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Harris County Behavioral Health Policy Efforts David S. Buck, MD, MPH Karen Love, MHA

Harris County Behavioral Health Policy Efforts David S. Buck, MD, MPH Karen Love, MHA February 2007. The Need. Harris County jail processed 93,921 unduplicated inmates in the year ending November 2006

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Harris County Behavioral Health Policy Efforts David S. Buck, MD, MPH Karen Love, MHA

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  1. Harris County Behavioral Health Policy Efforts David S. Buck, MD, MPH Karen Love, MHA February 2007

  2. The Need • Harris County jail processed 93,921 unduplicated inmates in the year ending November 2006 • 24% of inmates have a diagnosable mental illness – about half of whom have a serious, disabling mental illness • 2.5% of inmates (~2500) are homeless and half of them also have a mental illness

  3. The Need • Inmates are often released without advance notice to case managers, making discharge planning problematic • Inmates are often released in the middle of the night with no medication

  4. The Need • Upon release, MHMRA patients may be referred to the Eligibility Center for assessment and continuation of care, but often do not follow through due to various circumstances including: • Lack of transportation • Lack of ID (TDL, Birth Certificate, SS etc.) • Lack of proof of income and/or insurance

  5. The Need • An inmate with mental illness and/or disability is more likely to be subsequently arrested and charged with another offense, face a more serious charge, stay twice as long in jail and incur more jail time for an equivalent offense (Nguyen, 2005).

  6. Silos of Care • County Jail • MHMRA • Harris County Hospital District • Social Service Agences • CPS • Community Clinics • Private BH Providers

  7. Other Factors • Harris County growing rapidly – resources not keeping pace • 30% uninsured • The behavioral health care system strained • changes in reimbursement requirements • private insurance priorities • reduction in psychiatric beds & services…

  8. Community Consensus • Patients with high priority needs face increasing difficulty in accessing services • Government, social services, public safety, physical and BH providers and advocates agree – access and service delivery system must be addressed • Change is a priority for the community

  9. Identifying Principles for Improving the Harris County Behavioral Health System

  10. Phase I: Health Indicators • Model for interventions to improve population health • Can serve as a basis for developing community goals • Adopted by the Council in November 2005

  11. Phase I: Health Indicators www.hcphsc.hctx.net/ReferenceMaterial.asp

  12. Phase I: Health Indicators (cont’d)

  13. Phase I: Health Indicators (cont’d)

  14. BH Performance Indicators • Overview: • Interviews • To identify principles, expectations, standards of care, and outcomes • Literature review • Investigate literature referenced in interviews • Create Harris County Behavioral Healthcare Report Card • Create mechanism for reporting modeled from healthcare indicator project

  15. Phase II: Provider Interviews • What are the principles, expectations, standards of care, and outcomes important to evaluating and defining an accountable behavioral healthcare system? • Summary of themes that emerged from these interviews:

  16. Methodologies in the Literature • Literature search conducted in community & adolescent psychiatry to look for systems of care that have evaluation tools on behavioral health • MHSIP (Mental Health Statistics Improvement Program): Specifically designed to assess consumer concerns with treatment, not merely global satisfaction with mental health services. • Report card with domains, concerns, indicators, and measures • Indicators included: • 1) objective measures of provider's commitment to mental healthcare • 2) consumer assessment of the convenience, appropriateness, and outcomes of the services the system supports

  17. Jack Callahan, JD Sarah Flick, MD Thomas Gavagan, MD Mary Lou Heater, RN, NP Sylvia Muzquiz, MD Fred Ramirez Pauline Rosenau, PhD John Sargent, MD Kim Szeto Stephen Williams  John Burruss, MD Avrim Fishkind, MD Sylvia Fitzgerald Andrew Harper, MD Lois Moore, PhD Tuan Nguyen, PhD Sonja Randle, MD Joe Rubio, PhD Steve Schnee, PhD Mel Taylor, MSW Phase II: BIG THANKS

  18. Draft Principles

  19. Selected Implications of Report Card: • Explore options for aligning resources more effectively • Common eligibility • Common set of utilization management tools • consumer and family involvement in treatment planning and treatment decisions • effective strategies for reducing admissions and long term use of incarceration and institutionalization and their offsetting costs

  20. Phase III: Structuring for Success • Technical Assistance Collaborative engaged: • On-site environmental scan/system review • Develop strategic option analyses • Develop legislative proposal for transformation? • Initial Report Due March 1st

  21. Contact Information David Buck dbuck@bcm.tmc.edu Karen Love karen_love@hctx.net

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