Treatment Capacity in IllinoisWednesday, June 3rd, 2015

1:00pm to 5:00pm

Commission on Criminal Justice and Sentencing Reform

Introduction• What is the treatment capacity in Illinois?• For mental health?• For substance abuse?• For forensic population?

• Where are the resources located?

• What are the data limitations?

2

Mental Health Treatment Capacity

3

Mental Health Treatment Numbers in Illinois

Source: Illinois Department of Human Services, Illinois Mental Health 2013-2018 Strategic Plan; Dr. Anderson Freeman and DMH staff.

State HospitalsPrivate Hospitals

Incarceration (Prisons)

8,586 admissions to 1,324 beds in FY2012

113,781 admissions to 3,481 beds in 2010

11,300 with mental illness needs in FY2012

Incarceration (Jails)1,400 of the 9,600

inmates in Cook County Jail receive DMH-Funded

psychiatric services

State Community-Based136,047 receiving

treatment in FY2012

Private Community-BasedCurrently researching for

additional data

4

Psychiatric Hospital; 18;

4%

Separate inpa-tient psychiatric unit of a general

hospital; 58; 11%

Residential treatment center for children; 34;

7%

Residential treatment center

for adults; 88; 17%

Outpatient, day treatment or par-

tial hospitaliza-tion mental

health facility; 291; 57%

Multi-setting (non-hospital) mental health

facility; 23; 4%

Source: SPAC analysis of N-MHSS data, SAMHSA, 2010.

Illinois Mental Health Facilities by Type512 Respondents

5

Civil admissions and presentations (sent to hospital, may not end in admission), as well as total served, are down almost 40%.

Source: SPAC analysis of figures provided by Dr. Anderson Freeman and DMH staff. 6

2005 2006 2007 2008 2009 2010 2011 2012 2013 20140

2,000

4,000

6,000

8,000

10,000

12,000

14,000

Division of Mental Health State Hospital Services: Civil and Total

Unduplicated Count of Individuals Re-ceiving Services

Civil Admissions

Civil Presentations

Fiscal Year

• Illinois has 222 hospitals spanning 80 counties in Illinois.

• 22 counties do NOT have a hospital.

• 80 hospitals have authorized psychiatric beds, for a total of 3,927 authorized psychiatric beds.

• 52 counties do NOT have authorized psychiatric hospital beds.

• 28 counties have inpatient behavioral health providers.

• 75 counties do NOT have inpatient behavioral health providers .

• Over half of Illinois counties lack sufficient numbers of psychiatrists.

Source: Illinois Hospital Association, Facts & Figures, 2015. 7

Programs for Co-occuring Dis-

orders, 42%

No Co-occurring Programs,

58%

Percent of Facilities with Programs for Co-occurring Disorders

Special Programs in Illinois Mental Health Facilities

Source: SPAC analysis of N-MHSS data, SAMHSA, 2010. 8

Substance Abuse Treatment Capacity

9

Admissions of Chicago Residents to Publicly Funded Treatment Programs, by Primary

Substance: FY2007 – FY2012

FY2007 FY2009 FY2010 FY20120

5,000

10,000

15,000

20,000

25,000

30,000

CocaineHeroinCannabisAlcohol

Source: Dr. Larry Ouellet of UIC, data from the Illinois Department of Alcohol and Substance Abuse

Largest reduction: cocaine 66%

10

Declining Admissions for Substance Abuse

The number served declined over 21% since 2003.

Declining admissions do not mean declining need. 11

2003 2004 2005 2006 2007 2008 2009 2010 201165,000

70,000

75,000

80,000

85,000

90,000

95,000

Unduplicated Number Served For Alcohol and Substance Abuse

Fiscal Year

Source: Illinois Auditor General DHS Financial Audits.

2002 2003 2004 2005 2006 2007 2008 2009 2010 201130,000

32,500

35,000

37,500

40,000

42,500

45,000

47,50043,971

Number of Clients in Community-Based Treatment as of March 30th of Each Year

Source: N-SSATS Illinois State Profile, SAMHSA, 2002-2011.12

Geographic Distribution of Substance Abuse Treatment Facilities In Illinois

Source: N-SSATS Illinois State Profile, SAMHSA, 2011.

• 11 counties had no one respond to the survey.

• 638 facilities responded to a survey by the National Survey of Substance Abuse Treatment Services Survey (N-SSATS) out of 663 surveyed.

