DMHAS Region 3
[PRIORITIES & RECOMMENDATIONS FOR MENTAL HEALTH AND SUBSTANCE ABUSE SERVICES & SUPPORTs]
2015 Updated version
Submitted by: The Eastern Regional Mental Health Board, Northeast Communities Against Substance Abuse (NECASA), and the Southeastern Regional Action Council (SERAC)
Note: for the 2015 Priorities Update, any relevant information can be found at the conclusion of each section in blue text.
The ERMHB utilized feedback gathered through our review & evaluation process, at focus groups, and from conversations with stakeholders. Appendices A & B also summarize the feedback received in response to our online Priorities Survey and our “Service Barriers Report.” A variety of stakeholders, including provider management and staff, consumers, and family members, participated in both processes.
I. Introduction
Every two years, the Department of Mental Health and Addiction Services (DMHAS) Planning Division is required to carry out a statewide needs assessment and priority planning process in order to capture needs and trends on the local, regional, and statewide basis. Regional Mental Health Boards (RMHBs) and Regional Substance Abuse Action Councils (RACs) assist in this process by gathering local and regional data and perspectives. Information gleaned from this process is used to inform the DMHAS Mental Health Block Grant and DMHAS biennial budgeting process as well as the planning and priority setting process for each RMHB and RAC.
This report summarizes the findings of the 2014 DMHAS Region 3 biennial needs assessment and presents recommendations for improvement in mental health and addictions services for Eastern Connecticut. Region 3 includes 39 towns in Windham County, New London County, and Tolland County: Ashford, Bozrah, Brooklyn, Canterbury, Chaplin, Colchester, Columbia, Coventry, East Lyme, Eastford, Franklin, Griswold, Groton, Hampton, Killingly, Lebanon, Ledyard, Lisbon, Mansfield, Montville, New London, North Stonington, Norwich, Plainfield, Pomfret, Preston, Salem, Scotland, Sprague, Sterling, Stonington, Thompson, Union, Voluntown, Waterford, Willington, Windham, and Woodstock.
II. Process
For the first time in many years, the Eastern Regional Mental Health Board (ERMHB) worked in close collaboration with the Regional Action Councils in Eastern Connecticut throughout all stages of the 2014 DMHAS Priority Process. In past years, the Eastern Regional Mental Health Board conducted the process separately from the two RACs in the region, and there was little or no communication between the ERMHB and the RACs until the formal presentation to the Office of the Commissioner of DMHAS. With a vastly different process in place this year, along with the new leadership at the ERMHB, it made sense to emulate the collaboration between RMHBs and RACs that has traditionally existed in other regions.
Beginning in early 2014, the Executive Directors of the RMHBs and RACs met with DMHAS staff and members of the Adult Behavioral Health Planning Council to plan the 2014 DMHAS Priority Process. Discussion centered on how the RMHBs could implement a uniform needs assessment and priority planning process in 2014 that would identify strengths, needs, and issues across the service system.
The Executive Directors of the Eastern Regional Mental Health Board, Northeast Communities Against Substance Abuse (NECASA), and the Southeastern Regional Action Council (SERAC) held two planning meetings in March and April of 2014 to determine how to gather information and data from throughout Eastern Connecticut. After holding a total of 7 focus groups throughout the region, the three Executive Directors met again in May 2014 to share and consolidate feedback from the various focus groups and to determine how to format the findings and recommendations gathered during this year’s process. It was immediately evident that all of the focus groups garnered very similar feedback, which will be reflected in this report’s recommendations.
Regional Surveys
The DMHAS Office of Evaluation, Quality Management & Improvement developed a web-based survey to capture the perspectives of DMHAS-funded and operated mental health and addiction providers regarding access and barriers to mental health and addiction services. Surveys were sent online to the chief administrators of mental health and/or substance abuse service providers throughout Connecticut. Surveys were completed by 10 of the 20 DMHAS- funded providers in Region 3.
