Table Of ContentUMASS/AMHERST
3izobt,oisfl 72487 3nweaith of Massachusetts
Human
Executive Office of Health and Services
Department of Mental Health
&
Adult Child-Adolescent
Progress Reports
on the
Comprehensive
Mental Health
Service
Plan
Fiscal Year 1992
December 31, 1992
Digitized by the Internet Archive
2014
in
https://archive.org/details/adultchildadolesOOmass
COMMONWEALTH OF MASSACHUSETTS
EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES
DEPARTMENT OF MENTAL HEALTH
Adult & Child-Adolescent
Progress Reports
on the
COMPREHENSIVE
MENTAL HEALTH
SERVICE PLAN
Fiscal Year 1992
Submitted as part of the 1993 Block Grant Application (P.L. 102-321)
December 31, 1992
Comprehensive Mental Health Plan Progress Report December. 1992
Massachusetts Department of Mental Health TABLEOFCONTENTS
TABLE OF CONTENTS
INTRODUCTION
1
PART A: IMPLEMENTATION REPORT TOPICS/ADULT
PROGRESS REPORT
7
REQUIREMENT
#l: Establishing and implementing an organized
community-based system of care for individuals with serious mental
illnesses 9
REQUIREMENT
#ll Specifying quantitative targets to be achieved in
the implementation of such system, including numbers of individuals
with serious mental illnesses residing in the areas to be served
under such system 21
REQUIREMENT
Describing available services, available
treatment options, and available resources (including Federal, State
and local public services and resources and to the extent practicable,
private services and resources) to be provided to individuals with
serious mental illnesses 2 9
REQUIREMENT
#IV: Describing health and mental health services,
rehabilitation services, employment services, housing services,
educational services, medical and dental care, and other support
services to be provided to individuals with serious emotional and
mental disorders with Federal, State and local public and private
resources to enable such individuals to function outside of inpatient
or residential institutions to the maximum extent of their
capabilities 4 1
REQUIREMENT #V: Describing the financial resources and staffing
necessary to implement the requirements of such plan; including
programs to train individuals as providers of mental health services,
and the plan emphasizes training of providers of emergency health
services regarding mental health 4 9
Comprehensive MentaJ Health Plan Progress Report December. 1992
TABLEOFCONTENTS
Massachusetts Department of MentaJ HeaJth
REQUIREMENT #VI: Providing activities to reduce the rate of
hospitalization of individuals with serious mental illnesses 6 1
REQUIREMENT
#VII
:
(A) Requiring the provision of case management services to each
individual with a serious mental illness in the State who receives
substantial amounts of public funds or services.
(B) Providing that the requirement of sub-paragraph (A) will not be
substantially completed until the end of fiscal year 1993 6 7
REQUIREMENT #VIII: Providing for the establishment and
implementation of a program of outreach to, and services for,
individuals with serious mental illnesses who are
homeless 71
REQUIREMENT
#X: Describing the manner in which mental health
services will be provided to individuals with serious mental illnesses
residing in rural areas 77
REQUIREMENT
#XI: Containing an estimate of the incidence and
prevalence in the State of serious mental illness among adults and
serious emotional disturbance among children 7 9
PART B: IMPLEMENTATION REPORT TOPICS/CHILD-ADOLESCENT
PROGRESS REPORT 81
REQUIREMENT
#l: Establishing and implementing an organized
community-based system of care for children with serious emotional
and mental disorders 8 3
Comprehensive Mental Health Plan Progress Report December. 1992
Massachusetts Department of Mental Health TABLEOFCONTENTS
REQUIREMENT
#11 Specifying quantitative targets to be achieved
in the implementation of such system, including numbers of
individuals with serious mental illnesses residing in the areas to be
served under such system 91
REQUIREMENT
#111: Describing available services, available
treatment options, and available resources (including Federal, State
and local public services and resources and to the extent practicable,
private services and resources) to be provided to individuals with
serious mental illnesses 97
REQUIREMENT
#IV: Describing health and mental health services,
rehabilitation services, employment services, housing services,
educational services, medical and dental care, and other support
services to be provided to children with serious emotional and mental
disorders with Federal, State and local public and private resources
to enable such individuals to function outside of inpatient or residential
institutions to the maximum extent of their capabilities, including
services to be provided by local school systems under the Individuals
with Disabilities Education Act 105
REQUIREMENT
#V: Describing the financial resources and staffing
necessary to implement the requirements of such plan; including
programs to train individuals as providers of mental health services,
and the plan emphasizes training of providers of emergency health
services regarding mental health 111
REQUIREMENT
#VI: Providing activities to reduce the rate of
hospitalization of individuals with serious mental illnesses 117
REQUIREMENT
#VII
:
(A) Requiring the provision of case management services to each
individual with a serious mental illness in the State who receives
substantial amounts of public funds or services.
