HomeMy WebLinkAboutCOUNCIL - AGENDA ITEM - 07/26/2016 - RECOMMENDATIONS FOR THE DEVELOPMENT OF CRITICAL BEDATE:
STAFF:
July 26, 2016
Beth Sowder, Director of Social Sustainability
Mike Beckstead, Chief Financial Officer
WORK SESSION ITEM
City Council
SUBJECT FOR DISCUSSION
Recommendations for the Development of Critical Behavioral Health Services in Larimer County.
EXECUTIVE SUMMARY
The purpose of this item is to provide information about the recommendations for the development of critical
behavioral health services in Larimer County. The Community Mental Health and Substance Abuse Partnership
of Larimer County recently commissioned a study to quantify the gaps in treatment for mental health and
substance use disorders locally. The study identified major gaps in critical behavioral health services, offering
recommendations in what services are most needed, at what levels, and for what cost. Because these gaps have
a significant impact on local citizens and their families, government, health, and social services, this is an
educational presentation to share the findings.
Carol Plock, Executive Director, Health District of Northern Larimer County, will present information on the study
findings. Laurie Stolen, Director, Larimer County Alternative Sentencing Department, will present information on
the possible solution.
GENERAL DIRECTION SOUGHT AND SPECIFIC QUESTIONS TO BE ANSWERED
1. Does Council have any questions about or feedback on the proposed recommendations for expanding critical
behavioral health services in Larimer County?
2. Does Council have direction on City support for these recommendations?
BACKGROUND / DISCUSSION
The lack of critical behavioral health services has a direct impact on major City of Fort Collins concerns.
Community residents, their families, and workplaces, are all directly significantly impacted by the lack of adequate
depth and continuum of mental health and substance use disorder treatment. The gaps in services also has a
substantial impact on services and issues with a direct relationship to the City, including police services, the
criminal justice system, businesses, poverty, homelessness, the new Outreach Fort Collins project, and Support
Services for those living in Permanent Supportive Housing. The Partnership’s study considered the additional
services needed in the community, how they could be organized, and the cost. Larimer County has been
considering the possibility of developing a long-term solution for filling the critical gaps. A citizens’ group has
formed to advocate for solutions. Bridging the critical gaps in behavioral health treatment services, if achieved, is
anticipated to have a notable impact on health, quality of life, and societal and services costs.
City Alignment and Impacts
The City has representatives from Police Services and Social Sustainability who are active members of the
Mental Health and Substance Abuse Partnership. This involvement, along with many other community agencies
represented, has been critical in the collaborative and comprehensive approach to the recommendations for
expanding critical behavioral health services in Larimer County.
When looking at how expanding critical behavioral health services in Larimer County will impact the City
organization, there will likely be both quantitative and qualitative results.
July 26, 2016 Page 2
Quantitative Data and Projection
Looking at Fort Collins Police Services calls for service (alcohol, drug, suicide, and welfare calls), there would be
a potential reduction in calls varying by call type by 5-15% (chart provided in PowerPoint presentation). This
could realize efficiencies that would be the equivalent of almost a half-time police employee; however, it would be
expected that these efficiencies would be effectively used rather than an actual reduction in workforce.
Additionally, it is expected that more of an impact would come from calls for service for the most frequent and
heavy consumers of multiple services (Police, Mental Health, Medical, etc.). Of a group of 131 high service
utilizers monitored by the Interagency Group convened by Fort Collins Police Services, 92 (70%) had contacts
with a police officer between January 1, 2015 and June 30, 2016. For those 92 individuals, there were:
A total of 1,125 police contacts (ranging from 1 to 178 contacts per individual)
1,584 officer hours spent
o Top 25 individuals’ cases used nearly 1,100 of the total 1,585 officer hours
Costs for these contacts include officer time, dispatch, booking, and court costs, if needed
Additional minor efficiencies could be realized in Parks, Municipal Court, and Natural Areas.
Qualitative Alignment and Benefits
The expansion of critical behavioral health services in Larimer County is in alignment with some of the City’s
stated goals:
The Social Sustainability Department Strategic Plan has a goal that states:
Foster increased availability and access to mental and behavioral healthcare through:
o Work with local organizations to ensure 24-hour availability of mental and behavioral health care
and treatment.
o Encourage and support programs providing mental and behavioral health care for low-income
persons and persons experiencing other barriers.
o Through education, outreach, partnerships, and collaboration, increase the community’s general
awareness/acceptance of mental and behavioral health and illness.
o Support education, outreach, partnerships, collaboration, and prevention/intervention efforts,
increasing the community’s general awareness regarding substance abuse.
o Support increased discharge coordination and planning, improving continuity of mental and
behavioral health care and recovery for people leaving hospitals, correctional facilities, and other
similar situations.
o Support development of halfway housing and permanent supportive housing for persons with
mental and behavioral illness.
o Partner with other community entities to create a residential treatment facility for people with
drug and alcohol addictions.
o Support creation and operation of a detox facility in Larimer County.
