Vermont Department of Mental Health FY2020 BUDGET PRESENTATION SARAH SQUIRRELL, COMMISSIONER MOURNING FOX, DEPUTY COMMISSIONER SHANNON THOMPSON, FINANCIAL DIRECTOR March 19, 2019 "There is no health without mental health." 1
Proposed Agenda DEPARTMENT OVERVIEW DEPARTMENTAL BUDGET RESULTS BASED ACCOUNTABILITY (RBA) March 19, 2019 "There is no health without mental health." 2
Departmental Overview DEPARTMENT RESPONSIBILITIES SYSTEM OF CARE COMMUNITY PROGRAMS MAP OF SYSTEM BED CAPACITY March 19, 2019 "There is no health without mental health." 3
Overview Budget $266 M Oversight, Designation and Collaboration with: 10 Designated Agencies 2 Specialized Service Agencies 7 Designated Hospitals Operations of Vermont Psychiatric Care Hospital (25 beds) Operations of Middlesex Therapeutic Care Residence (7 beds) 320 staff, 255 at the facilities, 62 at Central Office Central Office Units: Administrative Support, Financial Services, Legal Service, Research & Statistics, Clinical Care Management, Operations, Policy & Planning, Quality Management, Child, Adolescent & Family, Adult Mental Health Services 25,000 people served through the DA/SSA system with even more served through Community Outreach, Emergency Services, and Crisis Teams Other Notable Partnerships: Child and adolescent psychiatric fellowship at UVM, Vermont Federation of Families for Children's Mental Health, Center for Health and Learning, Vermont Psychiatric Survivors, National Alliance on Mental Illness VT, Pathways Vermont and many others. Collaboration with sister departments, hospitals, other community providers, One Care, police departments, courts and others March 19, 2019 "There is no health without mental health." 4
Designated Providers Designated Hospitals Designated Agencies • Brattleboro Retreat • Clara Martin Center • Central Vermont Medical Center • Counseling Services of Addison County • Rutland Regional Medical Center • Health Care and Rehabilitation Services of Southeastern • University of Vermont Medical Center Vermont • Windham Center • Howard Center • Vermont Psychiatric Care Hospital (State-run) • Lamoille County Mental Health Services • White River Junction VA Medical Center • Northwest Counseling and Support Services • Northeast Kingdom Human Services • Rutland Mental Health Services • United Counseling Service • Washington County Mental Heath Services Specialized Services Agencies State Secure Residential • Pathways Vermont • Middlesex Therapeutic Community Residence • Northeastern Family Institute (State-run) March 19, 2019 "There is no health without mental health." 5
March 19, 2019 "There is no health without mental health." 6
Department of Mental Health Adult Mental Health System of Care Community Mental Health Color Legend Providing an array of service and supports to adults seeking mental health services Department of Services Programs Mental Health (DMH) • Individual, family, and group therapy • Community Rehabilitation and Treatment • Medication and medical consultation • Adult Outpatient • Clinical assessment Designated Agencies • Service planning and coordination private, non-profit service providers that • Community supports are responsible for ensuring needed services • Employment services are available through program delivery, local • Housing and home supports planning, service coordination, and monitoring • Group residential living outcomes within their geographic region. • Individual support throughout the continuum of care • Peer programming Specialized Services Agencies private, non-profit service providers that provide a distinctive approach to service Emergency Mental Health delivery and coordination or provide services Providing services and supports to adults in crisis that meet distinctive individual needs. Services Programs • Mobile Crisis • Emergency Mental Health Private Providers • Crisis assessment, support, and • Team Two Psychiatrists, Psychologist, Nurse Practitioners, referral Social Workers Physician Assistants, Licensed • Continuing education and advocacy Mental Health Clinicians, Community Hospitals Crisis Beds Programs – providing extra support to adults in crisis to prevent hospitalization Inpatient Hospitalization – providing service to adults at risk of harm to self or others Intensive Residential Programs – providing additional services to adults recently discharged to support recovery Secure Residential Program – providing services to adults to support recovery in a secure environment Peer Run Residential Programs- providing individual support throughout the continuum of care March 19, 2019 "There is no health without mental health." 7
