[Vision2020] Fwd: Mental Health in central Idaho

[Darrell Keim]

Visioneers:****

** **

We are now about 1 month past the shootings at Sandy Hook elementary.
Predictably, there has been discussion of gun control.  It takes a human
being to pull a trigger.  I believe cuts we have continually made to our
national mental health system since the Reagan era are the primary
culprit.  What I couldn’t mention at the time of the shooting was that I
had seen a draft survey of how mental health state budget cuts made in
FY2011 have impacted us in central Idaho.  This survey shows the
direct impact of lowered funding of mental health treatment.  It indicates
funding mental health saves us money in more expensive areas.  I believe
this same relationship holds for the national picture.****

** **

The survey is now officially out.  I have copied it for your perusal
below.  Copies are also going to legislators.  ****

** **

Survey conducted by members of the Idaho Region 2 Mental Health Board.  Its
purpose was to see what impact 20011 cuts to the states mental health
budget have had in our local area.  ****

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Looks like that 2011 budget cut cost us a lot of money!****

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Without further comment:****

** **

*LEGISLATIVE IMPACT SURVEY – FY 2012*

*Purpose of the research:  *To identify needs and gaps in the delivery of
behavioral health services to Region II. Follow up research to Fiscal Year
(FY) 2011 Legislative Impact Survey****

*Participants: *County Prosecutors; Law Enforcement; Private Behavioral
Health Providers; County Health and Welfare Directors; Region II – Director
of Health and Welfare; School Counselors, School Social Workers, School
Psychologists; and Hospitals.****

** **

**·        **Total Surveys completed - 28****

*Increasing number of individual requiring behavioral health services*****

**·        ***Region II – Health and Welfare*

**o   **Crisis Response – Children ****

**§  **FY 2010 -- 35 incidents****

**§  **FY 2011 – 28 incidents****

**§  **FY2012  – 38 incidents****

**o   **Crisis Response - Adults****

**§  **FY 2010 – 265 incidents****

**§  **FY 2011 – 274 incidents****

**§  **FY 2012 – 340 incidents****

**o   **Hospitalizations – Mental Health Holds****

**§  **FY 2010 – 25 days ****

**§  **FY 2011-   47 days****

**§  **FY 2012 - 105 days****

**o   **Cost of Hospitalizations****

**§  **FY 2010 – $27,175****

**§  **FY 2011 – $53,295****

**§  **FY 2012--  $112,700****

**o   **Clients with Substance Abuse Disorders****

**§  **FY 2010 – 585 individuals****

**§  **FY 2011 – 903 individuals****

**§  **FY 2012 -- 958 individual****

**·        ***County Prosecutors*

**o   **Number of defendants with mental health and/or substance abuse
involvement****

**§  **Increasing over last three years in 3 jurisdictions****

**§  **15-30%  of defendants have mental health issues****

**§  **30-80% of defendants have substance abuse issues****

**§  **These cases require more time, money and resources****

**§  **Individuals  more likely to be incarcerated****

**o   **Resources****

**§  **Increasingly fewer options and fewer volunteers since 2009****

**§  **Defendants unable to access services due to inability to afford
and/or lack of transportation****

**§  **Loss of ACT Team in one community increased number of crises and
reduced general level of  functioning of individuals****

**·        ***Law Enforcement*

**o   **Mental Health Holds and Transports****

**§  **Between 2010 & 2011 number of holds and transports almost doubled in
one jurisdiction – 31 to 59 respectively****

**§  **Between 2010 & 2012 in same jurisdiction number of suicide attempts
also increased from 34 to 62 incidents. Each incident requires 2 to 5 hours
of staff  time****

**o   **Indirect Costs****

**§  **Removing officers from area****

**§  **Calling in off-duty officers****

**§  **Fuel costs to transport****

**·        ***Private Medicaid Providers*

**o   **Medicaid Client Served**

**§  **Agency 1**

**·        **2010 – 157 individuals**

**·        **2011 – 121 individuals**

**·        **2012 – 106 individuals**

**·        **Served by 12 clinicians**

**§  **Agency 2**

**·        **2010 – 60 individuals**

**·        **2011 – 60 individuals**

**·        **2012 – 100 individuals**

**·        **Served by 4 clinicians**

**o   **Neither agency would continue to serve Medicaid clients if
agencies required to complete accreditation requirements due to cost**

**o   **Reasons for continued services for Medicaid clients**

**§  **Idaho’s rural residence deserved care**

**§  **Medicaid is often only way rural clients can receive services**

**o   **Experience as Medicaid contractor**

**§  **Reimbursement rate 55% below standard hourly rate & 50% below
insurance reimbursement rate**

**§  **Rules not readily announced and interpretations may be subjective**

**o   **What is working**

**§  **State of Idaho pays bills on time**

**§  **Overall coverage of services for psychotherapy and testing good**

**o   **Perceived needs and gaps**

**§  **Testing**

**·        **Reimbursement too low**

**·        **Waiting list extraordinarily long**

**§  **Compensation**

**·        **No  reimbursement for collateral contacts, case reviews or
paperwork**

**§  **Privatization**

**·        **Will not improve services**

**·        **Will increase cost and reduce services**

**·        **Will be fewer Medicaid providers**

**§  **Excessive rules and regulations cost businesses more and reduce
patient care**

**·        **Streamline for more efficient  care**

**·        **Reduce number of rules and regulations**

**§  **Physician supervision added expense**

**·        **Make use of client’s primary care provider**

**·        ***Hospitals*

**o   **Emergency Room Visits – Mental Health ****

**§  **2010 – 1532 visits****

**§  **2011 – 1649 visits****

**o   **Emergency Room Visits – Substance Abuse Disorders****

**§  **2010 – 160 visits****

**§  **2011 – 158 visits****

**o   **Hospital Admissions – Mental Health ****

**§  **2010 -  499****

**§  **2011 -  529****

**o   **Hospital Admission – Substance Abuse Disorders****

**§  **2010--  242 ****

**§  **2011 – 272****

**o   **Indigent Costs for  Mental Health and Substance Abuse Disorders****

**§  **2010 - $672,296****

**§  **2011-  $877,190****

**·        ***County Health and Welfare Directors*

**o   **Cost of Mental Health Holds in one county****

**§  **2010 – $51,008****

**§  **2011 – $84,923****

*Need for school-based behavioral health services* ****

**·        **Number of children with mental health diagnoses has increase
from the 2010-2011 school year to 2012-13 school year****

**·        **87% of respondents indicated that community mental health
services are less than adequate****

**·        **Services needed ****

**o   **More community based services (73% of  respondents)****

**§  **Additional staffing for community based mental health services ****

**o   **Availability and accessibility of community services particularly
for low income families****

**o   **Child psychiatrist who will communicate with schools (87%)****

**o   **School –based mental health and PSR services (60%)****

Eleanor Pepi Downey, MSW, PhD****

Diana Pals, LCPC, M.Ed.****

** **

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