Interactive Article: http://www.texastribune.org/library/data/texas-mental-health-shortage/

Thanks to John Debus MD for forwarding this article.  Dr. Debus is a past president of NTSPP and long-time Executive Council member.  

THOUSANDS OF THE MOST SEVERELY AND  PERSISTENTLY MENTALLY ILL AND/OR ADDICTED PERSONS IN NORTH TEXAS FACE CUTBACKS IN TREATMENT (beginning November 1).

Below see three responses from leaders in our public mental health system which were sent to the North Texas Behavioral Health Authority Board  (NTBHA) and which express serious concern about the care and treatment of the mentally ill and addicted in North Texas.  

 1.      ”I reviewed VO’s summary of potential medical expense reductions and the reactions from a couple of other providers.  Its hard for me to judge the merits of any of those until I truly understand the magnitude and source of the financial issues.  I do have grave concerns about the value or wisdom of VO’s recommendations that further reduce our ability to meet the communities’ needs in the outpatient programs.  It only seems to reinforce the downward spiral that increases the number of emergencies, crises and bad outcomes for clients.  In order, however, for us to determine which adjustments are the most productive and least destructive, we must start with a common understanding of the actual financial changes from last year.”    ~ J. Randy Routon, Ph.D., Chief Executive Officer, Life Path Systems 

2.       “NorthSTAR is spending less and less real dollars on out patient community based services as each of the last five or more years have gone by. Five years ago we spent more than four years ago, four years more than three years ago, three years ago more than two years ago. Am I not reading this data correctly? We have a  runaway increase in crisis expenditures. It is time to redesign crisis services with the goal to spend less and less dollars while maintaining current out patient expenditures.”  ~ James W. Williams, Director Mental Health, Lakes Regional MHMR Center

3.         “Respectfully, here’s what NTBHA should do instead of approving the cuts, caps and closings:

Ask  VO to propose a crisis services redesign that spends less money on people in clinics, offices and ER’s and more money on clinicians out in the streets with our police

Ask VO to propose a  homeless/justice redesign that incentivizes VO and its provider network to get people off the streets and keep them out of jail

Ask VO to propose an outpatient services redesign that spends more money on the types of services for children, families and adults that address community priorities identified by BHLT

Help VO tie every redesign idea to a NTBHA or BHLT goal and outcome measure

Assure that the redesigns also significantly cut VO’s costs and so help meet its fiscal goals

Help  VO shift its risk-reward curve toward more risk, thereby offering it a greater chance of the reward of achieving its profit goal, through more utilization review and less fixed rates and “cap” agreements.”

 ~ James G. Baker, MD,MBA  Chief Executive Officer  Metrocare Services

Here are the proposed cuts in an already deficiently funded system which are being proposed by value options (VO), the insurance company that runs our public treatment system:

*Proposed cuts, caps and closings for implementation on November 1st and contingent cuts proposed for March 1st are listed below.  Our models show that the November changes represent a 20% cut in outpatient service dollars available, leaving too few doctors and other clinicians for viable treatment programs.  Access and quality will go down.  Crises will go up — and so will homelessness, ER visits, and jail stays.  The proposed March cuts would reduce outpatient service dollars by another 6%.

Cut doctor, hospital and case worker rates by 5% “across-the-board”
Cap the dollars available for emergency room services (23-hour program)
Cap the cost of hospital care
Close Metrocare after-hour clinic
Close Centro de Mi Salud after-hours
Cut out the supported employment that helps patients find jobs
Cut UTSW funding for psychiatrists in training in public sector settings
Cut funding to Transicare for case management and patient transportation
Close The Club (“Dallas drop-in center”)
Close transitional housing (“rental subsidies”) for patients just released from the hospital
Cut low-intensity outpatient services (SP1) case rate to $70 per month
Cap low-intensity outpatient service duration (SP1) at 90 days per patient
Cut physician-only services reimbursement to $40 per month
Cap the number of patients who can get higher-intensity services (SP2 and SP3), in March
Cut Transicare even more, in March
Cut peer services, in March

North Texas Psychiatrists & Psychiatrists in Training – Contact your state legislators (www.capitol.state.tx.us) and/or the NTBHA Board expressing the need to prevent these cuts and to put treatment back in the hands of doctors with other mental health professionals.

 NTBHA can be reached at:   North Texas Behavioral Health Authority, 1201 Richardson Drive, Suite 270, Richardson , TX  75080.   Attention: Alex Smith – Executive Director and Judge Michael Chitty- President NTBHA Board    Tel. 214-366-9407   fax 214-366-9417  or email: bruckdeschel@ntbha.org.

