IARF Recommendations to the Commission on Government Forecasting and Accountability: Proposed Closures of Chester, Singer, and Tinley Park Mental Health Centers

October 26, 2011

NEWS

The Illinois Association of Rehabilitation Facilities (IARF) represents over 90 community-based providers serving children and adults with intellectual/developmental disabilities, mental illness, and/or substance use dependencies in over 900 locations throughout the state. For over 35 years, IARF has been a leading voice in support of public policy that promotes high quality community-based services in healthy communities throughout Illinois. Approximately 600 licensed and/or certified community-based providers provide services and supports to over 200,000 children and adults in the community system.
IARF believes that a strong network of community providers, including community mental health centers, hospitals, and crisis service providers, are integral to healthy communities in Illinois. Therefore, the Department of Human Services (DHS)’ announcement of its intent to close three state-operated mental health facilities during state fiscal year 2012 is particularly troubling, as this announcement comes at a time when the community system of care is ill-equipped to manage the influx of individuals with serious mental illness due to the result of significant budget cuts over the past four state fiscal years.
However, IARF stands ready to work with the Administration, the General Assembly, and those legislators on the Commission of Government Forecasting and Accountability to put in place those elements that are necessary to ensure the closure of any state-operated mental health facility is done correctly and with the best interests of individuals with serious mental illness and the organizations that support them. As such, we offer the following specific recommendations below, which are more fully explored in the attached document.

Comply with P.A. 97-0438, which statutorily requires DHS’ Division of Mental Health to establish a Mental Health Services Strategic Planning Task Force charged with producing a 5-year comprehensive strategic plan for mental health services by February 2013. The work of this Task Force should focus early discussions on the most appropriate role the state-operated mental health facilities should play in Illinois’ mental health system of care.

Continue funding of all state-operated mental health facilities until early recommendations by the Task Force have been put forward.

Establish networks of willing and geographically appropriate mental health providers, including hospitals and community mental health centers, per the requirements of P.A. 97-0381.

Develop adequate rates and reimbursements to cover the cost of mental health care. This should include re-evaluating the Community Hospital Inpatient Psychiatric Services (CHIPS) program.

Increase community provider contract flexibility to develop aftercare and crisis programs regardless of Medicaid payor source.

Establish a jail diversion program.

Reconsider Preferred Drug List formularies
If meaningful action is taken by the Administration in conjunction with the General Assembly and stakeholders on these recommendations, then IARF has full faith in our members’ ability to assist with the Administration’s policy goals of closing state-operated mental health facilities. However, until such time as these recommendations are implemented, IARF cannot support the closure of Chester Mental Health Center, Singer Mental Health Center, or Tinley Park Mental Health Center according to the timeframes or the implementation plans established by DHS in its recommendations to the Commission.

Comments on the Announcements
The announced closures of the Chester, H.Douglas Singer, and Tinley Park Mental Health Centers present an important opportunity for discussion on the future of services and supports for persons with mental illness in Illinois. While IARF is very familiar with the state budget development process, the approach and the timing of the announcements caught most community mental health providers by surprise. The timeframe for the announced closures, which has subsequently been expressed during individual closure hearings, are purely driven by reductions in the state fiscal year 2012 budget, not necessarily by a policy endorsement by the Administration. These announced closures, compliance with the Williams consent decree, as well as the forthcoming Colbert consent decree require the community-based system of mental health care to serve far past the capacity for which it is currently funded.
Many issues drive the discussion of serving individuals with mental illness in Illinois in the least restrictive setting that meets the individual’s stated goals and service needs, which are outlined below. The Association has full faith in our members’ ability to assist with the service needs for most individuals currently served in state-operated mental health facilities. That confidence is built on the assumption of sound planning, which ensures community mental health providers’ ability to build capacity to support individuals who might no longer be supported at the state facilities. It is also based on the requirement that state resources will supplement – and not supplant – current resources supporting individuals currently receiving community-based mental health care.
Closure Process: Issues and Solutions
The proposed closure of three state operated facilities – which is being driven by budgetary concerns – is forcing the DHS Division of Mental Health to restructure its hospital system more rapidly than it otherwise intended, and without the benefit of stakeholder discussions. The restructuring plans the Division has outlined to-date, which is a state provided system of only forensic care, will take time to implement and require community support to address the proposed closure of inpatient psychiatric beds in the state facilities. Non-forensic individuals currently served at Chester, Singer, and Tinley Park do not reside at the facility, but are provided hospital care when facing an acute episode.
Issue(s):

There is no plan in place to address the existing gap in community-based mental health care services and supports, not to mention the dramatic loss of psychiatric beds the existing closure recommendations would create.
Solution(s):

