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HomeMy WebLinkAboutAgenda - 02-21-2017 - 4-d - FY2016-17 Mental Health Gap Analysis Results and Prioritized Recommendations 1 ORANGE COUNTY BOARD OF COMMISSIONERS ACTION AGENDA ITEM ABSTRACT Meeting Date: February 21, 2017 Action Agenda Item No. 4-d SUBJECT: FY2016-17 Mental Health Gap Analysis Results and Prioritized Recommendations DEPARTMENT: Health ATTACHMENT(S): INFORMATION CONTACT: Mental Health Gap Analysis Presentation Dr. Colleen Bridger, 919-245-2412 Orange County Access to Mental Health Rebecca Crawford, 919-245-2414 and Substance Abuse Services Report PURPOSE: To present a report summarizing the results of the Health Department's FY 2016 Mental Health Gap Analysis and stakeholder-identified priorities. BACKGROUND: The 2016-2018 Board of Health Strategic Plan requests advocacy for and the pursuit of policies, practices, and partnerships that improve substance abuse and mental health services in Orange County, especially to vulnerable populations such as the homeless and those connected with the criminal justice system. Beginning in the fall of 2016, the Health Department engaged a Master of Public Administration intern from UNC to undertake an analysis of the barriers to mental health care in Orange County for residents 0-25 years old. Intern Sabrina Willard reviewed UNC Emergency Department data, interviewed 10 key stakeholders, surveyed 150 service providers and community advocates to determine the major barriers to care. Using this information the Health Department then held focus groups with stakeholders (mental health providers, educators, law enforcement, etc.) to prioritize the top barriers and propose action plans for prioritizing needs and meeting them. This presentation will include a summary of the focus group findings and potential next steps. FINANCIAL IMPACT: There is no financial impact to this report; however there is a potential for future financial impact related to additional programming in FY2017-18 based on the pleasure of the Board of County Commissioners. The source of funding will be recommended as part of the County Manager's FY2017-18 Recommended Budget which could include a reallocation of Maintenance of Effort (MOE) funding. SOCIAL JUSTICE IMPACT: The following Orange County Social Justice Goals are applicable to this agenda item: • GOAL: ENSURE ECONOMIC SELF-SUFFICIENCY 2 The creation and preservation of infrastructure, policies, programs and funding necessary for residents to provide shelter, food, clothing and medical care for themselves and their dependents. • GOAL: CREATE A SAFE COMMUNITY The reduction of risks from vehicle/traffic accidents, childhood and senior injuries, gang activity, substance abuse and domestic violence. RECOMMENDATION(S): The Manager recommends that the Board receive a report summarizing the results of the FY 2016 Mental Health Gap Analysis and Focus Group discussions. 3 AiAssessment of Orange County Mental Health and Substance Abuse Services An assessment to identify community assets and needs in Orange Count NC ORANGE COUNTY y Y� � HEALTH DEPARTMENT ■ August to December 2016 RHASt le, GAP ANALYSIS 5 Background Initiated by the Orange County Health Department to determine the barriers professionals face as they seek to refer county residents aged U-25 to mental health and substance abuse treatment services. ➢ F'"Youth hospitalization 0 records from 2009- 2015 indicate: as a proportion of health visits due to mental health visits psychoactive From 18% to 24% Lsubstance abuse 6 Research Methodology ✓ r . O informational interviews with prominent figures in the mental health community ✓ 15 individuals surveyed based in the fields of healthcare, social services, criminal justice, behavioral therapy, K- 12 education, and others 7 Barriers to Accessing Treatment The most common barriers for Orange County residents aged 0-25 who need mental health and/or substance abuse treatment services were : ➢ Affordability: Many low-income residents either do not have insurance or find their coverage inadequately covers these services ➢ High deductibles, few sliding scale/pro bono options, low maximum number of appointments ➢ Accessibility: Based on a variety of factors, all of which result in barriers to access ➢ Citizenship status, language/cultural, location, type of condition, where/how to find care, transportation January 2017 PHASE 2s, FOCUS GROUPS Small groups Large g ro u p • Educators • Citizen All participants activists/partners reconvened to • Law enforcement, etc. align on strategic • Mental Health priorities. Purpose & rmat Health department hosted 39 survey participants at a session to strategize thres� overarching prioritiec for improving the mental health system in FY 2017- 186 Providers 10 Feedback The majority of focus group participants were in favor of increasing the capacity for three overarching priorities : 1 . Restore funding for mental health services for birth to age 5 2 . Provide greater in-school mental health services in K- 12t" grade (e.g. external, licensed providers who can bill for insurance and Medicaid in the schools) 3 . Improve community's ability to access services (e.g., know: who to call, what number to call, when to call) 11 Next Steps Mental Health Program Coordinator to work on priorities 1 &2 (to be requested with the FY 17- 18 Budget process) National Grant with UNC to address priority #3 Look for ways to use MH MOE funds to address priorities ■ 12 Contacts Coby Austin, Director of Programs and Policy caustin@orangecountync.gov 