People Served by Program AOP CRT C&F ES 12,000 10,661 10,000 8,000 Numbers Served 6,905 6,000 6,567 4,000 2,640 2,000 0 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 Fiscal Year March 19, 2019 "There is no health without mental health." 8
March 19, 2019 "There is no health without mental health." 9
Departmental Budget SUMMARY AND HIGHLIGHTS FY20 PROPOSED EXPENSES FY20 BUDGET REQUEST (UPS/DOWNS) March 19, 2019 "There is no health without mental health." 10
Agency of Human Services, FY 2020 SUMMARY & HIGHLIGHTS Department of Mental Health FY 2020 Governor’s Recommend Budget DMH Budget Ups - Gross: $28,166,091 GF Equivalent: $13,353,343 • Salary and Fringe • Increase Physician Contract with UVMMC MISSION: to promote and improve the mental health of • Additional VPCH Revenue Vermonters. VPCH Contracts – Travel Nurses • • Internal Service Fund Changes Mental health will be a cornerstone of health in Vermont. People will live in caring communities with compassion for • HUD Funding Replacement for Howard Center Branches and a determination to respond effectively and respectfully • Kids Residential Cost and Case Load to the mental-health needs of all citizens. Vermonters will • Room & Board Phasedown have access to effective prevention, early intervention, and Adult CRT Enhanced Plans • mental-health treatment and supports as needed to live, • ADS True-up from AHS Central Office (AHS Net Neutral) work, learn, and participate fully in their communities. • Success Beyond Six (Match Paid by Schools) • DVHA to DMH for Payment Reform (Net Neutral) Governor's Recommend Budget Department of Mental FY 2020 ($266,606,504) DMH Budget Downs – Gross ($4,812,884), GF Equivalent: ($2,270,553) • Eliminate Sheriff Supervision in EDs • DMH Contract Savings General Fund Medicaid GCF $7,694,909 • Operating Savings $193,297,130 3% Grant Savings/Reductions • 73% • Allocation of AHS-Wide Grant Reduction Plan Federal Funds $9,132,390 • NCSS ABA Funds Move Back to DVHA (Net Neutral) 3% • ISB Funds Move Back to DCF (Net Neutral) Interdepartmental Transfer Other DMH Budget Neutral $73,248 Medicaid 0% 12 New Level 1 Beds Beginning 2 nd half of 2020 Investment GCF • $55,223,923 21% Special Funds $1,184,904 0% March 19, 2019 "There is no health without mental health." 11
FY 2019 & 2020 NOTABLE HIGHLIGHTS FY20 • $17.9M in additional investment in Success Beyond Six to support School Based Mental Health Programs • Increased funding for children’s residential (PNMI – private non-medical institutions) • Additional funding to support Branches a community residential program of the Howard Center • Increased funding for Adult CRT Enhanced Plans • Funding for 12 new level 1 beds at the Brattleboro Retreat • Successful implementation of Mental Health Payment Reform – children and adults (Jan 2019) FY20 Capital Bill • $5M in funding allocated towards the replacement of Middlesex Secure Residential FY19 & FY19 BAA • Successful realization and implementation of several grants and pilots advancing integration of mental health, health care and collaboration with public education • Expanded Hospital Diversion Program to add 6 beds for children and adolescents in southern Vermont (Cont. FY19) • Funding to establish Community Outreach Teams in Chittenden County (Cont. FY19) March 19, 2019 "There is no health without mental health." 12
FY20 Proposed Expenses DMH Admin AOP, Adult Community $8,388,274 Partners and Other Adult 3% Grants and Contracts Level 1 AOP, Adult Community Partners and Other Adult $15,741,801 $8,711,618 Grants and Contracts 6% 3% MTCR Emergency Grants $2,972,125 VPCH 1% $23,467,380 Peer Supports 9% Children's PNMI Residential CRT Childrens Services $7,002,114 $63,967,908 3% 24% Success Beyond Six/CUPS Children's PNMI Residential Success Beyond Six/CUPS $72,250,289 MTCR 27% Emergency Grants VPCH $8,517,462 3% Level 1 Childrens Services Peer Supports $53,087,766 $2,499,767 20% 1% DMH Admin March 19, 2019 "There is no health without mental health." 13
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