• Each red dot on the map represents one responding facility.

13

2002 2003 2004 2005 2006 2007 2008 2009 2010 20110

10,000

20,000

30,000

40,000

50,00040,687

3,014270

Patients by Type of Facility

Outpatient

Residential

Hospital Inpatient

2002 2003 2004 2005 2006 2007 2008 2009 2010 20110

100200300400500600700

Care Facilities by Type

OutpatientResidentialHospital Inpatient

Source: N-SSATS Illinois State Profile, SAMHSA, 2002-2011.14

2002 2003 2004 2005 2006 2007 2008 2009 2010 20110

10203040506070

Number of Illinois Facilities with Medi-cation-Assisted Treatment for Opioid

Dependence

Faci

lities

Source: N-SSATS Illinois State Profile, SAMHSA, 2002-2011.15

Source: N-SSATS Illinois State Profile, SAMHSA, 2002-2011.

2002 2003 2004 2005 2006 2007 2008 2009 2010 20110.0

1.0

2.0

3.0

4.0

5.0

6.0

7.0

8.0

6.3

1.4

3.4

Substance Abuse Treatment Rate per 1,000 Population

New YorkCaliforniaFloridaTexasIllinois

Per

son

s in

Tre

atm

ent p

er 1

,00

0 o

f Pop

ulat

ion

Treatment rate provides a metric to compare between states. Calculated by dividing the total number receiving treatment by the state population.

16

Source: N-SSATS Illinois State Profile, SAMHSA, 2002-2011.

20022003

20042005

20062007

20082009

20102011

0.0

1.0

2.0

3.0

4.0

5.0

6.0

7.0

8.0

IllinoisMissouriIndianaWisconsin

Per

son

s in

Tre

atm

ent p

er 1

,00

0 P

opul

atio

n

Treatment Rate Comparison With Regional States

17

Forensic Population

18

Forensic admissions to state mental health hospitals have increased 15% since 2005.

These admissions are for those found Unfit to Stand Trial (UST) or Not Guilty by Reason of Insanity (NGRI), and nearly 20% are for misdemeanor offenses.

Waiting list for admission is 80+ persons, with wait times 30 to 40 days.

Source: SPAC analysis of figures provided by Dr. Anderson Freeman and DMH staff. 19

2002 2003 2004 2005 2006 2007 2008 2009 2010 20110

50

100

150

200

250

300

350

400

163140

361

Number of Special Programs in Treatment Facilities

Co-occuring Disorder Criminal Justice clients DUI/DWI offenders

Source: N-SSATS Illinois State Profile, SAMHSA, 2002-2011.20

No67%

Yes19%

Un-known

13%

Forensic Programs in Illinois Mental Health Facilities

Source: SPAC analysis of N-MHSS data, SAMHSA, 2010. 21

Impact of Reduction

22

Impact on Mental Health Capacity

The Bureau of Justice Statistics estimates that 55% of male inmates and 73% of female inmates have mental health needs. Applying this estimate to the reduction goal of 12,000 means an additional 7,000 individuals accessing mental health treatment in the community.

That is a 5% increase over 2014 numbers. 23

Source: SPAC analysis of figures provided by Dr. Anderson Freeman and DMH staff.

2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 100,000

110,000

120,000

130,000

140,000

150,000

160,000

170,000

180,000

190,000

142197

135,197

Number of Individuals Receiving Community-Based Mental Health Treatment: Historical and Predicted

Fiscal Year

Impact on Substance Abuse Capacity

The Centers for Disease Control and Prevention estimates that 80% of inmates have substance abuse problems. Applying that to the reduction goal would mean 9,600 individuals will have substance abuse issues and will need community-based treatment.

That is a 21% increase in population served. 24Source: N-SSATS Illinois State Profile, SAMHSA, 2002-2011.

2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 20150

10,000

20,000

30,000

40,000

50,000

60,000 53571

Number in Substance Abuse Treatment: Historical and Predicted

Funding

25

Funding for DMH has decreased 10% since FY2005.

State appropriations to DHS has decreased 39% since 1998.

