Human Services

Chemical & Mental Health

Statewide Outcome(s):

The Chemical & Mental Health Services Administration supports the following statewide outcome(s).

Minnesotans are healthy.

Strong and stable families and communities.

Context:

In order to meet the shifting needs of adults with mental illness, children with an emotional disturbance or those struggling with substance abuse problems, the Department of Human Services (DHS) Chemical and Mental Health Services Administration (CMHS) works to ensure that the state has an accessible and comprehensive system for delivering treatment and supports for persons with mental illness and/or substance addiction.

The life expectancy of persons with serious mental illness is, on average, 25 years shorter than the general population. The causes of physical illness and death among people with serious mental illness are the same as those in other groups - smoking, obesity, diabetes - and are just as treatable.

About half of persons who have a serious mental illness also have a substance use problem. Research has found that integrating mental health and chemical dependency treatment is more effective than parallel services or completing treatment in one specific area (i.e. mental health) and then receiving treatment in the other area (i.e. chemical dependency).

Finally, the impact of traumatic experiences on the mental, physical and developmental health of children is coming to the forefront as an issue that must be dealt with. Trauma is common in the lives of children, and is ubiquitous across the child welfare population. Unmediated trauma creates toxic stress in the form of increased cortisol level, which interrupts the development of brain architecture in young children and produces chronic health and mental health problems in older children and youth through effects on the immune system. From there, negative life course consequences accrue, including school and employment problems, chronic health conditions, substance abuse, justice system involvement and early mortality and morbidity. The wide distribution of research studies on adverse childhood experiences (ACE) and early brain development has led to national attention on trauma-informed care, spearheaded by the Administration for Children and Families.

Strategies:

The three divisions within CMHS shape and implement state policy around mental health and chemical dependency treatment and prevention services. They work in close partnership with the continuing care, health care and state operated services arms of the department. Collaborative partners within state government include the departments of Health, Economic Development, Housing Finance and Corrections. External partners include tribes, counties, advocacy organizations a large array of treatment and supportive services providers health plans, professional training colleges, universities and research institutions. Among the key strategies now being pursued by CMHS staff are:

·         Administering grants for mental health and substance abuse treatment, prevention, ancillary services and capacity development.

·         Taking the lead role in coordinating and implementing mental and chemical health policy in the department’s health care programs, county human services programs, licensing activities and continuing care programs.

·         Working to better integrate chemical and mental health with primary health care and continuing care. One of the concrete goals within this effort is to increase the average lifespan of Minnesotans with Bipolar Disorder or Schizophrenia by ten years within the next ten years, known as the MN 10 by 10 Initiative. CMHS is also partnering with the Department of Health and the Institute for Clinical Systems to expand training for primary care clinicians, emergency departments and mental health professionals on screening, brief intervention and referral to treatment (SBIRT) of persons with substance use disorders.

·         Working to integrate health care for children and schools to improve access to prevention and early intervention services by reaching families in normal, non-stigmatizing environments and, ultimately, improving effectiveness of care by coordinating comprehensive assessment, evidence-based treatment, and outcomes measurement across several child-serving systems.

·         Improving access to evidence-based care by providing training and incentives for the provision of treatment and supportive service models that have been proven effective through nationally recognized research, including Integrated Dual Disorders Treatment (IDDT), Assertive Community Treatment (ACT) and Illness Self-management and Recovery. CMHS continues to train clinicians serving children and youth in the use of the Minnesota Evidence-Based Practices Database and to collect individual treatment outcomes using standardized instruments.

·         Launching statewide practice changes to implement trauma-informed care—based on the latest research from the University Minnesota, Kaiser Permanente, and the Centers for Disease Control and Prevention. Working with child welfare, public health, schools, and others, to prevent and remediate the lasting effects of adverse childhood experiences, CMHS will develop providers’ capacity to reduce the long-term effects of traumatic events when they occur.

·         Finally, Leading the State Substance Abuse Strategy group to implement the 2012 Minnesota State Substance Abuse Strategy Report recommendations related to prevention and treatment for abuse of opioids such as Oxycontin and heroin.

CMHS supports the following strategies in the DHS Framework for the Future: 2012

(https://edocs.dhs.state.mn.us/lfserver/Public/DHS-6464-ENG):

·         Increase the number of Minnesotans served in their homes and communities rather than in institutions.

·         Integrate primary care, behavioral health and long-term care.

·         Improve life expectancy for people with a serious mental illness.

Results:

Performance Measures Notes:

1.     With parental consent, counties conduct mental health screenings for children in the child welfare and juvenile justice systems who have not had a recent assessment. The Previous measure is Calendar Year 2009; the Current measure is CY 2010. (DHS Public Dashboard)

2.     Compares CY 2010 (Previous) and CY 2011 (Current). The measure is based on ACT recipients who are not Medicare eligible and who are enrolled 12 months in MA or MinnesotaCare. (DHS Public Dashboard)

3.     Compares state Fiscal Year 2004 (Previous) and SFY 2010 (Current) as reported in the Minnesota Student Survey in communities receiving substance abuse prevention grant funds. The Department goal is to reduce this rate annually. (DHS internal performance tracking.)

4.     Establish base measure for a new priority. Current year is CY 2012. Source: DHS Central Office Learning Center