Crisis Redesign

Crisis Redesign

FY 2008

Background

For the past two decades, the State of Texas has contracted with MHMR Centers, as the Local Mental Health Authorities, to ensure provision of emergency mental health services throughout the 254 counties in Texas. The services, available 24 hours, 7 days a week, have been historically provided through crisis hotline services; emergency screenings for hospitalization; and 7 day follow-up services subsequent to a crisis.

In 2006, the Texas Department of State Health Services requested testimony on the statewide need for improved mental health services. The Department received input from medical and mental health professionals, law enforcement, consumers, family members, local constituents and community leaders regarding the erosion of crisis mental health services in their cities and counties.

The result of this input is the Crisis Redesign initiative. This initiative is supported by the Texas Legislature through an allocation of $82 million for additional crisis services for the FY 2008-2009 biennium. Recommendations for the design of the additional crisis services and the expenditure of these funds were made by a task force assembled by the Department of State Health Services.

Crisis Funding Categories

The Department of State Health Services with the Legislative Budget Board is dividing the allocation from different funding opportunities. The Center will be required to participate in the funding requirements for crisis services, noted below.

A second opportunity is for enhanced crisis services through a competitive bidding process. This funding will be granted to centers on a competitive bid basis. This grant funding will only cover 75% of the cost of the project; participation in this competitive bid process requires a 25% local match. The RFP process for these grants will take place in late spring 2008.

Crisis Program Requirements

The Department of State Health Services is mandating that equity funding and per capita funding be used for the development of improved hotline services and mobile crisis outreach teams:

• Hotlines Services are to be provided through a provider, accredited by the American Association of Suicidology. This standard requires that a trained Qualified Mental Health Professional (QMHP) answer the hotline. The QMHP will provide screening and intervention services. If needed, QMHP will call the local MHMR on-call crisis worker to intervene with the consumer in person.
• Mobile Crisis Outreach Services will be expanded from screening, psychiatric evaluation, safety monitoring, crisis intervention, and crisis follow-up services to include counseling, routine case management, medication training and support, pharmacological management, supplemental nursing services, the provision of medication, crisis transportation and flexible benefits. The Mobile Crisis Outreach Team standards for rural areas require the services of a Physician and an LPHA (Masters Level Counselor). In addition, services of an RN or APN are also recommended.

The MHMRCenter must provide these services to each of the counties in the Center’s service area. Bluebonnet Trails is currently negotiating with the Williamson County Mobile Outreach Team to contract for LPHA, nursing and crisis intervention and crisis follow-up services. To cover our service area, the next step will be to work with Bastrop, Burnet, Caldwell, Fayette, Gonzales, Guadalupe and LeeCounties.