(B) Providing that the requirement of sub-paragraph (A) will not be
substantially completed until the end of fiscal year 1993 1 21
Comprehensive Mental Health Plan Progress Report December. 1992
Massachusetts Department of Mental Health TABLEOFCONTENTS
REQUIREMENT
#VIII: Providing for the establishment and
implementation of a program of outreach to, and services for,
individuals with serious mental illness who are
homeless 125
REQUIREMENT
#IX: In the case of children with a serious
emotional disturbance, providing for a system of integrated social
services, educational services, juvenile services, and substance
abuse services that, together with health and mental health services,
will be provided in order for such children to receive care appropriate
for their multiple needs (which includes services provided under the
Individuals with Disabilities Education Act) 129
PART C: STATE MENTAL HEALTH PLANNING COUNCIL 135
Members
Affiliations
APPENDIX
FY'93 Budget Overview
Revenue Comparison Chart
Multi-Cultural Programs
DMH
Policy #87-3 (Case Management)
DMH
Policy #89-3 (Priority Clients)
Comprehensive Mental HealthPlan Progress Report December. 1992
Massachusetts Department of Mental Health Introduction
INTRODUCTION
The September, 1991 Progress Report outlined the Massachusetts Department of
Mental Health's (DMH) commitment to the planning and development of a consumer
driven, comprehensive system of care for seriously mentally ill adults and seriously
mentally and severely emotionally disturbed children and adolescents. DMH's
ill
goals for accomplishing this task were embodied in the concepts of public Managed
Care, Accountability and Partnership. DMH has made remarkable progress
toward achieving a community based system of care since the inception and
implementation of the P.L.99-660 planning process.
DMH is presently engaged in a comprehensive reorganization of its service system.
This reorganization is aimed at shifting resources from state hospital inpatient care to
an expanded community based service system for adults, children and
adolescents that is responsive to the preferences and needs of its recipients and
removes barriers to access often experienced by communities of color, multicultural
and linguistic minority groups. It has involved hundreds of consumers, family
members, providers, advocates and professionals as well as DMH staff Public
Managed Care, the goal of DMH's initiative to restructure its system, is predicated on
the building of a community based system of care and an anticipated reduction in
DMH
utilization of inpatient care. has utilized facility closure and consolidation,
privatization of acute inpatient care and collaboration with the Medicaid division of the
Department of Public Welfare's mental health and substance abuse managed care
initiative as the mechanisms to achieve its goal.
The Department closed two of its seven (adult) state hospitals in FY*92 A third will be
closed in May, 1993 A total of 543 new residential beds were added during the year
to expedite the closure and consolidation process. In addition, the Governor's Special
Commission recommended closing the Gaebler Children's Center, the only state
1
Comprehensive Mental Health Plan Progress Report December, 1992
Massachusetts Department of Mental Health Introduction
hospital for children 14 and under, in favor of community-based alternatives. This was
accomplished on September 30, 1992. These closures enable DMH to redirect state
hospital funding to the development of acute inpatient care (for adults in general and
private psychiatric hospitals), intensive residential treatment (for adolescents),
community residential, case management, day and other home-based and community
support services, and to close facilities that are often removed from the locus of
community services and supports. In particular, the transfer of acute inpatient care
from state to community hospitals is intended to reduce somatization of the seriously
mentally by integrating mental health care into the general health care system.
ill
Furthermore, the Department intends to take the necessary steps to ensure that all
remaining state hospitals, community mental health centers and other eligible
community programs receive and/or maintain certification and accreditation The pace
and magnitude of this change are unprecedented for the Commonwealth.
The development of public managed care will only be as effective as the
organizational context within which it is incorporated. Therefore, the community based
service system is not only being expanded, but it is also being reorganized into a
Comprehensive Community Support System (CCSS) design, in each "natural service
area" of the state This initiative, described in the last P.L. 99-660 Progress Report,
resulted in the Commissioner's approval of identified "natural service areas" in eight of
the nine DMH Areas The CCSS design will enable the various system components to
be better coordinated and consumer driven, will facilitate linkages among the various
system components and is expected to be more flexible and responsive to consumer
and family need, populations with special service needs and multicultural and
linguistic minority groups Through the CCSS, the Department will be able to manage
the entire array of services consumers need and receive. In order to ensure
accountability, accessibility - including access for cultural and lingustic minorities -
quality and cost effectiveness, the Department is developing a comprehensive quality
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