26

19981999

20002001

20022003

20042005

20062007

20082009

20102011

20122013

20140

1,000,000

2,000,000

3,000,000

4,000,000

5,000,000

6,000,000

State Appropriations to Department of Human Services (2015 Dollars)

App

ropr

iati

ons

Am

ount

(201

5 D

olla

rs)

FY05 FY06 FY07 FY08 FY09 FY10 FY11 FY12 FY13 FY14 FY150

100,000

200,000

300,000

400,000

500,000

600,000

700,000

800,000

900,000

Division of Mental Health Expenditures: (2015 Dollars)

Spen

t (20

15 D

olla

rs)

Source: SPAC analysis of figures provided by Dr. Anderson Freeman and DMH staff; Illinois Auditor General DHS Financial Audits

Medicaid

State Mental Health

State Child Welfare

US Veterans Admin

Private Insurance

Medicare

Other

0.0% 10.0% 20.0% 30.0% 40.0% 50.0% 60.0%

48.0%

26.5%

10.3%

4.6%

3.6%

2.0%

5.0%

Primary Funding Source in Illinois Mental Health Facilities

512 Facilities Surveyed in IllinoisOf 442 responses, 306 (69%) had one primary funding source that made up over half of their overall revenue.

Source: SPAC analysis of N-MHSS data, SAMHSA, 2010. 27

General Sources• This information is specific to the state of Illinois. • Information was gathered from: • Special thanks to Dr. Anderson Freeman and his staff at the Division of Mental Health

for their data on funding and numbers served.• Illinois Auditor General Financial Audits on Department of Human Services. • the National Survey of Substance Abuse Treatment Services (N-SSATS) Survey. This

annual survey collects information on all substance abuse facilities, including both alcohol and drug abuse, and in facilities private and public. They produce state profiles of their findings for 2002 through 2011, available on their website.

• the National Mental Health Services Survey (N-MHSS). Surveys all mental health facilities in US, both private and public, available for 2010.

• Both surveys are conducted by Substance Abuse and Mental Health Services Administration (SAMHSA).

• University of Illinois at Chicago (UIC) School of Public Health professor Larry Ouellette prepared the analysis of Illinois’ publicly-funded admissions for substance abuse.

• Illinois Hospital Association tallies the number of hospitals, authorized beds, and behavioral health providers by county across the state of Illinois.

• Other figures gathered from various sources such as the National Alliance on Mental Illness (NAMI), Illinois Department of Health Services, and Illinois Department of Public Health (Center for Rural Health). 28

References• Slide 4: Illinois Department of Human Services, Illinois Mental Health 2013-2018 Strategic Plan. Available

at: https://www.dhs.state.il.us/onenetlibrary/27897/documents/mental%20health/marysmith/strategicplan/mentalhealthservicesfiveyearstrategicplan2013.pdf, p.3 of Appendix B.

• Slide 7: Illinois Hospital Association. (2015). Facts & Figures. Available at: http://www.ihatoday.org/News-and-Reports/Facts-and-Figures/Maps.aspx

• Slide 7 map: Generated by IHA COMPdata informatics (April 02, 2014). Available at: http://www.ihatoday.org/uploadDocs/1/bhcountymap.pdf

• Slide 8: Estimate of comorbidity: National Institute on Drug Abuse. (2010). Comorbidity: Addiction and Other Mental Illnesses. Research Report Series. Available at https://www.drugabuse.gov/sites/default/files/rrcomorbidity.pdf

• Slides 8-9: Substance Abuse and Mental Health Services Administration (SAMHSA). (2010). National Mental Health Services Survey (N-MHSS). Available at: http://www.icpsr.umich.edu/icpsrweb/SAMHDA/studies/34945#datasetsSection

• Slide 12: Graph created by Dr. Larry Ouellet of UIC, with data from the Illinois Department of Alcohol and Substance Abuse.

• Slides 13-17: Substance Abuse and Mental Health Services Administration (SAMHSA). (2002-2011). National Survey of Substance Abuse Treatment Services (N-SSATS) State Profiles. Available at: http://wwwdasis.samhsa.gov/webt/tedsweb/tab_year.choose_year_state_profile?t_state=IL

• Slide 23: Estimate of mental health issues: Glaze, L.E. & James, D.J. (2006). Mental Health Problems of Prison and Jail Inmates. Bureau of Justice Statistics Special Report. Available at http://www.bjs.gov/index.cfm?ty=pbdetail&iid=789.

• Slide 24: Estimate of 80% with substance abuse issues from CDC report. U.S. Centers for Disease Control and Prevention, Substance Abuse Treatment for Drug Users in the Criminal Justice System, (Aug. 2001), available at: http://www.cdc.gov/idu/facts/cj-satreat.pdf 29