Program B: Community Mental Health

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Program B: Community Mental Health

Program Authorization: R.S. 28:1-723

PROGRAM DESCRIPTION

The mission of the Community Mental Health Program is to provide an integrated, community-based system of mental health services that is based on the principles established in Plan 2002, the OMH Strategic Plan, and is accessible to adults, children and youth with serious mental and emotional disorders, or at risk of such disorders and enable them to function outside of inpatient or residential treatment institutions to the maximum extent of their capabilities.

The goals of the Community Mental Health program are:

1. Operate a system of care in 58 of 64 parishes through the provision of managed care services, psychiatric rehabilitation, acute stabilization and acute inpatient services through an organized system of regional administration units.

2. Ensure services are in accord with Plan 2002.

The Community Mental Health Program includes two activities: Community and Family Support, and Hospital Acute Inpatient Psychiatric Units.

OBJECTIVES AND PERFORMANCE INDICATORS

1. In FY 1998-99, the Community Mental Health Program, will establish and maintain a comprehensive, integrated community-based system of mental health care to meet the needs of adults with serious mental illness and children with serious emotional disturbance, thereby reducing the need for long-term inpatient treatment in FY 1998-1999.

1 Includes all means of financing.

2 Includes all means of financing.

3 Includes all means of financing.

4 Office of Mental Health Electronic Data Book, Regional Service System Statistics FY 96-97, LA Department of Health and Hospitals, Office of Mental Health. Does not include CAHSD as well as JPHSA for FY 98-99 column.

5 Office of Mental Health Electronic Date Book, Regional Service System Statistics FY 96-97, LA Department of Health and Hospitals, Office of Mental Health. Does not include CAHSD as well as JPHSA for FY 98-99 column.

6 Office of Mental Health Electronic Data Book, Regional Service System Statistics FY 96-97, LA Department of Health and Hospitals, Office of Mental Health. Does not include CAHSD as well as JPHSA for FY 98-99 column.

7 The key indicator, included in Act 18, was replaced with two more accurate performance indicators.

2. In FY 1998-99, the Community Mental Health Program will increase the percentage of persons in Priority Service Group who receive community-based services to 95%.

1 Priority Service Group is comprised of persons in the SMI, Acute, Aftercare, and Judicial Service Groups.

2 These indicators were revised to more accurately reflect performance.

3. In FY 1998-99, the Community Mental Health Program will bring the Louisiana per capita expenditure for community-based services closer in line with the United States per capita expenditure for community-based services of $24.24. (Note: This figure was obtained from Funding Sources and Expenditures of State Mental Health Agencies: Supplemental Report Fiscal Year 1993, NASMHPD Research Institute, Inc., March 1996.)

1 Total community services appropriation divided by total persons served. Calculated using the costs of all community-based services except acute unit cost.

2 Total acute unit appropriation divided by patient days in acute units.

3 Total community services expenditure divided by 2,992,704. The population of Louisiana was taken from the Population Census U.S. Bureau of the Census, 1990 census of Population and Housing, Summary Tape File IC, as approved by the Louisiana State University Data Center.

4. In FY 1998-99, Community Mental Health Program will maintain appropriate licensure and/or certification at all community mental health centers.

RESOURCE ALLOCATION FOR THE PROGRAM

SOURCE OF FUNDING

The Community Based Program is funded with general fund, interagency transfers, fees and self-generated revenues, and federal funds. Interagency transfers include Title XIX reimbursement for services provided to Medicaid eligible patients, and interagency transfers from the Health Care Services Division for mental health's operation of the acute psychiatric inpatient units at various locations in the state. Self-generated revenue represents reimbursement from ineligible patients with insurance or personal payments based on a sliding fee scale and for meals served to employees and visitors. Federal funds are Title XVIII reimbursement for services provided to Medicare eligible patients.

ANALYSIS OF RECOMMENDATION

GENERAL FUND	TOTAL	T.O.	DESCRIPTION

$52,067,281	$78,971,953	918	ACT 18 FISCAL YEAR 1997-1998

			BA-7 TRANSACTIONS:
($38,976)	($38,976)	0	Transfer general fund to Jefferson Parish Human Services Authority (BA-7 #269)for Mental Health Services
$0	$0	0	None

