Transcript Alcohol and Drug Abuse Administration

Public Mental Health Treatment
in Maryland: Past, Present and
the Future
Gayle Jordan-Randolph, M.D.
Deputy Secretary for Behavioral Health
and Disabilities
November 5, 2013
Maryland’s Mental Health
Memory Lane
1798 – Maryland General Assembly
authorizes Medical and Chirurgical Faculty
of Maryland “to protect citizens from
ignorant medical practitioners and quacks
by disseminating medical knowledge and
licensing doctors.” (Md. Archives)
The 1700’s
1797- Maryland Hospital
– Established ‘for relief of indigent sick persons and for the
reception and care of lunatics.” (Acts, 1797)
– Prior-“inebriates,” “feeble-minded” and lunatics resided
at home, jails and almshouses.
– Maryland’s first public health hospital
– Coincided with Yellow Fever Epidemics
– Provided physical and mental health treatment for the
indigent population
– Originally overseen by the Mayor and the City Council of
Baltimore with some State influence
– State assumed governance in 1834 in response to
concerns about conditions at the hospital
The 1800’s
Care in Maryland Hospital
• average cost of care estimated at $150/year
• served both private and indigent patients
• physicians “gratuitously” provided
services (briefly)
• State funds physician services-$500/year
Maryland Hospital for the Insane
• Established in 1938
• 1839 – devoted to the treatment of
lunatics and inebriates.
• half to be devoted to the treatment
of “pauper lunatics.”
Board of Mental Hygiene –
Early 1900’s
 Board Assumed commission’s duties
(1922)
 Previously state mental institutions
came under the Department of
Welfare
 Overcrowding
 Funding
 Staffing
Department of Mental Hygiene
1950’s-1960s
• Replaced the Board of Mental Hygiene in
1949
• Coordinated research activities
• Managed the state mental health institutions
• Maryland Alcohol Commission established
• Provided education/training of personnel
within the institutions
• Drug Abuse Authority established
• Maryland state hospital systems
desegregated.
– Patients redistributed regardless of race.
The 1970’s
• Approximately 4500 beds state-wide
• Inpatient treatment emphasis of care
• State facilities had individualized
residency training program
• State plan merged State residency training
programs with The University of Maryland,
– Increased trainees expose to public mental
health, encouraged graduates to seek state
employment
• Drug Abuse Administration and
Alcoholism Control Administration
consolidated under Mental Health
Administration.
– Later removed from MHA administrative oversight
The 1990’s
• Merger of Drug and Alcohol Administration
and Alcohol Control Administration to form
Alcohol and Drug Abuse Administration in
the late 1980s.
• Expansion of community mental health
services,
• Downsizing of state-operated inpatient beds
• Development of evidence based practices,
• Creation of Health Choice MCOs
• Mental Health Carve Out
National Mental Health
Agenda
New Freedom Commission Report (2003)
 Mental Health is Essential to Overall Health
 Mental Health Care is Consumer and
Family Driven
 Emphasizes the elimination of disparities in
mental health services
 Mental Health Care is Delivered and
Research is Accelerated While Maintaining
Efficient Services and System
Accountability
 Technology is Used to Access Mental Health
Care and Information
Early 2000’s
• Evidence Based Practices
• Expansion of Community Services
• Expansion of Consumer Involvement in Policy
Development and Planning
• Embracing Recovery principles
• Integration of Services/Systems
• Technology
Transformation
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Mental Health First Aid
Veterans Initiative
Wellness Recovery Action Plan
Integration of Care
Recovery Trainings for providers,
consumers, and clinicians
• Cultural and Linguistic Competence
Training Initiative
Behavioral Health
Integration in Maryland
Better Care, Better Health, Lower Cost
DHMH-Behavioral Health
Services 2013 and Beyond
Mission:
 To develop and manage an outcome guided
behavioral health service delivery system:
 Integrating prevention, health disparities,
recovery principles evidence based practices and
cost effectiveness
Key features of Integrated BH System
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Increase public health and outcomes focus
Increase prevention efforts and early intervention
Promote clinical integration
Increase data collection and outcome measurement
One point of contact for BH providers
Coordination for individuals moving between
Medicaid and Maryland Health Benefit Exchange
• Preservation of Safety Net
• Reduce Health Disparities
Significant Changes Planned
• ADAA and MHA to integrate into a single Behavioral
Health Administration – July 1, 2014
• One Administrative Services Organization (ASO) will
manage behavioral health benefits for Medicaid
recipients and uninsured
• New integrated regulations
• Accreditation
Behavioral Health Administration
– Restructured organizational chart
– Staff integration and cross-training
– Increased public health mission
• Overdose Prevention Initiative, Suicide
Commission, Drug Monitoring, Smoking
Reduction, Primary care consultation, Problem
Gambling, Early Intervention
Administrative Services
Organization
• Manage behavioral health benefits for Medicaid recipients
and uninsured
• Single point of contact for behavioral health providers
• Collect and analyze data
• Make data available to local authorities to improve
monitoring and management of behavioral health services
• Train and assist providers new to ASO system
Regulations and Accreditation
 Streamline regulations and maintain quality of care
 Accreditation
– Consistent with current medical practice
– Reduces redundancy
– Simplification of the regulations with some degree of
flexibility
– Integrates evidence based practice
 Regulations to address services not covered by
accreditation
Need for Flexible Integration
Options
• Seriously mentally ill have significant
comorbidity
• Seriously mentally ill have difficulty
navigating health service delivery system
• Promote clinical integration of mental
health, substance use disorder, and
somatic care
• Health Homes
Outcomes
• Increased consumer participation in entire
health care service delivery system
• Reduction in the morbidity associated with
chronic medical and behavioral health
conditions
• Improved communication and collaboration that
leads to integration
• Reduction in the overall cost of health care
• Change in consumer satisfaction and wellness
Exciting Times
Health Care Models-OTP Health homes
Consolidation of the Behavioral Health Management
Implementation of the New Model
Utilization of data to improve service delivery system
Support and improve the overall wellness of the
citizens of Maryland.