919-245-2070 Rebecca Crawford, Finance and Administrative Services Director rcrawford@orangecountync. gov 919-24:3-2414 � I � 13 AIIII6‘'' ALoc lipr ASSESSMENT OF ORANGE COUNTY HD MENTAL HEALTH AND SUBSTANCE ABUSE SERVICES AN ASSESSMENT OF COMMUNITY ASSETS AND NEEDS IN ORANGE COUNTY, NC BACKGROUND The North Carolina Institute of Medicine (NCIOM) stated in an October 2016 publication that"mental health and substance use are at the forefront of health policy issues today, both at the national and state levels, due to rising visibility of the costs of not addressing mental health and substance use treatment needs" (NCIOM, 2016). North Carolina's transition to a managed care system 15 years ago brought fresh challenges for local officials seeking to implement comprehensive, coordinated community-based prevention, treatment, and recovery services to meet the needs of their residents. Though progress is evident in some areas, NCIOM reported that this level of care "remains an elusive goal for many North Carolinians with mental health and substance use disorders." Like the rest of North Carolina, Orange County struggles to meet the need for mental health and substance abuse services for residents, especially those ages 0-25. This assessment was initiated by the Orange County Health Department (OCHD) to determine what barriers professionals face as they seek to refer county residents to mental health and substance abuse treatment services. The results of this assessment will be shared with the Board of County Commissioners prior to their strategic planning session in January 2017. According to the U.S. Department of Health and Human Services, the majority of adolescents in North Carolina with mental health and substance use needs do not receive treatment services. Orange County is home to more than 141,000 residents, including up to 2,200 residents aged 3-17 that are currently being treated for these conditions through the managed care organization Cardinal Innovations. In Orange County, hospitalization records from 2009-2015 demonstrate the percentage of visits due to mental health for youth 0-24 years is increasing as a proportion of all mental health visits (an increase from around 18% to 24% of all mental health visits). Data from the same period show that between 27% and 31% of all mental health visits for 0-24 year olds are a result of mental and behavioral disorders due to psychoactive substance abuse. OCHD sought a clearer understanding of the extent patients in the 0-25 age group have access to resources for prevention and early intervention, as well as follow-up care and other support systems for recovery. Simultaneously,we sought to identify the areas where these services could be improved by pinpointing significant barriers to treatment. UNC Master of Public Administration student Sabrina Willard conducted the assessment from August to November 2016. Ms. Willard interviewed ten prominent figures in the mental health community, surveyed more than 150 individuals based in the fields of healthcare, 14 social services, criminal justice,behavioral therapy, K-12 education, and others, and analyzed UNC Chapel Hill Emergency Department records. BARRIERS TO ACCESSING TREATMENT The primary findings of the assessment showed that existing levels of service do not adequately address the needs of this population although there are many examples of successful collaborations taking place across the county in an attempt to address the gaps. Responses from key opinion leaders around the barriers to accessing treatment for mental health and substance abuse helped to inform the findings included in the below table. These common themes were also incorporated into the survey questionnaire as a method for confirming their validity with a larger group. BARRIERS TO MENTAL HEALTH (MH)AND SUBSTANCE ABUSE (SA) TREATMENT AND RESOURCES Theme D$scription Affordability- #1 Gap The#1 gap in the OC mental health system is affordability. Many low-income residents either do not have insurance or find their coverage inadequately covers treatment services for MH and SA(e.g.must meet a high deductible before any coverage is provided, lack of reimbursement options,restricted to a low maximum number of appointments, etc.). This issue is exacerbated when adolescents age out of the Medicaid system at 18.There are very few sliding scale or pro bono options to fill this gap. Children and adolescents have difficulty with recovery if parents with mental health issues aren't treated as well,but parents run into these same issues with affordability. Transportation was ranked as the 2nd largest Location/Transportation -#2 Gap barrier to MH/SA services in Orange County. Services are especially scarce in the northern part of the county(i.e. Hillsborough and unincorporated areas). Public transportation helps somewhat with the older patients in the southern sector,but the younger ones still have unmet needs.This dilemma emphasizes the need for more accessible treatment centers and in/near-school care,especially when parents are unable to take their children to necessary appointments due to busy work schedules or other conflicts. Language/Cultural-#3 Gap For the most part, services for non-English speaking patients are either difficult to obtain or virtually inaccessible. 