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Program B: Community Mental Health

Program Authorization: R.S. 28:1-723

PROGRAM DESCRIPTION

The mission of the Community Mental Health Program is to provide an integrated, community-based system of mental health services that is based on the principles established in Plan 2002, the Office of Mental Health (OMH) Strategic Plan, and which is accessible to adults, children and youth with serious mental and emotional disorders, or at risk of such disorders, and which will enable them to function outside of inpatient or residential treatment institutions to the maximum of their capabilities.

The goals of the Community Mental Health Program are:

1. Operate a system of care in 58 of 64 parishes through managing services, psychiatric rehabilitation, acute stabilization and acute inpatient services through an organized system of regional administration units.

2. Ensure services are in accord with Plan 2002.

The Community Mental Health Program is organized across the 64 parishes into nine regions. Each region is administered by a regional manager who reports directly to the OMH director of community services. Eight of the regions have an advisory board composed of local citizenry including consumers and family members. In Jefferson Parish and Region 2, a governing board is responsible for delivering services consistent with the administrative and regulatory policies of the OMH.

Activities of the Community Mental Health Program include: Community Mental Health Clinics, Day Programs/Psychosocial Rehabilitation, Residential, Prior Authorization, Hospital Acute Inpatient Psychiatric Units, Pharmacy Costs, Community and Family Support (Act 378 of 1989), contracted Telephone Crisis Lines, Mental Health (Technical Assistance) Consultants, other community based programs cost/specialized contracted services, seasonal disasters, and Adam A Decree Consent.

The Community Mental Health Clinics (CMHC) in FY 1997-98, served over 3,490 adults with serious and persistent mental illness, and children and youth with serious emotional disturbances receiving outpatient mental health services through the operation of 37 licensed community mental health centers and their satellite outreach clinics located throughout the eight OMH geographical regions. The CMHC facilities provide an array of the following facility-based services: screening and assessment; emergency crisis care; individual evaluation and treatment; medication administration and management; clinical casework services; specialized services for children and adolescents; specialized services for criminal justice; specialized services for the elderly; and pharmacy services.

Day Programs/Psychosocial Rehabilitation provide opportunities for teaching new rehabilitative skills related to community living and work activities, build networks of peer support, teach self-help community activities, and provide a place where individuals can learn how to successfully relate to persons and communicate their needs and desires. In addition, day programs provide secure structured environments where individuals experiencing disruption in routine behaviors brought on by their illness can receive treatment and support.

Hospital Acute Inpatient Psychiatric Units are an integral component of the regions’ crisis response system. The acute units provide comprehensive inpatient care in a community based setting for adults with serious mental illness. These units are designed with a close linkage to community services and resources, providing a greater degree of continuity of care for the consumer.

Community and Family Support (Act 378 of 1989) helps support programs for emotionally/behaviorally disordered children and helps support programs for adults wit serious mental illness. These programs are designed specifically to assist individuals to remain in their own home or with their families rather than in out-of-home placements. Act 378 supported programs strive to fit the program to the person rather than fitting the person to the program. With Act 378 funds, the OMH provides a wide range of supports such as respite care, assistance with medical and dental care not otherwise covered, recreational activities for children, and assistance with transportation.

Telephone Crisis Lines provides 24-hour a day, seven days a week, telephone counseling services, including information and referral services for people in crisis, especially suicide crisis who are consumers of OMH services and/or potential OMH consumers.

Other community based programs cost/specialized contracted services are highly specialized to specific mental health planning requirements or to special population needs. This includes such services as consumers and family empowerment, self-help, and educational needs, specialized demonstration initiatives designed to test the efficacy of certain interventions are also under this category. These services are often innovative in approach and require piloting prior to including these programs as mainstream mental health interventions.

Seasonal Disasters Response provides supportive mental health services to emergency response personnel and persons impacted by emergency conditions due to natural or man-made disasters. OMH is the lead agency for the state in coordinating the mental health response to presidential declared disasters such as hurricanes, floods, and tornadoes. The OMH response includes working in collaboration with the Office of Emergency Preparedness, the Federal Emergency Management Agency, and the Center for Mental Health Service. OMH is the agency responsible for administering federal crisis counseling grants that are awarded as a result of catastrophic events of sufficient magnitude to be declared as presidential major disasters.

