What does the group see as the top five human services needs currently facing Fairfax County residents?

Transcription

1 Thank you for this opportunity to provide input to the Human Services Council through this Needs Assessment process. Responding as a group using the Meeting-on-the-Go prompts, our responses are provided below. Concerned Fairfax is an advocacy group that seeks to convey the concerns of Fairfax residents about needed services for people who live with mental health conditions and substance use disorders. Since its formation in 2012, Concerned Fairfax has identified the following four topics of concern: 1. Expanding the supply of affordable housing for individuals living with chronic mental illness. 2. Expanding the public s awareness of the services available in the community. 3. Youth and families 4. Local law enforcement and criminal justice systems What does the group see as the top five human services needs currently facing Fairfax County residents? 1. Services-enriched housing for individuals living with mental illness. Affordable and supported housing options are extremely limited throughout our community, and are particularly limited for individuals living with a mental health disability. Current work within Fairfax County on affordable housing for physically-disabled and intellectually-disabled residents does not capture the very different and critical housing needs of individuals with severe mental illness. Affordable housing that combines a range of supportive treatment and case management services tailored to the range of disabilities present in this population can increase the ability of these individuals to manage their illness and achieve recovery. Co-located, community-based housing may enable these support services to be delivered more cost-effectively. Concerned Fairfax is very interested in working with the Human Services Council, the Affordable Housing Advisory Committee, and the Fairfax-Falls Church Community Services Board (FFCCSB) to initiate planning efforts for development of services-enriched housing options. We would like to explore the possibility that the Northern Virginia Training Center property might present an opportunity to develop new forms of supported housing for persons with different types and degrees of disability, including persons with early stage and severe mental illness. Page 1 of 10

2 2. Enhanced Systems of Care for Children, Adolescents, and Young Adults. We know that for more than 50% of individuals who develop serious mental illness, symptoms emerge before the age of 14. We seek enhanced, expanded and improved coordination of behavioral mental health support services for youth, as well as for their parents, primary care providers and educators. Early and Periodic Screening, Diagnostic and Treatment (EPSDT) is a comprehensive and preventive child health program of Medicaid services for youth under age 21, mandated by the Social Security Act. We support defining EPSDT objectives for mental and behavioral health of all residents up to age 24. Extending the age to 24 is recommended because the recent Centers for Disease Control study of youth in Fairfax County indicated that in 2013 the suicide rate in the 20 to 24 year old age range was an alarmingly high per 100,000 population, a rate that is double the average of the prior 8 years in Fairfax County and significantly higher than the 2012 national rate of per 100,000 reported in the National Violent Death Reporting System. (CDC, 2014 and 2015). With the goal of creating a coordinated medical home model across youth-serving organizations and health providers, we suggest a need exists for a County-wide Systems of Care plan that recommends roles and communication models for delivering these services in a comprehensive way, engaging primary health care providers, mental health and behavioral health providers, both private and public school systems, local hospitals and county agencies. Issues of health care system capacity and quality need to be carefully reviewed to ensure the necessary therapeutic services for mental and behavioral health needs of our youth are available within the County without delays due to scarcity of providers or acute care hospital beds. Particular attention should be paid to youth transitioning out of high school who are not engaged in further education or work. These young adults may be living with an undiagnosed or emerging serious mental health condition. These individuals may be at higher risk for isolation, substance use, and, without treatment, worsening symptoms of mental illness. Mentoring programs to target these individuals with employment assistance and life coaching may make significant difference in long term outcomes and prevent the need for more intensive disability services in the future. The current IEP requirement for vocational guidance/transition planning is not adequate to meet the needs of these youth. Page 2 of 10

3 3. Expand the capacity, quality, and geographic-accessibility of psychiatric and substance use crisis services, including mobile crisis units, drop-off assessment centers, and acute in-patient stabilization services for children, youth, and adults. Mobile crisis units for children and youth, as well as adult mobile crisis units, are over-subscribed and unable to meet the demand by Fairfax County residents. As a result, when calling for crisis assistance, families frequently find that there are no units that can be dispatched immediately to help their family member experiencing a psychiatric emergency. The response time for this "crisis" service can run to days or weeks. By contrast, if you call for an ambulance for a cardiac emergency, assistance is assured within minutes. We call on Fairfax County to ensure there is parity in the mobile response capacity to respond to mental health emergencies, as is done for other health emergencies. The current levels of acute assessment and in-patient stabilization care services appears to be insufficient to meet critical needs of County residents. Youth and adults who are taken to the emergency department are often discharged home without having reached a level of stabilization, without a care plan and without a timely follow-up appointment with a mental health provider. Because of the nature of psychiatric medications (it can take days or weeks before medications reach therapeutic levels in the body) and the variability of in each individual s response to medication, inpatient acute care may need to continue for a few weeks in order to get these patients stabilized on appropriate medications. Unfortunately, caregivers are challenged with caring for actively psychotic, suicidal family members in their home after the family member has been discharged and before they are medically stable. As a result, the significant efforts and cost expended in getting initial treatment may be quickly undone, rather than providing a foundation for longer term recovery. We believe that a renewed assessment of the capacity, quality and geographic accessibility of crisis and stabilization services is needed. Our current care system should be considered relative to utilization demands, unmet calls for service, County trends in adverse outcomes for residents in need of mental health and substance use services (drug overdoses, suicide rates, homelessness and justiceinvolvement), as well as comparative service-to-population ratios for other areas that are considered well-served. Page 3 of 10

