Behavioral Health Management

Ha, Ha, Ha, Ha, Ha

2011-10-05T16:59:00.000-07:00

There has been a recommendation come out of one of the task forces formed to precipitate the integration of the Mental Hygiene Administration and the Alcohol and Drug Abuse Administration that is surely causing apoplexy for Community Behavioral Health Association members. The Regulation task force has recommended that regulations for mental health and substance abuse providers be scrapped in lieu of mandating that providers secure accrediting from national accrediting bodies like CARF or JCAHO.

A mandate was proposed fifteen years or so ago and CBH fought it because members were afraid of the costs of getting accredited. The state backed off (unfortunately) and only a three or four mental health agencies actually moved forward with accreditation. The dearth of accreditted organizations in Maryland should be an embarrassment to the system but nobody has seemed to mind, even when systems as fragile as North Carolina has mandated accreditation.

A lack of a mandate certainly has been part of the reason ford Maryland's mental health system's mediocrity.

If the decision to mandate accreditation succeeds it will have the following positive effects:

The Office of Health Care Quality will be able to focus on complaints, incidents, emergent quality of care issues instead of routine regulatory reviews of providers.
Providers will be held to significantly higher quality of scrutiny by external accrediting organizations.
There will be more focus on clinical and rehabilitation outcomes rather than process.
There will be an intensive focus on continuous quality improvement that will benefit persons served.
Important advocacy issues like the ongoing moratorium on the development of affordable housing will be revealed to external surveyors, hopefully, prompting change.

But CBH members must be shaking in their boots at the possibility. Will CBH make another run at promoting mediocrity by opposing an accreditation mandate?

We will see, but all I can do right now is LMAO!

Shameful

2011-10-05T16:44:00.000-07:00

I had the good fortune of attending the United States Psychiatric Rehabilitation Association Advocacy ceremony in Washington, DC a few weeks back. The association uses this opportunity for members to visit legislators on key issues important to rehabilitation and recovery and also to honor national legislators who have contributed to the well-being of individuals in recovery. One of those individuals being honored that evening was Maryland's own Senator Ben Cardin.

Unfortunately, it was very embarrassing for me and should be embarrassing for all Marylanders. There were only four Marylanders at the ceremony. I was one of them and the CEO of USPRA was one of the others.

Shame on the Community Behavioral Health Association for their lack of attendance. This is just another example of how CBH has abandoned psychiatric rehabilitation in the State of Maryland and how impotent it is in advocacy for the practice and for people in recovery.

I did the best I could to congratulate Ben and try to be an ambassador for the state's psychiatric rehabilitation efforts but I was fuming.

Is crawling up the butt of the Mental Hygiene Administration and playing Neville Chamberlain when it comes to tough issues more important for CBH than honoring those who have championed our causes?

No wonder we have such a mediocre mental health system. We've seen the enemy and it is us.

Maryland Medicaid Cuts

2011-08-03T15:45:00.000-07:00

If it didn't impact the lives of Marylanders most vulnerable, the recent request for comment by the Maryland Department of Health and Mental Hygiene (are we ever going to move two centuries forward and change that name) would be laughable.

The Mental Hygiene Administration, itself, has been the cause of hundreds of millions of dollars iof unecessary expenses to the state Medicaid budget. Some examples:

A ten-year moratorium on the development of affordable housing opportunities by community mental health providers that has ultimately driven thousands of individuals to emergency room visits.
An intense implementation focus on expensive, evidence-based practices that have not been proven to be efficacious in the state and cost the state tens of millions of Medicaid dollars.
The reduction of psychiatric rehabilitation day program visits for people with severe psychiatric disabilities that has minimized their ability to learn social skills that help them integrate into the community.

These are just a few examples of how an administrative, void of strategic vision, has caused Medicaid expenditures to escalate over the last decade.

Unfortunately, the state provider association and the consumer "advocacy" organization, which is in the pocket of the Mental Hygiene Administration, have been largely ineffective in pushing for the changes that are needed to positively impact the State's Medicaid budget. If the State is truly interested in cutting costs in the Medicaid budget it needs a significant change in the vision, or lack there of, of the leadership of the Mental Hygiene Administration.

