Division of Mental Health, Developmental Disabilities and Addictive Diseases

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Re-Balancing the Service System for People with

• Mental Illness, Developmental Disabilities and
  Addictive Diseases (MHDDAD)

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What is MHDDAD?
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Department of Human Resources
Division of Mental Health, Developmental
Disabilities and Addictive Diseases
5 MHDDAD Regional Offices
7 State Hospitals
Community Providers
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Who we serve
Children Adults with serious mental
illness developmental disabilities addictive
diseases
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Funding Sources

• State funds
• Federal Block Grant funds
• Medicaid funds
• Medicare funds
• Private insurance / private pay
• County funds
• Various public and private grants

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MHDDAD

• Services for children adolescents

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MHDDAD Children Adolescents Services

• Preserve families
• Avoid hospitalization
• Support participation in everyday life

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Community Services - CA Served
Serious Emotional Disturbances
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Community Services - CA Served
Addictive Diseases
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Hospital Services - CA Served
Serious Emotional Disturbances
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Services for adults with mental illness and/or
addictive diseases
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Adults (MH AD) Services

• Best Practices
• Transition from institutions
• Assure availability of medication

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Community Services - Adults Served
Mental Health
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Community Services - Adults Served
Addictive Diseases
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Hospital Services - Adults Served
Mental Health
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• Services for people with developmental
  disabilities

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Developmental Disabilities Services

• Reduce the waiting list
• Transition from institutions
• Ensure provider availability
• Ensure community capacity

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Community Services - Adults Served
Developmental Disabilities
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Community Services - CA Served
Developmental Disabilities
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Consumers with DD Served in State Hospitals
Note FY07 Data is Oct. 31, 06
Source BHIS Dec.06 HB
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Developmental Disabilities Waiver Planning List
Persons Waiting for Waiver Services
Nov. 06
Source MHDDAD Dec. 06 HB
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Forensic Services
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Forensic Services

• Ensure timely movement from jails
• Ensure appropriate treatment setting

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State Mental Health Administrators in the major
of the states report increasing percentages of
forensic patients in state hospitals. Source
State Profile Highlights National Association
of State Mental Health Program Directors Research
Institute, Inc. (NRI)
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Why does the system need to be re-balanced?
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Old Paradigm

• Isolation of people with mental illness,
  addictive diseases and developmental disabilities
  in hospitals and institutions
• Use of hospitals as the preferred treatment
  forced people and resources into deep end
  services
• Example Central State Hospital housed 13,000
  people in the 1960s. Todays system of 7
  hospitals has 2,513 beds

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Old Paradigm

• Historical grant-in-aid funding to CSBs not
  driven by need, demographics or outcomes
• Children not considered priority customers
• Lack of accountability for the people most in
  need getting effective services

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New Paradigm

• People served as close to home, family and
  community as possible
• Provider competition affords greater consumer
  choice
• Fee for service and utilization review ensure
  that the right people are getting the right
  services in the right amount at the right price
• Children get their fair share of the resources
• Nobody should live in a hospital (particularly
  children and people with developmental
  disabilities)

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Hospitals are our Burning Platform

• Public behavioral health system is the safety
  net when private systems are exhausted
• Increased demand for substance abuse treatment is
  driving people into deep end services such as
  emergency rooms and state hospitals
• Courts are increasingly relying on state
  hospitals
• Mental illness causes more disability than any
  other class of medical illness in America.

