800

beds plus hundreds of vouchers) Serving ~7000 people a year Working in Cook, McHenry, & Kankakee,

Counties More than 70% of services provided out of

offices and day programs

Founding member of USPRA First urban replication in the world of ACT First US program for mothers with severe MI who

wanted to retain custody First MH provider accredited by CARF 33 year old research institute Early adopter of evidence based integrated

treatment Writing new version of Illness Mgt. & Recovery with

Dartmouth to include physical wellness Writing shared decision making technology with

Dartmouth for smoking cessation

Thresholds Pushes the Envelope

Thresholds Builds Unique Capacity To Meet Individual Needs

People with substance abuse disorders Deaf & hard of hearing Homeless individuals Pregnant & parenting teens Transitioning youth Individuals with extensive criminal justice

histories People with diabetes & extensive health

concerns People with histories of severe trauma Vets with serious mental illness Finds a solution for everyone

Thresholds Is Nationally Recognized: A Sample 2011 Annapolis Coalition Pacesetter Award (IDDT) 2006-10 Chicago's 101 Best & Brightest Places To Work 2009 APA Gold Achievement Award (Sup. Emp.) 2009 Belle Greve Memorial Award from National

Rehabilitation Association (Peer Svcs.)

2009 SAMASA Science to Service Award (IDDT) 2009 NAMI Exemplary Psychiatrist Award 2009 NAMI Heroes in the Fight (three awards) 2008 SAMHSA Science to Service Award (Sup. Emp.) 2008 Projects for Assistance in Transition from

Homelessness (PATH) Award 2008 NAMI Gordon Nash Award (Public Education) 2006 Eli Lilly Reintegration Awards First Place 2003 APA Silver Achievement Award (IDDT) 2001 APA Gold Achievement Award (Jail Diversion)

Unwavering commitment to recovery and real lives in the community

Smart implementation of evidence based practices

A very practical “we can find a way to do this” approach to problems

Long history of innovation and learning from practice

33 years of translational research Lots of partners and supporters

What Makes Thresholds Special?

Deep community support that adjusts to the needs of clients. Can see people daily and more often when needed.

Fully mobile. Goes where clients are. Housing supports Supported employment services Peer services Rep payee services Integrated health & wellness services Integrated psychiatry and pharm services Integrated treatment 24/7 availability Day services Lots of friend and partners to help And a genuine commitment to doing everything that it can to help a

person succeed!

Most Of All, Thresholds Provides A Comprehensive, Robust, Flexible Recovery Services Platform

Educated the plaintiffs’ legal team about the Illinois MH system

Helped find and support original plaintiffs Provided technical assistance to the

plaintiffs and advice to the state on the suit and settlement strategies

Provided testimony Moved the first clients from their institutions

after the settlement

Thresholds & Olmstead Case in Illinois

State budget is a disaster MH funding is shrinking, Medicaid rates are low, grant

dollars disappearing Over-reliance on institutional care (3 Olmstead suits in

process) Weak MH leadership Growing admin burden and Medicaid managed care “Interesting” politics Weak provider recovery and EBP expertise Limited community support infrastructure It is a tough place in which to do good work, but one

can always find ways to do better

And Illinois Is A Real Mess, A Pretty Tough Place to Do This Work

Recovery is real. People can have great lives in spite of the most severe mental illnesses

Symptoms, substance abuse, criminal history, etc. do not predict success. Recovery can be real for every person

Recovery is best operationalized through high fidelity, evidence based work & implementing EBPs takes persistence and dedicated resources

State reimbursement needs to support recovery. There is no substitute for cash being available for the RIGHT services.

10 Lessons From Thresholds

ACT or ACT like services plus housing subsidies are the essential platform for success.

Providers need to live and breathe recovery. There is no substitute for mission. And not every provider is good at this kind of work.

Providers can do a lot with the hand that they are dealt… if they want to or are pushed to do it.

It takes a village… or a whole city… to make recovery real. This is our collective issue.

Humility is the openness to being taught. We can always learn and do better work.

More Lessons

It’s not about waiting for the storm to pass, but about learning to dance in the rain

Final Lesson: Start Where You Are & Keep Moving