2011-07-27T20:33:00.000-07:00

I just returned from an open house for a new affordable housing initiative in Baltimore City which is a shining example of the possibilities for creating housing for people with psychiatric disabilities. No one from the Maryland Mental Hygiene Administration attended the event. Why?

Because the administration has failed to understand that affordable housing is an integral part of the recovery process for people with psychiatric disabilities in Maryland. Instead, they have extended a moratorium on the development of affordable housing by mental health providers that has been in effect since 2001.

Despite the best efforts of small housing development providers like the one I attended today, the effects of the moratorium have been ruinous. This is not to mention the advocacy efforts of the state's consumer "advocacy" organization, in the pocket of the Mental Hygiene Administration, who has advocated for the moratorium, yet benefitted from state funding to develop their own housing.

Although it cannot be scientifically connected, emergency room utilization by people with psychiatric disabilities has increased over the decade.

The prohibition, initially based on financial, potential liability, has come back to bite the entire system. The state is looking to cut $40 million dollars in Medicaid savings would do well to look at the major reason for repetitive emergency room visits- housing.

MD budget hearings

2011-02-10T16:43:00.000-08:00

I testified at the Senate budget hearing for the Alcohol and Drug Abuse Administration today and the committee was sympathetic and attentive.

What was really interesting, though, were the folks waiting to testify on the Mental Hygiene Budget. You had the lapdog provider association that has, for years, been "Chamberlainesque" in their dealings with the Mental Hygiene Administration for years, failing to protest obvious state violations of the Supreme Court Olmstead Decision and On-Our-Own members, who have forgotten the face of their fathers, don't come close to representing the vast majority of people with psychiatric disabilities and actually advocate for violations of the Olmstead Decision, specifically the moratorium on the development of affordable housing for people with psychiatric disabilities. This, at the same time, as they reap state monies to develop housing themselves. Hypocrites and violators of civil rights at the same time.

Ultimately, though, the problem lies with a lack of vision and leadership at the state level -- state leaders who pat providers on the head for not making waves or filing legitimate civil rights law suits or lining the pockets of "consumer" leaders who pretend to have the best interest of the masses with severe mental illnesses in mind.

In the richest state in the Union can we afford to have these perennial games go on? I would hope not.

But my hope is lagging.

USPRA

2010-06-29T18:08:00.000-07:00

I recently returned from the United States Psychiatric Rehabilitation Association annual conference in Boise, ID. Aside from some representatives from MD VA facilities, I was the only Marylander at the conference.

I think that this is a clear sign that the State of Maryland has abandoned any pretense of wanting the practice of psychiatric rehabiliation in the state.

The Mental Hygiene Administration has continually eschewed the acceptance of the CPRP certification for practitioners, effectively thumbing its nose at quality practice in the field.

The Mental Hygiene Administration has blindly pursued the implementation of expensive "evidenced-based practices" such as assertive community teams and supportive employment, spending scarce resources to benefit the few and ignoring the masses.

The Mental Hygiene Administration is in its 9th year of a moratorium of the development of affordable housing by community mental health providers, thereby denying hundreds, if not thousands, of Marylanders from affordable housing opportunities but denying them the opportunity to learn important living skills in the rare opportunities the get for housing.

The Maryland Mental Hygiene Administration, by forsaking strategies to implement and sustain psychiatric rehabilitation, has demonstrated that it is not only strategically bankrupt, but in the case of its housing policy, morally bankrupt, as well.

They woke up?

2010-01-22T14:57:00.000-08:00

Apparently, the forced closure of the Upper Shore Hospital in Maryland's eastern shore has caused enough shock to the Maryland Mental Hygiene Administration that they have quietly abandoned their nine-long year moratorium on the development of affordable housing opportunities for people with psychiatric disabilities.

In preparation for the closure of the hospital, contracts have been let for crisis services, intensive intervention services and residential services for those who will leave the hospital.

Those supports have been tested and available for decades. MHA has consistently chosen not to support crisis residential services at adequate rates and supports for individuals in new residential programs.