$52,028,305	$78,932,977	918	EXISTING OPERATING BUDGET - December 10, 1997

$2,386	$2,386	0	Equipment/Major Repairs Adjustment(s) (Non-recurring: -$571,386; Replacement/New: +$569,000)
$542,877	$542,877	0	Annualization of 1997 -'98 Merit Pay Adjustment(s)
$553,735	$553,735	0	1998 -'99 Merit Pay Adjustment(s)
($1,509,698)	($1,509,698)	0	Attrition Adjustment(s)
$0	($22,260)	0	Retirement Rate Adjustment(s)
$204,776	$284,412	0	Risk Management Adjustment(s)
($17,297)	($17,297)	0	Maintenance of State-owned Buildings Adjustment(s)
$0	($420,617)	0	Transfer of Risk Management Funds that were taken in FY 96/97 to Greenwell Springs Hospital
$0	$81,040	0	Increase in funding for (12) Additional Retirees

$51,800,312	$78,422,783	918	TOTAL RECOMMENDED

($227,993)	($510,194)	0	DIFFERENCE (TOTAL RECOMMENDED AND EXISTING OPERATING BUDGET)

The total means of financing for this program is recommended at 99.4% of the existing operating budget. It represents 78.3% of the total request ($100,165,537) for this program. The major changes include: reducing risk management premiums by $284,412; transferring $420,617 of interagency transfer means of financing to Greenwell Springs Hospital to replace risk management funds that were taken in FY 96/97; and increasing interagency transfer means of financing due to an increase of twelve (12) additional retirees in FY 98/99. The changes should have no significant impact on the delivery of these services.

PROFESSIONAL SERVICES

$3,322,726		Contracts to provide Psychiatric services to Mental Health Centers and Acute Unit patients including psychiatric evaluation, medication management, patient staffing, formation and authorization of treatment plans and provide consultation to staff members as needed
$444,065		Contracts to provide Psychological services to Mental Health and Acute Unit patients including psychological testing, psychological profiles and psychological consultation to members of the staff
$897,347		Contracts to provide diagnostic and treatment services to patients, conduct medication evaluations, approve treatment plans, complete medication orders and consultations to staff members as needed
$242,899		Contracts to provide Other Medical Services including pharmacists, lab services, therapists, and dietitian services.
$318,920		Other Professional Services contracts including computer consultants and mental health training consultants
$7,136		Provision of registered nurses to mental health and acute units

$5,233,093		TOTAL PROFESSIONAL SERVICES

OTHER CHARGES

$1,186,319		Contract provides structure and psychosocial skills training that contributes to maintaining the stability of the clientele. In intensive day programs, people with serious mental illness are provided training to increase daily living skills (e.g., food preparation, personal hygiene, money management), social skills which enhance interpersonal relationships with landlords, employers, family and friends and pre-vocational skills

$462,657		Contract provides support, education and services to families of children/youth with serious emotional disturbance for the purpose of keeping children in school and in their own home rather than in institutions. Services include routine respite, summer programs, parent support groups, parent education, parent skill training, help lines and transportation

$1,085,916		Contracted services are used to assist mental health consumers in successfully living in the community, including assisted housing and other supported services (e.g., rent, subsidies, board and care, supportive housing, transition from group homes, vocational and employment services and respite care)

$931,710		Contracted services provide for crisis intervention via public access to 24-hour crisis line, mobile crisis response service in Orleans and Jefferson parishes, crisis interventions at each Mental Health Center during business hours, Acute Care programs in general hospitals, efficient and effective crisis screening and care with the crisis intervention unit (CIU) at Charity Hospital in New Orleans, increase in number of programs in Region 1 and community education about other available crisis services


$274,867		Informational/Educational, family and consumer run support services. These programs help families and consumers help each other through existing use of natural support systems, thus limiting their reliance on professionally delivered services

$1,479,211		Residential Group Homes service provides a transitional environment normalizing therapeutic with a vocational focus. The overall goal is to provide chronically mentally ill persons a safe and secure structured environment in which they can practice the pre-vocational skills (self care, independent living skills, socialization principles, managing their money) necessary for maintenance, eventual vocational training and/or remunerative occupation. This activity is for individuals requiring a higher degree of structure and supervision


$453,542		Residential Supervised Apartments provide transitional living arrangements safe and secure in purpose normalizing therapeutic with a vocational focus. The overall goal is to provide chronically mental ill persons a secure environment in which they can practice the pre-vocational skills. This activity is for individuals with less need of staff and supervision

$461,744		Case Management/Mental Rehabilitation Services assure that seriously mentally ill youth, adults and their families are receiving the full array of appropriate and needed services offered by area mental health, mental retardation and substance programs as well as other medical, social, vocational, educational, residential and support services. It provides individualized support and advocacy and promotes independence by empowering consumers to do things for themselves