4 4. Expand and improve intensive outpatient treatment and management services for persons with severe mental illness, including expanded use of peer mentoring services. Effective intensive outpatient treatment services meet the client at his or her point in recovery. That starting point may require outreach to a client who is unwilling or unable to leave his or her home. Peer mentoring is well-established, evidence-based, and cost-effective. The mainstream success of peer-run programs is attested to by the fact that there are now thirty-eight states that offer peerspecialist training and accreditation. (Texas Institute for Excellence in Mental Health, 2014). NAMI Northern Virginia, along with other community partners, offers peer programs and services, and has seen firsthand the powerful and long-term effect of peer support in supporting recovery. Peer support and mentoring should be significantly expanded in Fairfax County. 5. Consistent with jail diversion program objectives, implement the priority recommendations contained in the Stepping Up Initiative. On June 3, 2015, the Fairfax County Board of Supervisors adopted a resolution to engage with the process outlined by the Stepping Up! Initiative, a project of the Council of State Governments Justice Center, to reduce the number of individuals with a "mental health condition" in our jail. In the resolution, the Supervisors committed to pursue actions to: Collect and review prevalence numbers and capacity Examine treatment and service capacity Develop a plan with measurable outcomes Implement research-based approaches and Create a process to track progress An initial set of recommendations for services required to support sustained diversion of persons with mental illness from the jail system are included in the attached document, Assessment of Status of Cross-System Mapping: Mental Health, Substance Use & Justice (23 June 2015). Further elicitation of these needs will come with the report of the Ad Hoc Police Practices Review Commission. Jail diversion offers the County a unique opportunity to transfer spending from the jails to mental health services where these expenditures can promote public safety and positive change in the lives of County residents. Page 4 of 10

5 Are there individuals most in need of each of these services? (Please link the individuals to the specific need listed in the response to Question #1). More information is needed about the population of Fairfax County residents in need of mental health services. We are not aware of any current, County-wide population profile of residents living with mental illness and/or substance use disorders. We recommend that there be a census performed broadly across the many County and state agencies serving these populations, including those that are homeless or in jail. Private and non-profit service providers should be included in this data collection effort. The recent addition to the daily police blotter of police calls involving "emotionallydisturbed" individuals is a positive step in capturing new and useful data. [We suggest the term "emotionally-disturbed" be changed to read: "Total mental health related calls for service" to mirror naming of other categories.] A quick brain-storming of metrics that our participants suggested might be helpful in Human Service program planning: Number of persons who contacted CSB services who were turned away after being found ineligible, and disposition of all contacts requesting services Number of hospitalized persons with mental illness who are released homeless (hotel vouchers should not be counted as providing a home) Number of Mobile Crisis Unit calls, average wait time, and disposition of calls Number of persons with mental illness on housing wait lists maintained by CSB Number of persons in County-subsidized affordable housing who are disabled, by the type of disability Number of persons with mental illness who live in rented rooms paid for by others Number of persons who are receiving CSB services who are living with a family member but who otherwise needs housing Number of calls to emergency dispatch regarding individuals with a mental health condition Number of police contacts with persons with a mental health condition Disposition of police calls for individuals with a mental health condition (no pick up, arrested-taken to jail, taken to CSB, etc.) Number of emergency room visits for psychosis Number of persons who receive services through the CSB by diagnosis Number of emergency room visits for suicide attempt/ideation Disposition of emergency room visits for suicidality Number of homeless persons with mental illness and substance use issues Number of in-patient hospital treatment beds available for adults and adolescents needing psychiatric and substance use care Number of students referred for mental health services Number of students referred for substance use treatment Page 5 of 10

6 Number of students with IEPs for emotional, behavioral health, mental health, or substance use, broken down by diagnosis Number of suicides per year, including the number who had been treated for mental illness Number of persons who receive detox services Average duration of incarceration at the Fairfax County Adult Detention Center (ADC) for persons with mental illness Breakdown on charges filed against persons with mental illness who are being held at the ADC Out-of-County placements for adults and juveniles needing acute psychiatric and substance use treatment services (through CSA, CSB referrals, foster systeminvolved, justice-involved, VAA, or other county-served persons) Are there specific geographic areas or communities in Fairfax County where residents are particularly lacking services and resources? As part of the census and population profile report on mental illness and substance use in Fairfax County in combination with the recommended inventory of services and comparison to population service needs, we recommend the geographic accessibility across the County be considered as well. Tennessee publishes an annual report that might be an example of a robust population metrics on mental illness and substance use. Do you know of examples where community members or organizations are helping to address these needs? 1. Examples of services-enriched affordable housing for persons with mental health disabilities Pathway Homes, Fairfax, Virginia The Brain Foundation, Fairfax, Virginia Project Transition, Chalfont, PA Page 6 of 10