The failure of the Mental Hygiene Administration to support these established efforts has cost taxpayers, probably, hundreds of millions of dollars and more importantly, an enhanced quality of life for persons served.

Shame on the Mental Hygiene Administration in Maryland for waiting until a budge crunch forced your hand. Shame on the advocacy community for not forcing your hand earlier.

Congratulations to those individuals who will get an opportunity to be full contributing partners in their community because of the closure of the Upper Shore Hospital. You should well-consider your legal options against the state because of their lack of vision.

2009-10-27T15:40:00.000-07:00

I went to a funeral of a friend today. He was 53 years old and died of pneumonia. He also suffered from a chronic, severe mental illness. His death was an avoidable tragedy in more than one way.

He was certainly a poster child for the federal study released two years ago that announced that individuals with severe and persistent mental illnesses tend to die 25 years earlier than those without the illnesses.

That fact is one of the most significant tragedies associated with my friend's death because it is indictment of the nation's and Maryland's health system. Integration of behavioral and somatic health happens rarely in our country and that is a signficant problem and that is why so many people with severe mental illnesses die so young.

I actually have colleagues who express caution in rushing to integrate the care, fearing that mental health care will get short shrift in an integrated system. Mental health care has gotten short shrift in a fragmented system! Come on! People are dying.

My friend actually got better mental health care than most in this country. He lived in a group residence with 24 hour support. He had a good medical daycare program to go to five days a week. He had case management support and access to clinical care.

Would that he had regular access to primary care instead of having to go to the emergency room repeatedly when his COPD became problematic.

My colleagues need to get over their paranoia and push for a system of integrated care for individuals like my friend. Twenty-five years is a crime!

Evidenced Based Practice

2009-10-22T18:13:00.000-07:00

This anonymous quote was posted on the OpenMinds site today and is indicative of the lack of vision, practicality and insight of the Maryland Mental Hygiene Administration:
"In our clinic, we are carrying out an EBP—family psychoeducation—and the reviewers who have deemed our practice to have high fidelity to the model focus entirely on process rather than on outcomes. We have been using a unique approach to co-occurring disorders that (in our fairly primitive field research) indicates between 40% and 50% one-year sobriety and stability rates for all who start the program. However, it will not meet the Maryland standard for an EBP, since it appears to be going to a model for which I can find no longitudinal outcome data whatsoever."

This is pretty typical of the MD MHA, which doesn't seem to have the capacity to devine what is in the best interest of Marylanders but must rely on EBP's that haven't been proven here. Millions of dollars have been wasted because of the lack of analytic capacity in the Administration.

Housing development has suffered, critical daily supports have been lost, cost-shifting to jails, emergency rooms and homeless shelters has been rampant because of exceedingly poor policy decisions.

Granted, a laudable, decades late, decision to close Upper Shore Hospital has been made and a decision to close 80 beds at Spring Grove Hospital Center has also come to fruition, but with such tardiness that no one will be able to judge the impact on the quality of lives of people with severe psychiatric disabilities in the state.

Clearly, MHA needs an opthalmic correction for its vision.

Housing Affordability

2009-09-22T08:20:00.000-07:00

According to 2008 US Census data more than 40 million Americans spent 30% or more of their household income on housing costs, 600,000 more than in 2007. This is despite the fact that housing prices dropped by 20%.

Renters were hit hardest by the changing financial climate. The number of renters swelled by 900,000 in 2008 and supply struggled to meet demand. The market clearing price for rental property escalated.

Obviously, the poor and disabled are hurt worst during a period like this and more and more of the poor and disabled are getting pushed out of the housing market.

Despite that fact, the Maryland Mental Hygiene Administration is about to enter the ninth year of a freeze on the development of affordable housing for people with psychiatric disabilities in the state. It is true, a few million dollars was allocated this year to develop housing in Baltimore City but this is a drop in the bucket compared what is needed statewide.

In contrast, a model program in Florida, yes Florida, Boley Centers in Pinellas County has developed hundreds of new beds for people with psychiatric disabilities since the turn of the century and the state mental health authority in Tennessee, yes Tennessee, has developed thousands of beds in the same period.

