David Lakey, M.D.

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TEXAS MENTAL HEALTH TRANSFORMATION
MOVING FAST FORWARD

• David Lakey, M.D.
• Commissioner, DSHS

Presentation at the Transformation Workgroup
Meeting, Austin, Texas, July 6, 2007
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MENTAL HEALTH TRANSFORMATION THE PROBLEM

• In any given year, one in 4 Texans suffer from a
  diagnosable mental disorder.
• Mental disorders are the leading cause of
  disability for ages 15-44.
• The number of suicides in Texas has increased by
  15 in the last 5 years. This number is 55
  higher than homicides and 134 higher than those
  who died from HIV.
• People with serious mental illness served by the
  public mental health system die, on average, 25
  years earlier that the general population.
• 75 of all persons with mental illness smoke
  persons with mental illness consume 44 of all
  cigarettes nationally.

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BEHAVIORAL HEALTH ISSUES IMPACT OTHER SYSTEMS

• 75 of children placed in foster care have
  parents with behavioral health problems
• 30 of adults in correctional institutions have
  received mental health
• services
• 26 of persons served through vocational
  rehabilitation have behavioral health problems
• 48 of youth served by TYC have serious emotional
  disturbances
• 26 of all hospital discharges are related to
  mental health or substance abuse problems
• 46 of all ER visits have behavioral health
  issues as a basic or contributing factor

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TEXAS MENTAL HEALTH TRANSFORMATION
PROBLEMS ADDRESSED BY TRANSFORMATION

• Fragmentation agency silos continuity of care
• Recovery-focus consumer-orientation
• Disparities in servicesrace/ethnicity
  geographic
• Back-end vs front-end services
• Lack of adequately trained human resources
• Coordination of health and mental health services
• Use of technology/data not optimal

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MENTAL HEALTH TRANSFORMATION THE FEDERAL VISION

• We envision a future when everyone with a mental
  illness will recover, mental illnesses can be
  prevented or cured, mental illnesses are detected
  early, everyone with a mental illness at any
  stage of life has access to effective treatment
  and supports essentials for living, working,
  learning, and participating fully in the
  community.
• The vision of a transformed system is one in
  which Americans understand that mental health is
  essential to overall health mental health is
  consumer and family driven Disparities in Mental
  Health Services are eliminated Appropriate and
  early mental health screening, assessment and
  referral to services occurs excellent mental
  health care is delivered and research is
  accelerated and technology is used to access
  mental health care and information

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MENTAL HEALTH TRANSFORMATION THE TEXAS VISION
KEY COMPONENTS

• Public health / population-based
• All Texans
• Early intervention
• Mental health care
• Appropriate, high quality services
• Quick and easy access
• Coordinated
• Seamless
• Efficient

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TRANSFORMATION VISION

• Persons with mental illness are productive,
  creative individuals
• Children live with their families and families
  receive the supports they need
• Mental health interventions are a societal
  investment
• People living with mental illnesses have choice,
  self determination and hope
• People will have quick easy access
• People will access services that are coordinated
  across agencies so that there is no wrong door
• The mental health system will have an adequate,
  competent workforce
• Mental health, with physical health, is an
  integral part of individual well-being
• Agencies will operate in partnership, not silos

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TRANSFORMATION INITIATIVES

• Partnerships - state agencies, local entities,
  consumers and family members
• Community collaboratives
• Consumer voice
• Workforce development
• Technology / data
• Special initiatives peer support, housing,
  employment, school-based services, criminal and
  juvenile justice, older adults

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ORGANIZATIONAL STRUCTURE TEXAS MENTAL HEALTH
TRANSFORMATION INITIATIVE
GOVERNOR STATE OF TEXAS

• MHT Grant Operating Agency
• DSHS
• Transformation Executive Team
• --------------------------------------------------
  ---
• David Lakey, M.D/Sam Shore TWG Chair
• Ben Delgado, Associate Commissioner
• Luanne Southern, Deputy Commissioner
• Bill Race, Medical Director
• Joe Vesowate, Assistant Commissioner for
  Behavioral Health Services

TRANSFORMATION WORK GROUP Statewide
Transformation Steering Committee CFPS, DADS,
DARS, DSHS, HHSC, TDCJ, TJPC, TDHCA, TEA, TVC,
TWC, TYC, VA VISN 17, Governors Office,
Legislature, Consumer Representatives
Special Initiatives Workgroups
Implementation Team
Vijay Ganju Project Director Ellen Trevino -
DSHS, Program Specialist Steve Eichner, DSHS,
IT Program Manager Valarie Garza,- THI, Consumer
Coordinator Havovi Katki THI, Project
Associate Contractors UT LBJ School of Public
Affairs, UT- School of Social Work, Texas Health
Institute.
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MENTAL HEALTH TRANSFORMATIONDSHS INITIATIVES

• Early Intervention Schools
• Crisis Redesign
• Epidemiology / Data
• Disaster Planning
• Integration with Health Initiatives

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MENTAL HEALTH TRANSFORMATION THE CHALLENGE

• OPPORTUNITIES ACROSS ALL AGENCIES
• How to identify ?
• How to put in a transformation framework ?
• RESOURCES
• Target next legislative session
• MAKING THE CASE
• BUILDING CONSENSUS
• Across Agencies
• State Local
• Stakeholders

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TEXAS MENTAL HEALTH TRANSFORMATION
KEY MESSAGES

• Mental health transformation remains a high
  priority at DSHS
• Mental health transformation will not occur
  because of a federal grant. Everything we do must
  be aligned with transformation
• The vision of mental health transformation must
  be the basis for the design and application of
  programs, policies and resources
• Mental health transformation ultimately will
  depend on partnershipsamong state agencies,
  with local agencies and with consumers, family
  members and advocates
• Mental health transformation is about the lives
  of Texans, not just about systems.