7 Community Access, New York City Examples of areas with mature systems of care for youth Belfaire JCB, Cleveland, Ohio (private provider) - San Diego County Behavioral Health Services - Community Circle of Care, Northern Iowa - North Carolina Department of Health and Human Services - Transition services - Additional resources are available and can be provided on request. 3. Examples of innovative psychiatric crisis stabilization services Parachute NYC - Tennessee Department of Mental Health and Substance use Services Examples of intensive outpatient treatment and management services for persons with severe mental illness, including the use of peer mentoring services and social "clubhouses." PRS, Inc - Multicultural Care Centers - Engage Thrive! - Fellowship House Resources - Fountain House Examples of model jail diversion systems and resources. Bexar County, Texas Miami-Dade County, Florida Page 7 of 10

8 Stepping Up Initiative - Council of State Governments Justice Center - List up to 3 three ways that the Fairfax County human services system could be improved. 1. Analyze mental health and substance use services as an integrated line of business across all County agencies. Stream-line fragmentation and consolidate programs within fewer departments and divisions to ensure more cost-effective, better coordinated and higher quality services. We understand that Fairfax County is initiating a Line of Business (LOB) analysis for the first time since Concerned Fairfax is interested in contributing to the discussion around how the LOB exercise can be framed around these issues, especially as these issues are so complex and cross-cut so many diverse agencies and into the private sector. We particularly would like to bring the expertise that NAMI is able to access to help benchmark programs using national models of excellence. We look forward to hearing more about this in the near future. We are interested in discussing what benefit there may be to having a county advisory body on mental and behavioral health that has a broader scope and purview. We are not aware of any single County advisory entity that currently is responsible for dealing primarily and comprehensively with mental and behavioral health issues across all County agencies, departments and services. 2. Implement common/shared data systems for tracking consenting consumers of mental health services across FCPS, Fairfax County agencies, law enforcement, and health care providers. Implement Smart 911. Michigan has a documented interagency Behavioral Health - Treatment Episodic Data System (BH-TEDS) - TEDS_Coding_Instructions_WIP_ _490986_7.pdf Page 8 of 10

9 3. Fairfax County needs a mental and substance use health services portal that is robust, maintained and easy-to-navigate. Development of a consolidated gateway for local private, non-profit, and public services is one of the highest priority needs that exists. Fairfax County residents have tremendous difficulties finding resources to help manage these disabilities. Limited community awareness regarding existing resources is a factor for residents in need of mental health and substance use services and inhibits help-seeking behavior. The Comprehensive Services Act (CSA) program is a good example of an excellent program that suffers from invisibility. Even at Woodson High School in 2015, school administrators, counselors and social workers say that they do not refer families to this resource because they are under the erroneous impression that it only serves families without insurance. All mental and behavioral health programs should be marketed to County residents. Virginia Senior Navigator - Any additional thoughts or comments? Neuropsychiatric disorders are the leading contributor to disability in the United States population, responsible for 18.7% of years lost to illness, disability, or premature death. (NIMH, 2015). The population of affected Fairfax County residents can be roughly estimated using the US Census 2014 population estimate (1,137,538) and the prevalence statistics summarized by NAMI. (NAMI, 2015), (US Census, 2015). Adults affected by mental illness in a given year (1 in 4): 216,312 Adults who live with serious mental illness (1 in 17): 66,973 (such schizophrenia, major depression or bipolar disorder) Adults who live with schizophrenia (1.1%) 22,023 Youth between the ages of 13 to 18 experience severe mental disorders in a given year (1 in 5): 39,158 The number of Fairfax County residents suffering from the leading causes of disability is substantial. Page 9 of 10

10 REFERENCES: Centers for Disease Control. (2014, October). Undetermined risk factors for suicide among youth, ages Fairfax County, VA, EPI-Aid. Centers for Disease Control. (2015). National Violent Death Reporting System (NVDRS). Fairfax County. (2015, June 23). Assessment of Status of Cross-System Mapping: Mental Health, Substance Use & Justice. Ad Hoc Police Practices Review Board - CIT/Mental Health Committee. (attached). National Alliance on Mental Illness. (2015). Mental Illness: Facts and Numbers. National Institute on Mental Illness. (2015). U.S. leading categories of disease/disorder. Website. Texas Institute for Excellence in Mental Health. (2014). Peer Specialist Training and Certification Programs A National Overview 2014 Update. Training-and-Certification-Programs-A-National-Overview-2014-Update.pdf U.S. Census. (2015). Fairfax County Census Quick Facts. Page 10 of 10