Adam A Decree Consent provides for a range of services to clients in Regions 1, 9, 10 (Jefferson Parish Human Services Authority), and 3 as an alternative to hospitalization at Charity Hospital Medical Center of Louisiana-New Orleans. These services are to include crisis intervention services, screening and assessment, case management services, and treatment services. Full ranges of community services are also to be developed for children and youth as an alternative to intervention at Charity Hospital Medical Center of Louisiana-New Orleans.

 

OBJECTIVES AND PERFORMANCE INDICATORS

Unless otherwise indicated, all objectives are to be accomplished during or by the end of FY 1999-2000. Performance indictors are made up of two parts: name and value. The indicator name describes what is being measured. The indicator value is the numeric value or level achieved within a given measurement period. For budgeting purposes, performance indicator values are shown for the prior fiscal year, the current fiscal year, and alternative funding scenarios (continuation budget level and Executive Budget recommendation level) for the ensuing fiscal year (the fiscal year of the budget document).

 

 

RESOURCE ALLOCATION FOR THE PROGRAM

SOURCE OF FUNDING

The Community Based Program is funded with General Fund, Interagency Transfers, Fees and Self-generated Revenues, and Federal Funds. Interagency Transfers include Title XIX reimbursement for services provided to Medicaid eligible patients, and interagency transfers from the Health Care Services Division for mental health's operation of the acute psychiatric inpatient units at various locations in the state. Self-generated Revenue represents reimbursement from ineligible patients with insurance or personal payments based on a sliding fee scale. Federal funds are Title XVIII reimbursement for services provided to Medicare eligible patients, the Mental Health Services Block Grant, and the Projects for Assistance in Transition from Homelessness (PATH) formula grant.

ANALYSIS OF RECOMMENDATION

GENERAL FUND

TOTAL

T.O.

DESCRIPTION

 

 

 

 

 

$52,162,964

$78,785,435

918

 

ACT 19 FISCAL YEAR 1998-1999

 

 

 

 

 

 

 

 

 

BA-7 TRANSACTIONS:

$0

$89,908

0

 

Carry Forward

($33,227)

($33,227)

0

 

BA-7 # 130 Transfer to Jefferson Parish Human Service Authority for pro-rata share

$0

$0

12

 

Transfer twelve positions from the Office of Public Health

 

 

 

 

 

$52,129,737

$78,842,116

930

 

EXISTING OPERATING BUDGET – November 20, 1998

 

 

 

 

 

$320,514

$320,514

0

 

Annualization of FY 1998 - 1999 Classified State Employees Merit Increase

$326,924

$326,924

0

 

Classified State Employees Merit Increases for FY 1999 - 2000

($263,119)

($268,626)

0

 

Risk Management Adjustment

$772,638

$772,638

0

 

Acquisitions and Major Repairs

($569,000)

($569,000)

0

 

Nonrecurring Acquisitions and Major Repairs

$0

($89,908)

0

 

Nonrecurring Carry Forwards

($118,430)

($118,430)

0

 

Salary Base Adjustment

($1,370,164)

($1,370,164)

0

 

Attrition Adjustment

$62,850

$62,850

0

 

Other Adjustments – Relocation of Alexandria Mental Health Center

$0

$617,971

0

 

Other Adjustments - Other compensation for nurses in acute units

 

 

(8)

 

Transfer 8 positions to Administration and Support Program to reflect changes made to EOB after November 20, 1998

         

$51,291,950

$78,526,885

922

 

TOTAL RECOMMENDED

         

($837,787)

($315,231)

(8)

 

DIFFERENCE (TOTAL RECOMMENDED AND EXISTING OPERATING BUDGET)

The total means of financing for this program is recommended at 99.6% of the existing operating budget. It represents 75.5% of the total request ($103,968,418) for this program. The major changes include: reducing risk management premiums by $268,626; a reduction of $841,156 to fully fund salaries in other programs, an increase of $617,971 for compensation for staff in the acute units, and a transfer of 8 positions to the Administration and Support Program. The changes should have no significant impact on the delivery of these services.