Come on, Maryland, get your policy act together!

34th USPRA Conference

2009-07-02T12:08:00.000-07:00

I just returned from the 34th USPRA conference in Norfolk, VA. Despite the devastation wrought by the economy on the mental health field, over 900 folks from as far away as Australia showed up to learn from thought leaders and peers in the field.

The agenda was overflowing with creative workshops and institutes related to recovery, employment, peer support and other scrumptious topics for practitioners.

Of course, Maryland was not represented, either by presenters or attendees. That's to be expected given the dearth of creativity in the Maryland system.

Next year -- June 13-17 in Boise, Idaho (it's a long story). Put it on your calendar and view it as an investment, not an expense.

Growing Number of Mentally Ill Inmates

2009-06-24T18:11:00.000-07:00

In "The Gazette of Politics and Business" June 12,2009 there is a front page article entitled "Growing numbers of mentally ill inmates struggle with inadequate treatment". A therapist at the Montgomery County Correctional Facility talked about her facility being a "revolving door. When inmates are released back into the the community, there often is not a strong support system of family or public programs to help them, and they revert to their prior behavior."

One can only point to the lack of vision and failed policies of the Maryland Mental Hygiene Administration over the last two decades. The Administration has held in check a moratorium on the development of affordable housing for individuals with psychiatric disabilities since its inception in 2001. The Administration then wonders why jails, emergency rooms and homeless shelters, and, most unfortunately, morgues have been flooded with individuals with severe psychiatric disabilities since then. Couple that with a de-emphasis on psychosocial programming that had demonstrated results in helping people stabilize and improve in their community settings and you have the makings of the perfect storm for increasing, inappropriate incarcerations as highlighted in The Gazette article.

The Administration instead focuses on the concept of "Recovery" which they clearly don't understand, Evidence Based Practices in lieu of practical solutions which have historically been proven to work and the platitudes of their "Transformation Grant" process, which has resulted in little but hot air. Until the Administration focuses on a real-world solution to the support of people with psychiatric disabilities and begins to develop a cogent vision of how the system works, the problems at the Montgomery County Correctional Facility will continue to escalate.

I'm not optimistic.

Primary Care Integration

2009-06-11T17:51:00.000-07:00

Not much stellar came out of Washington during the past years in regards to mental health. The New Freedom Commission Report and SAMHSA's 16 State Study were probably the most worthwhile products of those eight years. The New Freedom Commission Report didn't have teeth and was followed up with few funds. The "Transformation Grants" that followed the New Freedom report have generally been viewed as a waste of money by those not bought by the grants.

The 16 State Study was excellent but essentially told us what we already knew. It was a wake up call in many respects.

It would seem that it even woke up SAMHSA, for there has been significant movement related to one of the issues highlighted in the study. The study's research revealed that individuals with severe and persistent mental illness die 25 years earlier than the population without the disabilities. There is a whole panapoly of reasons for this but one of them has been the silos that have built for behavioral health care and physical health care in our health care delivery systems.

A few months ago, SAMHSA let an RFP to fund 11 primary care integration sites with the purpose of promoting primary care services for the target population in community mental health centers. The funding level was not piddling, either, at 1/2 million dollars a pop. The request was written well with a significant number of points allowed for the research and outcomes management component of the projects.

There are pockets of excellence in the US related to primary care integration and a growing interest in doing something about the problem. I believe there is some real promise for successful, replicable projects to come out of this funding.

Good job, SAMHSA!

State mental health budget shortfalls

2009-06-10T10:05:00.000-07:00

I just came across an article produced by the NASMHPD Research Institute that was published in December of last year related to a survey they conducted of state mental health authorities last year. NRI queried the states about whether there mental health systems were experiencing shortfalls. 32 of the 42 responding states said they were.

To deal with the shortfall, 42% of the states are closing state hospital beds, wards or entire hospitals.

Wouldn't it be nice if my state, Maryland, would learn something from this? Maryland continues to be one of the highest per capita spenders on state hospital beds in the nation. When you couple this with the state's eight year moratorium on the development of affordable housing for people with psychiatric disabilities, you have a system in peril.

It is time for a change!