DMH and Rosie: What are they saying?

Today, I attended a meeting sponsored by the Department of Mental Health where they featured Joan Mikula from the Department of Mental Health talking about the implications of the Rosie D. case for children's mental health care in the Commonwealth. I'm taking notes on-line, because I am experimenting with this form of commentary. The talk was coupled with a talk of "restraint prevention", which is an interesting issue in it's own right. But, back to Joan: She wanted to make sure that the agencies are aware of the implications of Rosie D. for inpatient and residential services.

Her key points:

• These change stems from the loss of a lawsuit by the Commonwealth.
  
• The lawsuit requires the Commonwealth to spend $200-460 million dollars on the remedy, and it will affect all aspects of the mental health system.
  
• The expectation is that the need for inpatient services over time will decrease, as we start intervening earlier, and putting new community supports in place.
  
• Her fear is that we will create a new silo.
  
• What we want is to create a new level of collaboration with community-based services to get children into services.
  

She sees this as a tremendous opportunity, that will require a new and unprecedented level of collaboration between families, doctors, mental health workers and the rest of the system.

The process is this:

Primary care doctors: Screen and refer. (MCPAP for assistance)

Mental health services: Assess with the CANS (Much training over the next few months)

A question remains: Who will assess the kids who are already in residential or inpatient treatment. The big advantage is that it will give us a common language to facilitate communication between agencies, even though it may not be the perfect tool.

Treatment: In the community as much as possible. There will be intensive care coordination, through programs like MHPSY and CFFC programs already in place. There will be a family partner to work with the child and family. There will be "crisis stabilization" services within a 7 day period to help divert children from hospitalization. There will be home based crisis services available throughout the Commonwealth, linked to the intensive care coordinators. There will be in-home behavioral health and therapy services, mentoring services for families and youth.

This is going to be major undertaking and the State is taking it very seriously: EOHHS has hired Emily Sherwood to be the quarterback of this process, and she has been out there, pulling together the team. This is our chance to really change a system that we all know has not always served our children well.

Ms. Mikula worries about many things:

• Kids go on and off Medicaid; what then?: How do we make services seamless for kids regardless of insurance?
  
• School is key: How do we coordinate this with special ed? The role of the school has to change. If more kids are in communities, more kids will be in schools.
  
• Workforce issues are hugh: We will need at least 1000 new clinicians, we need hundreds of trained "family partners", the new graduates need to be trained in the techniques needed to make this work.

She ended by calling for our help, because this is our chance to finally do all of the things that we have been talking about for years.

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Questions:
Wraparound services: Not sure how that fits in, since it is not Medicaid-reimbursable, even though the services are the key to success. The child and family teams need to be trained in "wraparound services". She wants the outcomes to be based on performance.

Money: Where will come from? This will be a state initiative, and the State must find the money. But it is a court-mandate, which means that the legislature must find a way to make it work.
Diagnosis: The younger the child, the less clear the diagnosis. How can we decide who needs service? Those creating the new paradigm will need to think long and hard on that, as the guidelines for treatment are less clear with younger children. It will be important to tie this evolving system of care into the evolving knowledge base regarding mental health.

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It was decidedly worth coming to hear the way in which the leadership of DMH has embraced the coming change.

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Please note that these notes reflect my understanding of what was said, and likely reflect my biases and my hidden agendas, which are often hidden even from me. Please let me know if I have misunderstood what is going on- the nice thing about blogs is that you can edit and correct them.