Providers were asked to respond to the following questions (See Appendix C for a summary of their responses):
· How could the Regional Action Councils (RACs) and/or the Regional Mental Health Boards (RMHBs) collaborate with your agency to improve the service system?
· What do you identify as the greatest strengths of the mental health and/or substance abuse service system?
· Where does the system have insufficient services or barriers to meeting service system demands?
· If you were in charge of the DMHAS service system, what would you change to improve it?
A number of comments made by provider representatives with regard to the RMHBs made it clear that there is a great deal of confusion in Region 3 regarding the role of the RMHBs in the state-funded system. This situation is largely due to the fact that in recent years, relationships with Region 3 providers and towns have not received enough attention, and our membership has been at an all-time low. Please see Appendix A for more detail on this subject, and Appendix B for the statutory language governing RMHB membership. Revitalizing these crucial relationships is a top priority for the Eastern Regional Mental Health Board, and since the transition to the new Executive Director took place, structured and persistent outreach to the region’s provider organizations and Town CEOs , including face-to-face meetings and special presentations, has been conducted . In addition, the new Executive Director is working more closely with the RACs in Region 3, and has conducted the first program site visits in several years.
Focus Groups
A total of seven focus groups were held throughout Region 3. Participants included community members, people in recovery, family members, community organizations, and providers of mental health services, with a total of approximate 90 participants.
Participants were asked to respond to the following questions based on their own direct experience or perceived experience of people in their sphere of influence:
1. What are the biggest challenges facing those in your community with substance abuse and/or mental health problems in your community?
2. Are people willing to talk about their substance use and/or mental health problems? Why or why not?
3. How can the community best support its members with mental health and substance abuse problems, especially those at risk of winding up in the prison system?
4. What are the strengths and weaknesses of your community with respect to caring for people with mental health and/or substance abuse problems?
5. If you, or someone you know, had a substance use and/or mental health problem, would you know what resources were available and how to access them?
6. Has the Sandy Hook school shooting and the resulting media coverage changed how you feel, think, or act with respect to mental health issues in your community?
7. What kind of impact have you seen in your community as a result of healthcare reform (otherwise known as the Affordable Care Act or Obama Care)?
8. If you were responsible for mental health and substance abuse services in your community, what kind of changes would you make?
9. How are mental health, substance abuse, and medical problems intertwined in your community?
Evaluations
Throughout 2013-14, the ERMHB participated in CSP/RP reviews at four state-operated or state-funded providers within Region 3, conducted site reviews at three Outpatient Clinical Programs in the region, and facilitated numerous discussions at Catchment Area Council meetings regarding barriers and/or unmet needs as perceived by those receiving services or provider staff. In addition, meetings with Region 3 clubhouses and Town CEOs elicited information that has been included in this report.
III. Priorities & Recommendations for Behavioral Health and Substance Use Services
Many of issues and recommendations identified below are not intended to be addressed solely by DMHAS. As the Eastern Regional Mental Health Board works to re-establish and strengthen relationships within the region, we intend to partner closely with DMHAS, the RACs, Region 3 towns, institutions of higher learning, provider agencies, and other community organizations, as well as at the grassroots level with people in recovery, family members, and concerned citizens to address many of the concerns identified. We fully expect that these issues will be central to the work of our Catchment Area Councils during the next biennium.
It is important to note that a number of strengths in the current system were identified during the focus groups, including:
· Town substance use prevention coalitions
· Church and community centers offer safe places for teens & young adults
· The Regional Board structure is grassroots style; integrates local voices & gives the ordinary citizen to change the system. The Catchment Area Council (CAC) meetings provide a huge level of support for members and local citizens.
· The clubhouses and social programs provide great support for independence and strength
· The Southeastern Mental Health Authority (SMHA) network of providers is highly collaborative and connected.