PROFESSIONAL SERVICES

$5,049,340

 

Contracts to provide psychiatric services to mental health centers and acute unit patients including psychiatric evaluation, medication management, patient staffing, formation and authorization of treatment plans and provide consultation to staff members as needed

$183,753

 

Other Professional Services contracts including computer consultants and mental health training consultants

 

 

 

$5,233,093

 

TOTAL PROFESSIONAL SERVICES

OTHER CHARGES

$1,339,034

 

Contract provides structure and psychosocial skills training that contributes to maintaining the stability of the clientele. In intensive day programs, people with serious mental illness are provided training to increase daily living skills (e.g., food preparation, personal hygiene, money management), social skills which enhance interpersonal relationships with landlords, employers, family and friends); and pre-vocational skills

$1,102,023

 

Contract provides support, education, and services to families of children/youth with serious emotional disturbance for the purpose of keeping children in school and in their own home rather than in institutions. Services include routine respite, summer programs, parent support groups, parent education, parent skill training, help lines and transportation

 

 

$985,530

 

Contracted services to assist mental health consumers in successfully living in the community, including assisted housing and other supported services (e.g., rent, subsidies, board and care, supportive housing, transition from group homes, vocational/employment services and respite care)

 

 

$943,023

 

Contracted services provide for crisis intervention via public access to 24-hour crisis line, mobile crisis response service in Orleans and Jefferson parishes, crisis interventions at each mental health center during business hours, acute care programs in general hospitals, efficient and effective crisis screening and care with the crisis intervention unit (CIU) at Charity Hospital in New Orleans, increase in number of programs in Region 1 and community education about other available crisis services

 

 

 

 

$42,283

 

Informational/educational, family and consumer run support services. These programs help families and consumers help each other through existing use of natural support systems, thus limiting their reliance on professionally delivered services

 

 

$914,353

 

An array of individualized services designed to increase the adaptive functioning of consumers with complex medical and social needs. These services support the application of the core principles of recovery from mental illness.

$1,140,928

 

Residential group homes provide a transitional environment, safe and secure in purpose, normalizing, therapeutic, with a vocational focus.  The overall goal is to provide chronically mentally ill persons a secure, structured environment in which they can practice the pre-vocational skills (self care, independent living skills, socialization principles, managing their money) necessary for maintenance of pre-vocational focus, eventual vocational training and/or remunerative occupation. This activity is for individuals requiring a higher degree of structure and supervision

 

 

 

 

$165,484

 

Residential supervised apartments provide transitional living arrangements, safe and secure in purpose, normalizing, therapeutic, with a vocational focus. The overall goal is to provide chronically mental ill persons a secure environment in which they can practice the pre-vocational skills. This activity is for individuals with less need for staff and supervision

 

 

$247,167

 

Case Management/Mental Rehabilitation Services assure that seriously mentally ill youth and adults and their families are receiving the full array of appropriate and needed services offered by area mental health, mental retardation, and substance programs as well as other medical, social, vocational, educational, residential, and support services. It provides individualized support and advocacy and promotes independence by empowering consumers to do things for themselves. This includes the function of authorization of case management and MHR services

 

 

 

 

$210,000

 

State-wide activities fund planning council meetings; computer software equipment related to production of the Plan and other related documents; special research and evaluation initiatives, OMH staff training and special projects

$887,624

 

Special contracted service provides a variety of services needed to assist mental health consumers in successfully living in the community, including assisted housing and other supported services (e.g., rent subsidies, board & care, supportive housing, supervised apartments, home settlement, transition from group homes, vocational /employment services, respite care)

$171,907

 

Provides for funding of positions in each region and the state office level to be filled by consumers of mental health services to provide for consumer input into the planning, development and implementation of self-help alternatives and to assure consumer participation in each regional mental health program. Also funds training and support of consumer employees

 

 

$206,996

 

Provides funding for consumer-run drop-in centers in each region providing a place for consumers to go to get mail, develop social skills, initiate job searches, etc.

