UMASS/AMHERST 3izobt,oisfl 72487 3nweaith of Massachusetts Human Executive Office of Health and Services Department of Mental Health & Adult Child-Adolescent Progress Reports on the Comprehensive Mental Health Service Plan Fiscal Year 1992 December 31, 1992 Digitized by the Internet Archive 2014 in https://archive.org/details/adultchildadolesOOmass COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES DEPARTMENT OF MENTAL HEALTH Adult & Child-Adolescent Progress Reports on the COMPREHENSIVE MENTAL HEALTH SERVICE PLAN Fiscal Year 1992 Submitted as part of the 1993 Block Grant Application (P.L. 102-321) December 31, 1992 Comprehensive Mental Health Plan Progress Report December. 1992 Massachusetts Department of Mental Health TABLEOFCONTENTS TABLE OF CONTENTS INTRODUCTION 1 PART A: IMPLEMENTATION REPORT TOPICS/ADULT PROGRESS REPORT 7 REQUIREMENT #l: Establishing and implementing an organized community-based system of care for individuals with serious mental illnesses 9 REQUIREMENT #ll Specifying quantitative targets to be achieved in the implementation of such system, including numbers of individuals with serious mental illnesses residing in the areas to be served under such system 21 REQUIREMENT Describing available services, available treatment options, and available resources (including Federal, State and local public services and resources and to the extent practicable, private services and resources) to be provided to individuals with serious mental illnesses 2 9 REQUIREMENT #IV: Describing health and mental health services, rehabilitation services, employment services, housing services, educational services, medical and dental care, and other support services to be provided to individuals with serious emotional and mental disorders with Federal, State and local public and private resources to enable such individuals to function outside of inpatient or residential institutions to the maximum extent of their capabilities 4 1 REQUIREMENT #V: Describing the financial resources and staffing necessary to implement the requirements of such plan; including programs to train individuals as providers of mental health services, and the plan emphasizes training of providers of emergency health services regarding mental health 4 9 Comprehensive MentaJ Health Plan Progress Report December. 1992 TABLEOFCONTENTS Massachusetts Department of MentaJ HeaJth REQUIREMENT #VI: Providing activities to reduce the rate of hospitalization of individuals with serious mental illnesses 6 1 REQUIREMENT #VII : (A) Requiring the provision of case management services to each individual with a serious mental illness in the State who receives substantial amounts of public funds or services. (B) Providing that the requirement of sub-paragraph (A) will not be substantially completed until the end of fiscal year 1993 6 7 REQUIREMENT #VIII: Providing for the establishment and implementation of a program of outreach to, and services for, individuals with serious mental illnesses who are homeless 71 REQUIREMENT #X: Describing the manner in which mental health services will be provided to individuals with serious mental illnesses residing in rural areas 77 REQUIREMENT #XI: Containing an estimate of the incidence and prevalence in the State of serious mental illness among adults and serious emotional disturbance among children 7 9 PART B: IMPLEMENTATION REPORT TOPICS/CHILD-ADOLESCENT PROGRESS REPORT 81 REQUIREMENT #l: Establishing and implementing an organized community-based system of care for children with serious emotional and mental disorders 8 3 Comprehensive Mental Health Plan Progress Report December. 1992 Massachusetts Department of Mental Health TABLEOFCONTENTS REQUIREMENT #11 Specifying quantitative targets to be achieved in the implementation of such system, including numbers of individuals with serious mental illnesses residing in the areas to be served under such system 91 REQUIREMENT #111: Describing available services, available treatment options, and available resources (including Federal, State and local public services and resources and to the extent practicable, private services and resources) to be provided to individuals with serious mental illnesses 97 REQUIREMENT #IV: Describing health and mental health services, rehabilitation services, employment services, housing services, educational services, medical and dental care, and other support services to be provided to children with serious emotional and mental disorders with Federal, State and local public and private resources to enable such individuals to function outside of inpatient or residential institutions to the maximum extent of their capabilities, including services to be provided by local school systems under the Individuals with Disabilities Education Act 105 REQUIREMENT #V: Describing the financial resources and staffing necessary to implement the requirements of such plan; including programs to train individuals as providers of mental health services, and the plan emphasizes training of providers of emergency health services regarding mental health 111 REQUIREMENT #VI: Providing activities to reduce the rate of hospitalization of individuals with serious mental illnesses 117 REQUIREMENT #VII : (A) Requiring the provision of case management services to each individual with a serious mental illness in the State who receives substantial amounts of public funds or services. (B) Providing that the requirement of sub-paragraph (A) will not be substantially completed until the end of fiscal year 1993 1 21 Comprehensive Mental Health Plan Progress Report December. 