60%of respondents said it was difficult for non-English speaking 15 residents to access services for any of the listed disorders (Major Depressive, Generalized Anxiety, Bipolar, Personality, Eating, Substance Language/Cultural-#3 Gap (cont'd) Abuse, or Schizophrenia Spectrum),making this the #3 gap identified in the survey. There is need for more diversity in the languages MH and SA services are offered in (i.e. Spanish, Burmese/Karen...etc.), as well as cultural competency training to help providers better understand how to work with refugee/undocumented populations. Culturally-relevant practices that provide support for LGBTQ teens are also needed. Education to combat stigma (adolescent Awareness initiatives in the community are and family) -#4 helping combat the stigma associated with MH conditions. More could be done to continue the dialogue encouraging people to seek appropriate treatment. Parents also need to be educated about the importance of ensuring their child gets the help they need. Barriers exist where parents are either unaware of the importance of taking their child to appointments or have busy schedules that conflict with their ability to do so. Knowing how to navigate the Cardinal system and properly enroll their child in MH and SA services is a barrier to accessing treatment. Post-diagnosis maintenance of care -#5 Non-emergency treatment options are non- existent or scarce. Psychiatric care in particular is a critical need for adolescents yet this type of therapy is largely unavailable to this population,especially if uninsured. In general, there is a need for more varied types of therapy(i.e. cognitive behavioral therapy, other types of counseling), as well as therapists trained to do trauma work both in the school systems and in the community. Preventive/Early intervention care-#6 Preliminary efforts to incorporate MH services into the school system are showing success. More robust systems for identifying issues earlier within the primary care and school settings are still needed.There is also a need for more variety of screening tools. Citizenship status-barrier identified Cardinal Innovations does not provide through stakeholder interviews and survey behavioral health services to residents without responses proof of US citizenship.Undocumented immigrants have to rely on the scarce services provided by other community organizations. Inpatient Care Usage/Access-barrier 2009-2015 UNC Hospital data obtained shows identified through stakeholder interviews that after an initial decline in mental health- and survey responses related Emergency Department(ED)visits 16 Inpatient Care Usage/Access-barrier between 2009 and 2012,we have begun to see identified through stakeholder interviews a large increase in visits for patients 0-24 and survey responses (cont'd) (51/%).This increase supports reports of ED overcrowding we've received from UNC Hospitals. The percentage increase of youth mental health ED visits is also increasing at a faster rate than overall mental health ED visits (25%compared to 18%.) In the case of substance abuse, 29%of all mental health ED visits for 0-24 year olds are substance abuse related. Disorder/Diagnosis Type -barrier Survey data indicates that generalized anxiety identified through stakeholder interviews disorder and major depressive disorder are the and survey responses two mental illnesses that most frequently affect residents aged 0-25 in Orange County(93% and 89%respectively) and are also the easiest to refer for treatment. Drug and alcohol abuse were also frequent diagnoses (80%of respondents for both) however, only 39%of respondents found them easy to refer for treatment. Schizophrenia spectrum and other psychotic disorders were deemed the most difficult to refer for treatment(25%) and treatment for eating disorders was said to be the most inaccessible (11%). CONCLUSION The most common barriers for people in Orange County aged 0-25 who need mental health and/or substance abuse treatment services were affordability and accessibility. Affordability One of the biggest barriers to accessing services, even when they are available, is the lack of services that are provided based on a person's ability to pay.Any improvement to the mental health system in Orange County will need to address the affordability of these services. Accessibility We found that the ability to access services depends on a variety of factors (service type, location, eligibility and cultural/linguistic appropriateness) all of which have gaps. Certain types of services such as substance abuse treatment and psychiatric care are hard to find. The location of mental health services in the population centers makes them difficult for this age group to access. Restrictions on who can receive services (e.g., age, citizenship, diagnosis) results in decreased access. Finally,the inability to provide needed mental health services in a linguistically and culturally appropriate manner significantly limits access. 17 Next Steps: The Health Department will convene a group of stakeholders to review the detailed results of this gap analysis (survey results attached). This group will prioritize which specific gaps to address first and identify potential programs and services to meet those prioritized needs by February 15, 2017. ACKNOWLEDGEMENTS Thank you to all of the participants who generously gave their time to this assessment. Special thanks to: Orange County Criminal Justice Resource Office (Caitlin Fenhagen) Orange County Health Department (Allison Young, Juliet Sheridan, Coby Austin, Jennifer Sharpe, and Karen Kyes) I Freedom House (Trish Hussey) I El Futuro (Luke Smith and Karla Siu) I Cardinal Innovations (Debra Farrington) I UNC Healthcare (Tammie Stanton) UNC Pediatric Psychiatry (Jack Naftel) I UNC School of Social Work(Josh Henson).