Thank you,
Edgar P. Nace MD     epnace@gmail.com
NTSPP Immediate Past President, Media Chair, & Co-Chair of the Public Psychiatry Committee 

From NAMI Collin County:

There will be a Town Hall Meeting for the North Texas Behavioral Health Authority (NTBHA) to gather information and input on the Public Sector Behavioral Health program (NorthSTAR) on Tuesday, March 9, from 6 to 8 PM at Custer Road Methodist Church.  The church is located on the west side of Custer Road north of Spring Creek and south of Legacy. 

We hope to see you all there!

Sharon DeBlanc
President NAMI of Collin County

OPEN TO THE PUBLIC  –  Regarding the Public Mental Health System in Dallas County (NorthSTAR)

DALLAS COUNTY  Behavioral Health System Redesign Task Force

Thursday, March 25, 2010  9:30 a.m.

Dallas County Health & Human Services Building    Hickman Conference Room (Room 627)
2377 Stemmons Freeway   Dallas, Texas  75207

Commissioner John Wiley Price, Chair  and Commissioner Maurine Dickey, Vice-Chair

Call to Order – 9:30 a.m.
Reports
(9:35 a.m.) Update on Parkland Study – Josh Flores
(9:40 a.m.) Update on Collin County Study – Dr. des Anges Cruser
(9:45 a.m.) Update on Transfer of Authority to NTBHA – Alex Smith
(9:55 a.m.) Update on NorthStar Psychiatrists Survey  – Dr. Ed Nace
(10:00 a.m.) Update on Goals of Project Transform – Ryan Brown

Legislative Advocacy Plan
(10:05 a.m.) – Legislative Report – Craig Pardue
(10:15 a.m.) – Review Advocacy Template – Janie Metzinger
(10:20 a.m.) – Discuss CJAB Legislative Agenda Item – Ron Stretcher
(10:25 a.m.) – Review/Assign Legislative Visits – Shay Cathey

Next Meeting Date: April 22, 2010

Adjournment

President’s Column from the Winter 2010 NTSPP Newsletter*

            The city of Seattle saved $4 million in hospital, jail and other public services after 95 homeless people moved into one housing project. These 95 people’s visits to hospitals and jails before had cost tax-payers nearly $8.2 million. Other facts concerning the wisdom of providing permanent supportive housing for the chronically homeless can be found in Kim Horner’s Dallas Morning News article of Sunday December 13, 2009. This article focuses on Dallas’s empty Plaza Hotel which a developer has been attempting to make available for permanent supportive housing. The state rejected this developer’s application for tax credits in March 2009, most likely because of neighborhood opposition. As a result, the twelve-story Plaza building remains empty and thousands of people in Dallas remain on the streets or in jail or emergency rooms, incurring costs of tens of millions of dollars, not to mention the human misery.

            Politics and bureaucracy seem to overrule humanitarian and common sense solutions. The American Heritage Dictionary defines bureaucracy as “administration of the government chiefly through bureaus or department staff with unelected officials”; “management or administration marked by diffusion of authority among numerous offices and adherence to inflexible rules of operation”; “an administration in which the need or inclination to follow complex procedures impedes effective action”. The dynamics of a bureaucracy can promote self-protection and self-serving behaviors at the expense of the actual mission of the bureaucracy.

            Can we as individual citizens and physicians, or as a small organization such as NTSPP, have some influence? I think we can but it does require patience, time and study of the issues. Should we not as a medical organization speak more loudly in the interest for permanent supportive housing? I hope that we will and I would welcome your thoughts on what NTSPP could do.

              Along similar lines, the possibility of the transfer of authority for mental health services may arrive in north Texas under the aegis of the North Texas Behavioral Health Authority. It is premature to assume that this is a done deal as the authority for mental health services resides in Austin in the Department of State Health Services. Several of us think it is critical that the authority be local, i.e. with the seven north Texas counties served by the NorthStar system. Should this transfer take place, it will be critical that the North Texas Behavioral Health Authority (NTBHA) have sufficient funds and personnel to do the job. NTBHA has a very strong board under the leadership of Judge Michael Chitty and has recently hired and effective executive director, Mr. Alex Smith. In my opinion, an additional positive step would be the creation of a NTBHA medical director’s position. This has existed in the past but not in recent years. Again, the issue of bureaucracy is relevant as the needs of the chronically and persistently mentally ill and addicted in the north Texas area needs to be a focus of concern and not issues of bureaucratic infighting. The Department of State Health Services allocates 38% of its $2,942,000,000 budget to mental health and addiction services. Yet, the Department of State Health Services does not have a psychiatrist with line authority. There is a psychiatrist on board but the position is more that of a consultant than one with authority to design appropriate services. If a psychiatrist or, more appropriately, several psychiatrists were to be included in the Department of State Health Services organization with real authority; it would behoove our professional organizations to consult with such psychiatrists and help assure that bureaucratic procedures do not impede what needs to be done for the individuals for whom the bureaucracy actually has been created to serve. 