The Administration must comply with P.A. 97-0438, which statutorily requires DHS’ Division of Mental Health to establish a Mental Health Services Strategic Planning Task Force charged with producing a 5-year comprehensive strategic plan for mental health services by February 2013. The work of this Task Force, which will include community stakeholders, should focus early discussions on the most appropriate role the state-operated mental health facilities should play in Illinois’ mental health system of care.
Issue(s):

The removal of 1,200 acute psychiatric beds from the state operated hospital system when 84 counties are already without a psychiatric unit will have a detrimental effect on the 18.1% of Illinoisans suffering with some form of mental illness, unless the capacity to serve the needs is enhanced in community settings.
Solution(s):

Continue funding of all state-operated mental health facilities at state fiscal year 2011 levels until early recommendations by the Task Force have been put forward establishing the proper role of state facilities in the mental health system of care.
Issue(s):

In the last twenty years, private psychiatric hospital beds have declined from 5,350 to 3,186 – a loss of 2,164 beds. Hospitals are not currently prepared to serve the complex psychiatric needs of individuals that would transfer out of the state facilities, as staffing, environment, and psychiatric programs would need to change.
Solution(s):

Establish networks of willing and geographically appropriate mental health providers, including hospitals and community mental health centers, per the requirements of P.A. 97-0381. This Act requires the creation of Regional Integrated Behavioral Networks.
Issue(s):

Funding for community-based mental health care services and supports has been cut 46% since state fiscal year 2009. In addition, the Community Hospital Inpatient Psychiatric Services (CHIPS) program was eliminated in 2009.
Solution(s):

Develop adequate rates and reimbursements to cover the cost of mental health care. This should include re-evaluating the Community Hospital Inpatient Psychiatric Services (CHIPS) program.

At a minimum, the General Assembly must restore the inadvertent $30 million reduction to mental health grants in the DHS Division of Mental Health’s budget by passing SB 2407.
Issue(s):

Due to the disproportionate number of unfunded individuals served by the state-operated facilities, many individuals with mental illness with not be provided proper care in the community. While hospitals are required to provide care, there are no services available upon discharge. Although stabilized, many individuals without Medicaid face barriers filling medication and finding an accepting psychiatrist after discharge.

Due to these circumstances and the lack of appropriate crisis services, recidivism remains high.
Solution(s):

Increase community provider contract flexibility to develop aftercare and crisis programs regardless of Medicaid payor source. Contracts with DHS’ Division of Mental Health have become rigid and reduce the flexibility of community providers to operate programs that target the individual needs of those they serve.

An aftercare program funded by the state to serve individuals both eligible and non-eligible for Medicaid could alleviate the pressures on the acute system of care. In addition, the development of an adult crisis system, similar to the children’s Screening, Assessment, and Support Services (SASS) program could be effective for short-term crisis care and could be directed toward the gap in services for the adult population.
Issue(s):

In July and August of this year, 2,453 individuals from only eight Illinois counties cross matched in both the Department of Corrections and Division of Mental Health. These individuals were both reported to receive services from a Division of Mental Health contracted providers and were admitted to one of the eight county
jails. There are more individuals in Cook County jails with mental illness than all state-operated mental health centers collectively.
Solution(s):

The DHS Division of Mental Health and the Department of Corrections must work collaboratively with stakeholders, including the county sheriffs, to develop a jail diversion program.
Issue(s):

Along with the inability to access medication, many individuals on Medicaid face recent instability due to the Department of Healthcare of Family Services (HFS)’ limitations on psychotropic medications. The changes to the Preferred Drug List have caused individuals with mental illness to go from stable to unstable, creating a higher need for acute and crisis care in the community. Although promised to be “grandfathered,” individuals were often denied authorization if their medication dose was adjusted. The new formulary also restricted the number of preferred injectables as an ideal method of medication management for individuals with high numbers of hospital admissions.
Solution(s):

The fiscally driven changes to the Preferred Drug List formularies should be reconsidered by HFS as it pertains to Medicaid-eligible individuals with mental illness.
IARF is Solution Driven
As shown by this list of recommendations, IARF is solution driven and stands ready to work with the Administration, the General Assembly, and those legislators on the Commission of Government Forecasting and Accountability to put in place these recommendations that are necessary to ensure the closure of any state-operated mental health facility is done correctly and with the best interests of individuals with serious mental illness and the organizations that support them.
However, in order to implement these recommendations, the state must openly and honestly commit to do what is necessary to invest resources that will re-vitalize the vision of an all-inclusive community system. Without adequate investment in community mental health services, consumers and their families will suffer, and there will be an increased need for expensive crisis care. Without proper supports, the community and individuals with mental illness will face continued hardships.

http://www.iarf.org/uploads/docuploads/forums/jevan06s/Position%20Papers/SOMHF%20Closure%20Recommendations%20for%20COGFA%2010-25-11.pdf

 

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