· The community college model offers an open door policy on counseling and seeking help
A. Public Education
General Public
There was unanimous agreement among all focus groups regarding the pressing need for more general public education about substance use issues, including problem substances, risk factors, warning signs, etc. Participants voiced significant concern about the growing problems with heroin addiction and overdose in the community, and several mayors and first selectmen within Region 3 have specifically identified this as a top concern within their towns.
It is also difficult for most people to know where to begin when mental health services are needed. Most people in the focus groups admitted that they would not know where to tell someone to start if asked for help. This included employees from the publicly funded mental health service system, who stated that given the entirely separate nature of privately funded services, they feel unprepared to assist friend and family members in need. Most people in the general community don’t understand how to identify warning signs of behavioral health problems, and find the huge array of available medications and services confusing. Those who understand that publicly funded services include a variety of wrap around services and supports resent that the same options aren’t available to those with private insurance.
Changes under the Affordable Care Act (ACA)
During our focus groups, it became evident that a great deal of confusion still exists, even among mental health professionals, regarding the impact of the Affordable Care Act (ACA). The conflicting, and sometimes erroneous, stories in the media exacerbate the problem. Management level staff for Region 3 providers say they need training and resources on structure and implementation for Behavioral Health Homes and the State Innovation Model (SIM). And with regard to billing, they are aware that their documentation needs to meet certain standards in order to maximize their billing potential and meet their costs, but say they need more information on how to document properly, i.e., a “representative note”.
Many in the general public don’t understand that the ACA and “Obamacare” are the same thing. People without access to computers or internet, or who lack basic computer skills, are at a disadvantage. We are also hearing that despite enactment of mental health parity, many insurance policies are still not offering proper levels of coverage.
Although on an individual level, people that couldn’t qualify for insurance previously (some people who went without care for chronic conditions) are now able to get coverage, municipal officials say the cost of health insurance for employees is now higher. In addition, small nonprofits have such limited resources due to flat funding, that as operating costs rise each year, their ability to assist employees with health insurance becomes more restricted each year. They believe that there has been some cost containment recently, but one provider in Region 3 for example experienced nearly $50,000 in health insurance cost increases over two years.
Professionals
Primary care physicians and school professionals are quite often the starting point for those seeking help, but these professionals often have only rudimentary knowledge of the community resources and referral options available for the people they serve. As a result, people who desperately want help for themselves or for loved ones, mistakenly believe that no help is available, leading to delayed diagnosis and treatment, and often worsened outcomes that are often complicated by problems in school or at work, substance use problems, involvement with the criminal justice system,
A number of clubhouse members who participated in the focus groups also said that even their own providers don’t tell them about all available treatment options, including non-pharmaceutical supports, nor are they informed of the full array of possible side effects of the medications they use. As one consumer member stated, “We can’t advocate for our needs if we don’t know our options.
We recommend the following approaches:
· Provide more community education at local levels to promote better understanding of mental illness and available resources. The Community Conversations model has proven effective in other regions, and we would like to pursue this possibility in our communities.
· Education & awareness campaigns, including Mental Health First Aid trainings, targeted at primary care providers and school professionals, will aid in early recognition of problems, promoting early intervention that will hopefully minimize the damage to a person’s relationships and prospects in life. RMHB and RAC staff in Region 3 have the training and expertise to offer this kind of outreach, but funding issues, along with resistance to discussing mental health issues in school settings make progress slow.
· Utilize more family-based therapies and approaches, including family psycho-education, to ensure that families understand diagnoses, treatments, and helpful responses to a family member living with a substance use or mental health problems.
· Many focus group members favor approaches to community education that don’t talk about “stigma”, but rather consider mental wellness as just a part of overall wellness.
2015 Update:
SERAC trained 125 school/community professional in Mental Health First Aid in the last year, over 100 in QPR and 150 in Current Drug Trends. The agency continues to offer these trainings and others to Community, School professional that work with young kids or those at risk. They also address stigma. We have worked very hard to address stigma especially with our first responders and police when talking with them in one-on-one meetings.