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Georgias Mental Health System is about 8
years behind other states in transitioning
resources to community-based services only
since 2001 has Georgia been spending more
resources on community services than hospital
services
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Burning Platform

• Children are hospitalized at 3X the national rate
• Adults are hospitalized at 3.5X the national
  rate
• Elderly are hospitalized at 24X the national
  rate
• 417 people currently in state hospitals could be
  discharged, but lack needed community services
• People are living in hospitals - 66 have been in
  the hospital for over 1 year 25 for 10 years

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Burning Platform

• Hospital readmission rates are twice the national
  rate
• Currently exceeding forensic bed capacity by 35
  (164 beds). Projecting a 89 capacity shortfall
  by 2010 (417 beds)
• 64 of forensic consumers have had previous
  MHDDAD contact missed opportunity
• Resources of other systems are drained
• Examples Sheriffs Offices, DFCS, DJJ, DOE,
  local emergency rooms

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Burning Platform

• 2001 - Revenue Maximization projected Medicaid
  revenue would replace 37.4M in state funds
  annually (did not occur)
• Medicare earnings were over-projected due to
  seriously mentally ill consumers exhausting their
  lifetime benefit
• Because public system is safety net when other
  resources are exhausted, most consumers come with
  no insurance or ability to pay
• Olmstead Decision accelerated community
  placements
• Escalating costs utilities, medical treatment ,
  staff

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Actions Taken

• Consistent statewide set of standards for the
  community
• Defined who will be served
• What basic services will be available to all
  Georgians
• Redistributed funding so every area gets their
  fair share

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Actions Taken

• 2) Created a front door to service system
• Established Single Point of Entry
  (1-800-715-4225)
• Funded Crisis Intervention Training for 20
  frontline law enforcement officers to divert
  mentally ill from jails
• Created 23 hour observation units at 4 hospitals
  to avoid 66 of hospital admissions
• Established crisis stabilization services for
  children to avoid 60-75 of hospital admissions
• Increased adult crisis stabilization services by
  30 since FY04

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Actions Taken

• Increased the number of people that can be served
  in the community
• Steady increase in number of MR/DD waivers
• Open competitive market place with
  fee-for-service to increase of providers,
  consumer choice and number of people served
• Use of Case Expeditors to safely move consumers
  from hospitals to the community
• External utilization review of hospital and
  community services to ensure the right services
  for the right people in the right amount

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Actions To Be Taken

• Reduce the cost of pharmacy operations and
  medications (estimated annual savings 1.2M)
• Operate smaller, more specialized hospitals
• Privatize specific services such as billing
• Consolidate selected hospital functions
• Potential federal funding of Money Follows the
  Person Grant
• Legislative proposal allowing misdemeanor
  defendants found incompetent to stand trial to be
  evaluated and treated for competency restoration
  in the community

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Future Initiatives

• Consolidation of MHDDAD and DFCS child and
  adolescent behavioral health systems -
  positioning MHDDAD to provide treatment and DFCS
  to provide protection
• Consolidation of MHDDAD and Public Health
  substance abuse prevention services - positioning
  DHR to impact health behaviors

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Future InitiativesRestructuring Child
Adolescent Substance Abuse Services

• Current System
• 4.9M funding
• 142 inpatient beds
• Length of stay 9-12 months
• 150-200 adolescents served annually

• New System
• 2.5M funding
• 32 inpatient beds
• Length of stay 3-6 months
• 120-150 children served annually
• 2.4M funding
• Outpatient, community-based services
• 1,350 adolescents served annually

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Future Initiatives

• Sheriffs Tele-medicine Pilot
• technology to link Sheriffs Offices and state
  hospitals only transport those who must be moved
• Crisis Services for children
• add mobile crisis services and funds to purchase
  additional crisis beds

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Future Initiatives

• Child Adolescent Parent-to-Parent Peer Support
  Program
• links parents of emotionally disturbed children
  with other parents who have successfully
  navigated the service delivery system
• Increase Medicaid waiver service slots and
  expand supports to families consumers with the
  new developmental disability waiver
• Individual Budgets
• Supports Intensity Scale
• Choice of Services
• Financial Support Services

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Characteristics of the Reformed System

• Every area of the state will have
• A true single point of entry
• Crisis stabilization for children and adults
• A set of core services
• Deinstitutionalization of developmentally
  disabled and long term mental health consumers
• Individualized treatment planning and utilization
  management
• Maximum self-sufficiency and independence for
  adults with appropriate supports

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