Western Interstate Commission for Higher Education (WICHE)
Western States Decision Support Group (WSDSG) -
Mental Health Statistics Improvement Program (MHSIP)
Jackson, Wyoming, August 2000, Brief anecdotal notes

20 - 30 present

UT wants to publically fund PACT

NM Office of Consumer Affairs job is vacant, being advertised

CA will be having a new round of training sessions for CALMHB/C community members focusing on performance outcomes and data analysis techniques

ID has hired C Joseph Drayton to their Office of Consumer Affairs and Technical Assistance

WYAMI dropped out of the WY consumer survey process because the surveys had no value to WYAMI

WY: Gonzales: Health care is business and we need good management information. Stop labeling kids "sed" (seriously emotional disturbed) - early intervention, health promotion, prevention, healthy communities. People with seriously and persistently mentally ill can not succeed in the community unless we have *healthy* communities. WY will not fund sed and spmi but rather healthy communities, using a public health model and a general blended funding stream.

WY is funding, through the block grant, the NAMI Family-to-Family program for "families who have relatives with brain disorders" "learn all about the biology of brain disorders - known as mental illnesses" "learn how families unite together against this disability" "attend with other family members just like you in a confidential setting"

WY has used the NAPAS model to implement Olmstead and is using the Olmstead plan as a marketing tool for legislative funding. The plan includes a state advance directive protocol.

Leadership Academy is coming to WY. WY Consumer meeting Sept 5/6.

Gilberto Romero has been an inspiration and mentor to Pablo Hernandez, WY M H Administrator

WY is planning to create an independent state-level ombudsman to enhance relations and demonstrate an open democratic and accountable form of public m h service administration.

WY uses deferred admission - a sheriff waits at the hospital during an emergency detention and intervention - often inpatient is avoided

The Oryx data system has seven fields for diagnosis

"Restrictive treatment" means restraints, seclusion

WY had a hospital sensitivity training - psychiatrists in training experienced seclusion, experienced restraints; staff, community members have experienced a 72 hour inpatient experience; hospital culture changed

No WY consumers at meeting.

Ron Manderscheid, CMHS, via speakerphone: October, draft typology of organization and m h financing has been developed; draft core data sets ongoing - encounter (FN11), population, performance indicators; decision support is core data sets linked via Internet based software to produce decisions; 16 state project will be "crafting measures for ACT;" phase two of consumer-oriented report card - second generation MHSIP Report Card including the consumer survey, consumer surveys may need to be varied by context or supplemented; recovery measure needs to be developed; link consumer assessment behavioral health (CABS) and MHSIP consumer survey into combined prototype (echo survey); VA: children’s survey (Child’s Outcomes Roundtable), parents’ survey; January: co-morbidity survey from age 12 to death; household survey of drug abuse released September 1; DSM !V 30 % lower prevalence of smi than from DSM IIIR (SGR 1 in 5 based on which? S.); system: modularity or integration?; U S needs to address "disability adjusted life year" concept - do interventions affect DALY data?; low level end user tech capacity in web based system with high level technology web enabled; Sept 11 planning meeting for May/June 2001 Stats conference; HRSA/Rural federally qualified health centers will include m h.

Study: The amount of improvement doesn’t correlate with the amount of treatment.    (I don't have the detail or citaion or population.  Sylvia)

Integration of data and services was discussed, a common state or national data directory, and using a public health model to coordinate and manage *all* the public services that an individual receives. Integrated databases will follow HIPPA/HFCA requirements and moving in the direction of national health care.

Harding: MAAPS (Multidisciplinary Algorithm for the Assessment of Persons with Schizophrenia).  Most people can improve or recover if the system doesn’t get in the way.  Hospital staff is most frustrated by patients with "treatment resistant schizophrenia." On the average, on intake, it takes 3.5 minutes to give a person a diagnosis of schizophrenia. 26 other disorders masquerade with schizophrenia-like symptoms. Dx of Scx is a rule-out one, and the 26 other disorders ought to be eliminated for accurate diagnosis. Pilot of algorithm in UT, SC: Target reevaluation of long term inpatients for renewed evaluation and treatment planning. Physicians section - 70 minutes, neuro-psychological evaluation - 2 hours; also section for nursing; for social work, for OT. (Since the atypical antipsychotics, side effects are no-longer being evaluated even though some have been on longer term antipsychotics.) Also, potential use of MAAPS for outpatient use for those languishing in community mental health centers. Contact charding@wiche.edu

DC, Sept 7,8 MHSIP Advisory Meeting, Omni Shoreham

From the State Mental Health Agency Profiling System:

Number of State Mental Health Authority operated PACT/ACT teams:
GA - 20; NH - 10; SC - 9, DC - 4, balance 0 -  3

Number of beds: 24 hour State psychiatric hospital inpatient care: CA 4185

Number of beds: 24 hour residential care: GA 6500

Harding, Reassessing a person with schizophrenia and developing a new treatment plan.

16 questions to assist the clinician and investigator

Have other possible causes of symptoms and behaviors been eliminated?
Is there an additional neurological impairment?
Does the person have other medical problems about which to worry?
Who is this person under a coat of illness?
What helps or hinders progress?
What are the specific cognitive deficits being coped with by this patient?
Are the medications really worth the trade-off?
Why is the is the person taking street drugs?
What are the relevant sex differences?
Where is the person in the course of illness?
What myths and misinformation are stresing the patient?
Who depends on the consumer for help?
Is there any cohesion in the system of care?
What is the person's worldview?
What is missing in the person's repertoire for living?
Where do the client and clinician start building the recovery process?  p 320

Many factors can stand in the way of the recovery process.    These factors include socialization into a patient role, limited economic opportunities, medication side effects, lack of rehabilitation, extreme virulence of the illness, lack of staff expectations, and loss of hope  p 324

"The treatment plan should always have a place for strengths listed first and everything else listed after that.  ...    Strengths can include domains not often thought of by the clinicians, such as playing a musical instrument, having a sense of humor, acquiring a driver's license, knowing how to work a computer, taking care of others, watering plants, or even manipulating systmes of care."  p 332

In Barron, Making Diagnosis Meaningful, 1998.  DC: American Psychological Association
(Missing from this otherwise excellent book chapter are any references to abuse.    Sylvia)