            I believe we, as citizens and physicians as well as a relatively small professional organization, can play a constructive role if we are willing to relate to these issues and interact with the entities which carry the responsibility. What is your point of view?

                                                                        Edgar P. Nace MD,  President NTSPP,   NTSPPpresident@gmail.com

*Note:  All psychiatrists and psychiatrists in training  in the Dallas Area for whom we have email addresses  receive the complete newsletter by e-mail.  Didn’t receive one?  Send your name with degree and email address to NTSPPchapter@gmail.com. 

URGENT NOTICE:  ON THE TABLE IN AUSTIN:  CUTTING 50 beds at Terrell State Hospital (and Rusk, Wichita Falls, San Antonio

REMEDY:   PLEASE e-mail hhs.communications@hhsc.state.tx.us by 5 pm today Friday February 12 with your OPPOSITION.

BACKGROUND  from reliable sources:

HHS held a meeting with little public notice yesterday in Austin to consider ways to meet Gov Perry’s 5% budget reduction including the strategy of cutting beds at Texas state mental hospitals!  TSH is at or above capacity most of the time!  Terrell State Hospital, Rusk, Wichita Falls and San Antonio would ALL lose 50 beds.  (TSH reportedly has always been at or above funded census while other facilities were often not). TSH would have to cut 110 staff or 2 treatment teams.  Consider the present back-up into jails, the Bridge, the streets, the ERs people already experience when TSH is on divert presently.  Now imagine these cuts in play.    PLEASE e-mail hhs.communications@hhsc.state.tx.us by 5 pm today!

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BACKGROUND From Matt Roberts NAMI Dallas:

John Dornheim (NAMI Dallas member and NAMI Texas President) attended the meeting.  He spoke in opposition to the cuts. Joe Lovelace also spoke in opposition to the cuts (Joe is a former NAMI Dallas president, currently working for the sate MHMR association).  Others spoke against the cuts as well. Here are some disturbing stats regarding what these cuts could mean:

- The loss of 50 beds could force Terrell to house Male adolescents with Female adolescents or adolescents could be housed with children. (Bad,Bad,Bad)

- In 2009 Terrell was full (i.e. sending patients away) an astonishing 33% of the time.

-Take away 50 beds and the projection is that Terrell will be full (i.e. sending patients away) 80% of the time.  (That projection comes from the administrator of Terrell State Hospital)

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SAMPLE EMAIL LETTER:

Below is one e-letter from Consumer Family Advocate Mike Katz with further information on this catastrophic proposal.  E-MAIL TODAY by 5 PM to hhs.communications@hhsc.state.tx.us and encourage everyone you know to do so.

From: michael katz
Sent: Friday, February 12, 2010 8:57 AM
To: ‘hhs.communications@hhsc.state.tx.us‘
Subject: Fight cut backs in NorthSTAR Mental Health Services

Gentlemen,

Re: Budget reduction options

Please do not cut back Behavioral Health Care funding/services in NORTHSTAR.

NorthSTAR is an open door system without wait lists that is already providing 17% of the mental health services in TEXAS for just 7% of the Texas funding.

NorthSTAR has proven over and over again its efficiency in giving the best access and treatment for the public mental health dollar in the state.

NorthSTAR has already put in place measures that provide less community outpatient treatment due to the increased numbers of individuals seeking help, mostly due to the economic downturn and the efforts in NorthSTAR in outreach to homeless individuals with mental illnesses and so many caught up in the criminal justice system who need treatment and not incarceration.  The outcomes of these programs are excellent. The potential of budget cut backs will endanger public safety, overburden already over burdened community resources and continue the terrible lives that so many who live with these illnesses sadly endure.

The potential of losing 50 beds at Terrell State Hospital will be a disaster based on current statistics which show that Terrell State Hospital was on divert for 122 of 365 days in calendar year 2009, which is 33.4% of the time. It is projected that with the loss of 50 beds Terrell State Hospital would be on divert up to 80% or more.

If funding is cut it will just mean more expensive treatment costs just down the road for longer periods of time.

Thank You.

Michael Katz

A family member and advocate for persons that live with mental illnesses and their families.

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From NTSPP:  PLEASE SEND YOUR EMAIL TODAY by 5 p to hhs.communications@hhsc.state.tx.us !!!!

For more information on the Austin considerations, write NTSPPchapter@gmail.com and we will send to you.  We respect your time and and mailbox capacity.

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If you are a psychiatrist and not already on our email list, please advise us at NTSPPchapter@gmail.com.