Illinois Insurance Law 26 Self Funded

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					Illinois Department of Human
           Services


Division of Mental Health Services and
          Forensic Initiatives

             April 23, 2009
                        Presenters

   Anderson Freeman, PhD., Director, Forensic Services
   Jordan Litvak, Executive Director, Region 3&4
   Gustavo Espinosa, Executive Director, Region 1 Central
   James Novelli, Executive Director, Region 5
   Robert Granger, Acting Executive Director, Region 1 South
   Dan Wasmer, Acting Director of Region Services




                                                            2
      Hospital-Based Care

• There are 9 State Operated
  Hospitals h mental illness.
• There are 23 private hospitals
  providing care funded by DMH
  under the Community Hospital
  Inpatient Psychiatric Services
  (CHIPS) contracts.
    Illinois
 Department of
Human Services
  Division of
Mental Health
State Operated
   Facilities
Catchment Area
Map by Hospital
      DMH Community Providers

• Regions manage contracts with 149 private
  provider organizations.
• Each provider operates a different array of
  program and residential sites.
• Some providers operate 1 site, others operate
  multiple sites.
• DHS/DMH sets standards the providers must
  conform to maintain certification.
• Individual services must comply with Rules and
  Regulations set by DHS/DMH.
                DMH Vision


It is the vision of the DMH that all persons with
 mental illness recover, and are able to participate
            fully in life in the community.

       “The Expectation is Recovery!”
     Three Ways to Access DMH
           Service System
1. Consumer request for services at local
   Community MH Center.
2. Consumer in crisis presents at a local community
   hospital emergency room.
3. Family and/or friends can go to the Cook County
   States Attorney’s Office to get a Writ of
   Detention.
           Local Emergency Room

 A common entry point for the public MH system.
 Result in the patient receiving:
     Medical Clearance
     Psychiatric Evaluation
     Benefits Clearance
     Pre-screening by community MH provider
          )Relationship building
          )Offer less restrictive, community based alternative
          )Begin discharge planning
       Emergency Room [Continued]

 If hospitalization needed -- three choices:
  1.   Private community hospital admission using
       insurance/other coverage;
  2.   Private community hospital admission using
       CHIPS funding from DMH; or
  3.   Transfer to State Operated Hospital.
Emergency Room [Continued]

 Sometimes hospital crisis workers, or community
  agency crisis workers co-located at the emergency
  room, will help construct a plan by which the
  individual can leave the ER without hospitalization.
 When this happens, the individual may be
  immediately linked or rapidly linked to community-
  based services.
        Principals of Recovery


 Hope                                                Non-Linear
 Self-Direction                                      Strength – based
 Individual and Person-                              Peer support
  Centered                                            Respect
 Empowerment                                         Responsibility
 Holistic
            Excerpts from the Goal of Services in a Transformed Mental Health System
          Prepared by: Nanette Larson, Director of Consumer Recovery Support Services
      DMH Community-Based Services:

      Designed for People who have
      a Serious Mental Illness (SMI) or a Serious
      Emotional Disorder
   Schizophrenia                Bipolar Disorders
   Schizophreniform Disorder    Major Depression
   Schizo-affective disorder    Obsessive-Compulsive
   Brief Psychotic Disorder      Disorders
   Psychotic Disorder NOS       Anorexia Nervosa
                                 Bulimia Nervosa
           DMH Funded Services


 Assertive Community          Counseling/Therapy
  Treatment (ACT)              Psychiatric evaluation,
 Case Management               medication administration &
 Community Support             monitoring
  (Team, Group, Individual)    Supported Residential
 Crisis Intervention          Supervised Residential
 Psychosocial                 Permanent Supportive
  Rehabilitation                Housing (New)
   Valued Approaches to People Recovering
        from a Serious Mental Illness

 Wellness Recovery        Individual Placement
  Action Planning           and Support
  (WRAP)                   Rapid engagement in
 Peer Support Services     job search, job
 Mental Health and         development and
  Justice Initiatives       retention,
 Diversion activities     Ongoing supports
    How to locate a mental health
              center?
By computer:
www.illinois.gov/government/agency.cfm
Scroll to: Department of Human Services, then down to
  Office Locator
Type in: Mental Health; Look up by County. For Cook
  County type in Zip Code. The nearest MH Center will be
  listed .
 Via phone call:
 1 (800) 853-6154 (voice)
 1 (800) 447-6404 (TTY)
                  DMH Regional Offices

   Regional Directors represent the Division of Mental Health
   Monitor state contracts with community mental health agencies
   Help Coordinate Services with other Divisions.
   Work towards integrating services.

