Department of State Health Services (DSHS)

1. Department of State Health Services (DSHS) House Human Services Committee August 8, 2006

2. Mission and Responsibilities Mission • Promote optimal health for individuals and communities • Provide effective health, mental health and substance abuse services Principles • Sound Mind ~ Sound Body • Prevention First • Partnerships • Community Focus

3. Current Initiatives Selected current initiatives include: • Resiliency and Disease Management (RDM) • Crisis Services Redesign • State Mental Health Hospital Capacity • Mental Health Transformation • Access to Recovery

4. Resiliency & 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)

5. Resiliency & Disease Management (RDM) • 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%ofadults avoided spending time in crisis (i.e., avoided being placed in 23-hour observation in a hospital setting, crisis counseling, etc.).

6. Resiliency & Disease Management (RDM) • 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 avoided spending time in crisis (i.e., avoided being placed in 23-hour observation in a hospital setting, crisis counseling, etc.).

7. Crisis Services Redesign • Crises do occur—but we should do all we can to avoid them. • 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.

8. Crisis Services Redesign • Initial conclusions for recommended services include: • 24-hour hotline • Mobile outreach • 23 to 48-hour hold capacity • On-call psychiatric services • Crisis residential services • Respite • In-home crisis resolution services

9. State Mental Health Hospital Capacity • In February 2006, the LBB approved $13.4 million in additional expenditures for state mental health hospital capacity. These funds were transferred from DSHS’ FY07 appropriations to FY06. • As a result, statewide hospital system capacity was increased by 96 forensic commitment beds and 144 civil commitment beds. • This increase in state hospital capacity has greatly enhanced our ability to meet the needs of local communities. • We continue to plan for long-term, community-based solutions to address the hospital capacity issue, such as redesigned crisis services.

10. Mental Health Transformation • Overarching goal is to improve the mental health of all Texans and meet the President’s New Freedom Commission goals, including ensuring consumer-driven services, eliminating of disparities, and using technology to increase access to mental health care • Participants on the Transformation Working Group include: • The Governor’s Office; Department of State Health Services; Texas Health and Human Services Commission; Department of Family and Protective Services; Criminal Justice Department; Juvenile Probation Commission; Texas Youth Commission; Service Consumers and Family Members; Texas Education Agency; Department of Aging and Disability Services; Workforce Commission; Veteran’s Administration; Department of Assistive and Rehabilitative Services.

11. 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

12. Access to Recovery (ATR) • Access to Recovery supports clients by providing needed substance abuse treatment or recovery support services to successfully complete their drug court program • Drug courts offer a cost-effective alternative to incarceration by providing community-based treatment as a condition of probation • Cost effectiveness of the ATR drug court program in Texas is reflected by preliminary data, which indicates that participating ATR clients are experiencing the following successful outcomes: • 92% Abstinent • 59% Employed or in School • 91% No Further Arrests • 99% Not Homeless • 87% Socially Connected

13. Looking Ahead As demand for mental health and substance abuse services continues, DSHS’ focus is on: • Making the most out of cross-agency partnerships • Making better use of information technology and evidence-based practices • Keeping individuals out of crisis • Reducing demand for hospital services • Maintaining quality hospital services • Analyzing the impact of behavioral health issues on other systems