$501,500		State-wide activities fund planning council meetings, computer software equipment related to production, provides for special research and evaluation initiatives and provide for staff training and special projects
$963,973		Special contracted service fund a variety of services needed to assist mental health consumers in successfully living in the community including assisted housing and other supported services (e.g., rent subsidies, board and care, supportive housing, supervised apartments, home settlement, transition from group homes, vocational /employment services, respite care)
$161,236		Provides for funding of positions in each region and the state office level to be filled by consumers of mental health services to provide for consumer input into the planning, development and implementation of self-help alternatives and to assure consumers participation in each regional mental health program. Also funds training and support of consumer employees (includes 14 positions)

$179,096		Provides funding for consumer-run drop-in centers in each region providing a place for consumers to go get mail, develop social skills, initiate job searches, etc.

$350,000		Contract provides Special Population Services funding for community residential forensic pilot project to provide intensive after care and support and provides for computer and educational video programs for enhancing services to special populations
$20,000		Equips Community Mental Health Clinics with educational videotapes and TV/VCR's, provides for supplies and activities, access to mental health services, day programs and drop-in centers via vehicle rental/leasing, bus tickets, taxi fares, driver reimbursement, etc.
$291,500		Provides support for CONFIDENT (Consumers Organized for New Freedoms Involving the Development, Education and Needs of Themselves) through state and local chapter development and operation of state organization. Provides for member training through annual statewide conference, participation in national meetings and conferences, training material, etc. Provides funding for administrative support for the Louisiana Alliance of Mentally Ill (LAMI) through state and local chapter development


$875,171		Crisis Management funding for community based, intensive in-home and mobile crisis and respite programs serving children/youth in six regions
$818,240		Family Support/Wraparound Services contracts provide for support, education and services to families of children/youth with serious emotional disturbance for the purpose of keeping children in school and in their own home rather than in institutions. Services are provided through contracts with private, non-profit agencies for parent education, parent skill training, help lines and transportation

$371,574		Rural System of Care is a pilot project to provide a wraparound program in Lafourche Parish for children ages 10-13. The program, based on the assertive community treatment model, is designed to provide a 24-hour, 7-day-a-week interdisciplinary team approach to integrated, comprehensive services (clinical, support and case management). Services which are provided are designed to prevent hospitalization and assist children and their families in successful community living


$766,776		This activity, per Act 378 of 1989, provides monthly general fund cash subsidies to families to keep emotionally disturbed/disordered children in the home to prevent out of placement, i.e., hospital, foster home or group home. Approximately 242 families receive $258 per month to provide the extra services required because of their child's handicapping condition

$300,000		Project for Assistance in Transition from Homelessness is a program to provide mental health services to the homeless or risk of homelessness population
$428,190		The Acute Care Psychiatric Inpatient Units provide psychiatric, psychological and medical services in compliance with all licensing and accreditation standards, to meet the individualized patient care needs of adults and adolescents, in the State of Louisiana, who need a level of care that must be rendered in an inpatient setting. These utilities address the need for inpatient treatment, in a less restrictive environment, shorter term, more cost effective setting than in the state longer term care psychiatric facilities. Additionally, the units are designed to be community based, with a close linkage to community services and resources, and greater degree of continuity of care for the patient

$12,363,222		TOTAL OTHER CHARGES

		Interagency Transfers:
$21,689		Payments to the Division of Administration for maintenance of state-owned buildings
$9,500		Reimbursement to Central LA State Hospital for routine maintenance and laboratory fees
$1,413,805		Professional services (psychologists, physicians, interns, etc.) provided by LSU Medical School to the Mental Health Clinics and Acute Psychiatric Units
$12,855		Payments to the Department of Health and Hospitals or Division of Administration for printing of forms and documents required during the year such as letterhead, stationary and envelopes ($9,349) and purchase of medical supplies by the Regional pharmacies ($3,157)
$55,510		Laboratory fees provided by University Medical Center to Acadiana Mental Health Center
$7,594,018		Capital Area Human Services District - to perform the functions which provided community based services and continuity of care for the diagnosis, prevention, detection, treatment, rehabilitation, and follow-up care of mental and emotional illness in the CAHSD
$46,050		Payments to the Department of Health and Hospitals or Division of Administration for purchase of medical supplies by the Regional pharmacies

$9,153,427		TOTAL INTERAGENCY TRANSFERS

ACQUISITIONS AND MAJOR REPAIRS

$569,000		Recommended level of funding for the replacement and repairs of obsolete, inoperable or damaged equipment and buildings

$569,000		TOTAL ACQUISITIONS AND MAJOR REPAIRS

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