   Region 1 North – (773) 794-4139
   Region 1 Central – (708) 338-7200
   Region 1 South – (708) 614-4002
   Region 2 (collar counties) – (847) 742-1040 #2002
   Region 2 (northwest)- (815) 987-7910
   Regions 3 and 4 (central) – (217) 786-6866
   Region 5 (metro east southern) – (618) 474-3348
   Region 5 (southern) – (618) 833-8266
       An FYI -- Illinois Mental Health Collaborative
          for Access and Choice (The Collaborative)


 Serves as a third party administrator for the Division of
  Mental Health
 Processes claims and maintains the DMH data base
 Supports DMH monitoring of services
 Supports DMH Recovery Services, including “Warm Line”
 Provides centralized clearing house for complaints:
       (866) 359-7953 (voice)
       (866) 880-4459 (TTY)
Questions
BREAK
Mental Health and Justice System
Transformation: Special Projects




       Anderson Freeman, Ph.D.,
   Deputy Director for Forensic Services
     Three Cs of Transformation

 Capacity Building
 Continuum of Care
 Collaboration

…….For the Justice Involved Individual with
 SMI and Co-Occurring Disorders
         DMH Community Treatment Data (2006)


 2,244 consumers of 129,564 consumers were UST or NGRI
 2,872 consumers of 129,564 were referred by corrections or under
  court supervision (parole or probation)
IDOC & Jail Data
    Based on IDOC data approximately 3000 or 10% of all
     inmates paroled in a given year have serious mental health
     issues that necessitate care in the community.
    Cook County Jail which has a daily census ranging from 9,000
     to 11,000 treats 10% of the jail population for serious mental
     illness.
    There 22,000+ jail beds in Illinois. Researchers estimate that
     10% -16% of detainees have serious mental illness.
              Data-Link July 1, 2007 - May 20, 2008

                Will   Peoria   Jefferson Marion   Proviso   Cook*
JailAdm.        7620   13409    2518      2188               75140

JailAdmU        6450    9016    1913      1684               62398

Positve X       1010    1528     292       368      514       4476

PositiveUX       786     934     202       251      387       3546

#exclus.         663     730      83       172      353       1292

#elig. Link      123     204     119       79        34       2254

Actual Link      118     184     119       79        31        168

30 Day           47       77      26       43        15         25
                Top Ten High Impact IDOC Re-Entry
                    Regions in Illinois (2004 data)
County/Community        % of Parole   Population   Parole       Rate #Parolees   Recidivism Rate
Ranked / Parole Rate    Population                 Population   per 100,000      (%)

Macon                   1.9           114,706      689          6.0              50.1
(Decatur)
Cook                    59.7          5,376,741    19,561       3.6              57.4

Winnebago               2.8           284,313      930          3.1              51.6
(Rockford)
Peoria                  1.8           183,433      571          3.1              60.7
Champaign/              2.3           262,969      764          2.9              54.4
Vermillion
Jefferson               0.3           40,045       105          2.6              54.4
Sangamon                1.5           114,706      460          2.4              54.6
(Springfield)
Rock Island             0.8           147,912      273          1.9              45.4
St. Clair /Madison      3.1           258,606      416          1.8              54.2
(East St. Louis)                      261,689      534
Collar Counties (esp.   9.8           2,954,577    3,223        1.1              n/a
Aurora)
    DMH Justice & Mental Health Transformation
                      Goals


 A Recovery Oriented System for
  Individuals with mental illness who are
  involved in the criminal justice system.

 Improved continuum of mental health
  care for individuals involved with the
  criminal justice system.
                                   Sequential Intercepts for Change: Criminal Justice - Mental Health Partnerships


Intercept 1                                   Intercept 2                                       Intercept 3        Intercept 4                Intercept 5
Law enforcement /                             Initial detention / Initial                       Jails / Courts     Reentry                    Community corrections/
Emergency services                            court hearings                                                                                  Community support

                                                                                                                                            Violation
                                                                                                          Courts




                                                                                                                                                         Parole
      Dispatch
        911




                                                                                                                                 Prison
                 Law Enforcement
 COMMUNITY




                                                                                                                                                                     COMMUNITY
                                                         Initial Detention




                                                                             Initial Hearings
                                     Arrest




                                                                                                                                                         Probation
                                                                                                                                            Violation