 

 

$0

 

Special Population Services moved to Interagency Transfer

$38,000

Equips community mental health clinics with educational videotapes, televisions, and VCRs. Provides access to mental health services, day programs and drop-in centers via vehicle rental/leasing, bus tickets, taxi fares, driver reimbursements, etc.

$323,978

 

Provides support for CONFIDENT (Consumers Organized for New Freedoms Involving the Development, Education and Needs of Themselves) through state and local chapter development and operation of state and local chapter development and operation of state organization.  Also provides for member training through annual statewide conference, participation in national meetings and conferences, training materials, etc. Provides administrative support for the Louisiana Alliance of Mentally Ill (LAMI) through state and local chapter development and operation of state organization

 

 

 

 

$762,544

 

Crisis management funding for community-based, intensive in-home and mobile crisis programs serving children/youth in six regions. Funds crisis and crisis respite programs for children/youth in the regions

$550,476

 

Family Support/Wraparound Services provides support, education, and services to families of children/youth with serious emotional disturbance for the purpose of keeping children in school and in their own home rather than in institutions. Services are provided through contracts with private, non-profit agencies, parent education, parent skill training, help lines and transportation

 

 

$483,976

 

Rural system of care is a wraparound program in Lafourche Parish for children ages 10-13.  The program, based on the assertive community treatment model, is designed to provide a 24-hour, 7-day-a-week interdisciplinary team approach to integrated, comprehensive services (clinical, support and case management).  Services are designed to prevent hospitalization and assist children and their families in successful community living

 

 

 

 

$300,000

 

Project for Assistance in Transition From Homelessness (PATH) is a program to provide mental health services to the homeless or a risk of homelessness population.

$888,389

 

This activity, per Act 378 of 1989, provides monthly cash subsidies to families to keep emotionally disturbed/disordered children in the home to prevent out of home placement. Without the cash subsidy program, these families would no longer receive the monthly supplement to provide the extra services required because of their child’s handicapping condition.

 

 

$218,413

 

The Acute Care Psychiatric Inpatient Units provide psychiatric, psychosocial and medical services in compliance with all licensing and accreditation standards, to meet the individualized patient care needs of adults and adolescents who need a level of care that must be rendered in an inpatient setting. These units address the need for inpatient treatment, in a less restrictive environment, shorter term, more cost effective setting than in the state longer term care psychiatric facilities. Additionally, the units are designed to be community based, with a close linkage to community services and resources, and greater degree of continuity of care for the patient

$400,000

 

The Hospital Admission Review Procedure (HARP) was implemented in Regions 1 (New Orleans) and VII (Shreveport) on July 1, 1998. The process involves a collaborative effort between OMH and Medicaid. The project is designed to utilize community resources whenever possible as an alternative to hospitalization or at discharge to prevent re-hospitalization.

$325,872

 

Payment to Jefferson Parish Human Services Authority for the purchase of psychiatric medications

 

 

 

$12,648,000

 

TOTAL OTHER CHARGES

 

 

 

 

 

Interagency Transfers:

$1,439,092

 

Professional services (psychologists, physicians, interns, etc.) provided by LSU Medical School to the acute units and the mental health clinics

$58,303

 

Payment to DSS for the purchase of normal office supplies including stationary, envelopes, etc.

$62,850

 

Payment to Central La. State Hospital for maintenance, repairs, and utilities for the Alexandria Mental Health Center

$11,310

 

Payments to State Buildings and Grounds for regional maintenance for VOA Group Home

$6,861,415

 

Transfer to Capital Area Human Services District to perform the functions which provide community based services and continuity for the diagnosis, prevention, detection, treatment, rehabilitation, and follow-up care of mental and emotional illness

$350,000

 

Transfer to Feliciana Forensic Facility for a community residential forensic project which provides intensive aftercare

$48,860

Transfer to University Medical Center for laboratory services

 

 

 

$8,831,830

 

TOTAL INTERAGENCY TRANSFERS

ACQUISITIONS AND MAJOR REPAIRS

$772,638

 

Recommended level of funding for the replacement and repairs of obsolete, inoperable or damaged equipment and buildings

 

 

 

$772,638

 

TOTAL ACQUISITIONS AND MAJOR REPAIRS


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