1992 Massachusetts Department of Mental Health TABLEOFCONTENTS REQUIREMENT #VIII: Providing for the establishment and implementation of a program of outreach to, and services for, individuals with serious mental illness who are homeless 125 REQUIREMENT #IX: In the case of children with a serious emotional disturbance, providing for a system of integrated social services, educational services, juvenile services, and substance abuse services that, together with health and mental health services, will be provided in order for such children to receive care appropriate for their multiple needs (which includes services provided under the Individuals with Disabilities Education Act) 129 PART C: STATE MENTAL HEALTH PLANNING COUNCIL 135 Members Affiliations APPENDIX FY'93 Budget Overview Revenue Comparison Chart Multi-Cultural Programs DMH Policy #87-3 (Case Management) DMH Policy #89-3 (Priority Clients) Comprehensive Mental HealthPlan Progress Report December. 1992 Massachusetts Department of Mental Health Introduction INTRODUCTION The September, 1991 Progress Report outlined the Massachusetts Department of Mental Health's (DMH) commitment to the planning and development of a consumer driven, comprehensive system of care for seriously mentally ill adults and seriously mentally and severely emotionally disturbed children and adolescents. DMH's ill goals for accomplishing this task were embodied in the concepts of public Managed Care, Accountability and Partnership. DMH has made remarkable progress toward achieving a community based system of care since the inception and implementation of the P.L.99-660 planning process. DMH is presently engaged in a comprehensive reorganization of its service system. This reorganization is aimed at shifting resources from state hospital inpatient care to an expanded community based service system for adults, children and adolescents that is responsive to the preferences and needs of its recipients and removes barriers to access often experienced by communities of color, multicultural and linguistic minority groups. It has involved hundreds of consumers, family members, providers, advocates and professionals as well as DMH staff Public Managed Care, the goal of DMH's initiative to restructure its system, is predicated on the building of a community based system of care and an anticipated reduction in DMH utilization of inpatient care. has utilized facility closure and consolidation, privatization of acute inpatient care and collaboration with the Medicaid division of the Department of Public Welfare's mental health and substance abuse managed care initiative as the mechanisms to achieve its goal. The Department closed two of its seven (adult) state hospitals in FY*92 A third will be closed in May, 1993 A total of 543 new residential beds were added during the year to expedite the closure and consolidation process. In addition, the Governor's Special Commission recommended closing the Gaebler Children's Center, the only state 1 Comprehensive Mental Health Plan Progress Report December, 1992 Massachusetts Department of Mental Health Introduction hospital for children 14 and under, in favor of community-based alternatives. This was accomplished on September 30, 1992. These closures enable DMH to redirect state hospital funding to the development of acute inpatient care (for adults in general and private psychiatric hospitals), intensive residential treatment (for adolescents), community residential, case management, day and other home-based and community support services, and to close facilities that are often removed from the locus of community services and supports. In particular, the transfer of acute inpatient care from state to community hospitals is intended to reduce somatization of the seriously mentally by integrating mental health care into the general health care system. ill Furthermore, the Department intends to take the necessary steps to ensure that all remaining state hospitals, community mental health centers and other eligible community programs receive and/or maintain certification and accreditation The pace and magnitude of this change are unprecedented for the Commonwealth. The development of public managed care will only be as effective as the organizational context within which it is incorporated. Therefore, the community based service system is not only being expanded, but it is also being reorganized into a Comprehensive Community Support System (CCSS) design, in each "natural service area" of the state This initiative, described in the last P.L. 99-660 Progress Report, resulted in the Commissioner's approval of identified "natural service areas" in eight of the nine DMH Areas The CCSS design will enable the various system components to be better coordinated and consumer driven, will facilitate linkages among the various system components and is expected to be more flexible and responsive to consumer and family need, populations with special service needs and multicultural and linguistic minority groups Through the CCSS, the Department will be able to manage the entire array of services consumers need and receive. In order to ensure accountability, accessibility - including access for cultural and lingustic minorities - quality and cost effectiveness, the Department is developing a comprehensive quality 2