                                                                                                            Jail




                                                                                                                            Jail Re-entry
           Transformative Activities

 Cook County Jail Diversion Community Re-integration Collaborative
  (SMHSA Grant 2006-2008)
 Jail Data Link Expansion 2 (ICJIA)
 Transformation Transfer Initiative/MHJ Regional and Statewide System
  Mapping (NASMHPD)
 Veterans Re-integration Initiative (SAMHSA Grant 2009)
 Mental Health Court Association Development
 Integrated Mental Health Court Database (Partnership with Justice
  Kathryn Zenoff and Council of State Governments)
 Mental Health and Justice Center of Excellence (BJA Grant Application
  3/12)
 Mental Health Juvenile Justice Program Expansions
             Examples of Impact of
            Transformation Activities
 Jail Data Link Program County Expansions
 Additional CIT officers trained (over 800 trained in Cook
  County)
 Expanded Cook County Mental Health Court
 Statewide Mental Health Court Expansions (over 300
  participants)
 Veterans Re-integration Initiative projects in Cook County
  and Rock Island
 Regional Mental Health and Justice stakeholder groups
 Judiciary Involvement
 Development of an Integrated MHC Database
 Development of a Center of Excellence for Mental Health
  and Justice (BJA grant application)
     Description of Jail Data Link

The Jail Data Link program provides a web based computer
 cross match between the census in county jails and open
 DHS cases. The program identifies individuals in our
 targeted mental health population that should have been
 involved in services with community mental health
 providers, but have been detained in jail. The program also
 provides case managers located with community providers
 that provide linkage to community services from county
 jails.
       Contact Information



Anderson Freeman, Ph.D.
Anderson.Freeman@Illinois.gov
(312) 814-1646
    DMH Justice & Mental Health Transformation
                 Goals (continued)

 Increased collaboration between system
  partners and stakeholders to facilitate federal
  funds to the state, advocacy for helpful
  legislation, and expansion of existing initiatives
  and practices.

 Improved integration with Illinois county court
  systems in responding to Forensic and
  MH/Criminal Justice issues.
                                Winnebago
                                            McHenry
                                MHC         MHC
                          PRU                         Lake         Cook
                                                      MHC          Proviso
                                                                   MHC
                                                                   Dupage
                                                                   MHC
                                                                                         PRU
                                                                             Cook
            Rock Island                                                      MHC
            MHC
                                                                    JDL

                                                                      Kane
            PRU                                                       MHC
                                                             JDL
JDL

                                                                    Illinois Mental
                                                                       Health &
                                                                    Justice Adult
                                                                       Diversion
      PRU
                                                                      Initiatives
                                                                   MHC = Mental Health
                                                                   Court

              PRU                                                  JDL = Jail Data Link
                                                                   Program (DMH)
             Madison
             MHC                                                   CIT = Police Crisis
                                                        PRU        Intervention Team

                                                                   PRU = Placement Resoure
                                                                   Unit (IDOC)
                                                       JDL
   Sample Case #1 -- Region 3 & 4


Steven -- Illustrates how people released
  from DOC informally make their way into
  DMH funded programs. At the same time,
  it underscores the risk factors that could be
  avoided if a coordinated referral and
  linkage effort was in place between these
  service sectors.
      Sample Case #2 -- Region 5


Alex – Illustrates how collaboration between
 the Probation Office and the local
 Community MHC can help to titrate
 services from each partner to match need
 of the individual over time.
      Sample Case #3 – Region 1


John -- A case that illustrates how some
  cases take continued hard work by all
  partners over time. Partners do much to
  keep each other going under circumstances
  that would overwhelm a single provider.
   Sample Case #4 -- Region 3 & 4


Sally -- A case that illustrates how existing
  relationships between Probation Office
  and Community Provider can pave the
  way for quick response to emergent needs
  that might otherwise cause a person to
  loose ground or return to an institution
  (prison/hospital/or both).
      Sample Case #5 -- Region 5


Jeremy -- A case that illustrates how the
  addition of a court order to existing ACT
  services helped a homeless person with a
  history of violence find stable housing,
  stay off drugs, make friends, and begin to
  re-connect with family.
    Sample Case #6 – Region 3&4


Bobby -- A case that illustrates how
 “disconnects” from DOC to community
 public mental health services could create
 high risk situations for the individual, the
 community MHC, and the Department of
 Correction.
      Sample Case #7 -- Region 5


John II -- A case that illustrates how the
  addition of mental health court oversight
  helped to bring very troublesome
  symptoms, which were not previously
  controlled by mental health care alone,
  under control and lead to positive steps to
  recovery.
Questions

				
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