we can solve this!
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We Can Solve This!. The Practicality, P ossibility, & Inevitability of Change Anthony M. Zipple. Sc.D., MBA Seven Counties Services [email protected]. Severe Mental Illness Is A Common Disorder… A nd Expensive for Us All. - PowerPoint PPT PresentationTRANSCRIPT
We Can Solve This!The Practicality, Possibility, & Inevitability of Change
Anthony M. Zipple. Sc.D., MBASeven Counties Services
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 MissionThresholds 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