The Social Sustainability Gaps Analysis also included the following goals:
o Residents are able to rapidly access and receive the depth of treatment needed for mental
health, physical health, and substance abuse needs.
o High quality health care is delivered across the continuum of care: therapy, outpatient care,
inpatient care, residential treatment for addictions, mental health care.
The City’s 2016 Strategic Plan includes the following strategic objectives:
o Neighborhood Livability & Social Health: Leverage and improve collaboration with other agencies
to address homelessness, poverty issues, and other high priority human service needs.
o Safe Community: Improve community involvement, education and regional partnerships to make
our community safer and stronger.
July 26, 2016 Page 3
Potential Benefits for Housing and Human Services Programs
The expansion of behavioral health services will also offer greater ability for residents of permanent
supportive housing have access to support services they need to retain their housing. There is a high
incidence of mental illness and substance use disorder in the homeless population. Evidence shows that
overall the population of those who were formerly homeless who became housed and receive behavioral
health treatment make significant health and functional improvements, and have significantly less use of
emergency service.
The expansion of behavioral health services will positively impact the coordination of services for many
of the non-profit service providers who receive funding from the City’s Human Service Program funds.
The expansion of behavioral health services will positively impact Municipal Court, Special Agency
Sessions, and Outreach Fort Collins by providing an immediate referral option.
Sales Tax Rate Considerations
The total sales tax rate within Fort Collins will increase from 7.4% to 7.65% if this measure is approved by voters.
At 7.65%, Fort Collins would be within the middle range of peer front range communities. Council Finance
Committee has recently discussed possible future tax initiatives of the City that include the renewal of Keep Fort
Collins Great, as well as funding for the Climate Action Plan, Transit Services, and Vine/Lemay grade separated
crossing.
ATTACHMENTS
1. Summary of Recommendations in Infographic form (PDF)
2. At-A-Glance Visual of Existing and Recommended Behavioral Health Capacity (PDF)
3. List of Services to be provided with estimated amounts (PDF)
4. Highlights of Quality Cost Effectiveness and Effectiveness of Treatment Studies (PDF)
5. Executive Summary of Report: Recommendations for the Development of Critical Behavioral Health Services
in Larimer County (PDF)
6. PowerPoint Presentation (PDF)
ATTACHMENT 1
ATTACHMENT 2
ATTACHMENT 3
ATTACHMENT 4
ATTACHMENT 5
Recommendations for
the Development of
Community Mental Health
and Substance Abuse
Partnership of Larimer County
Critical Behavioral
Health Services
In Larimer County
July 26, 2016
ATTACHMENT 6
1. Does Council have any questions
about or feedback on the
proposed recommendations for
expanding critical behavioral
health services in Larimer County?
2. Does Council have direction on
City support for these
recommendations?
Council Direction Sought
Families, individuals,
health and human services providers,
the criminal justice system,
schools, and more
In our community’s ability to adequately address
mental health and substance use disorders
Consistently
report
major gaps
The Issue
“ The service I need to connect him to
does not exist in this community.
What do you expect me to do??? ”
- Care Coordinator
Like other illnesses,
mental illness and
substance use disorders
§ Can be disabling, even life-threatening
§ Can be chronic and relapsing
§ Affect families and work places too
§ Are treatable
(early ID and access to treatment are critical)
It’s Not a Small Problem
Major
Health Burden
Leading Cause of
Disability in US
Impacts Thousands in
Larimer County
44,300 Mental Illness (MI)
(10,000 w/serious MI)
31,200 Substance Use
Disorders (SUDs)
(Numbers may overlap; many have
co-occurring MI and SUD)
Disability & early death
Medical Costs
Lost productivity
Unemployment/Poverty
Criminal Justice
Impact on Family
Costs are High
The
Process of
Developing
Recommendations
§ Identify the behavioral health services most
needed in our community.
§ Determine the level of need
§ Analyze potential costs, revenues,
remaining need
§ Create recommendations for development
of critical services
_________________________________________________________________
Key Finding
The local continuum
of behavioral health treatment and support services
is not sufficient to meet the need
Larimer County Jail High Utilizers (4 bookings in 1 year in LC Jail):
Costs of Crisis and Treatment Services
Annual Expenditures (2013)
TOTAL: $1,708,424
Crisis Services Treatment Services
TOTAL: $ 239,159
2.5
Substance Use Disorders: The ASAM* Continuum of Care
*ASAM: American Society of Addiction Medicine
0
0.5 3.1
3.3
3.5
3.7
1 2 3 4
2.1
Outpatient
Services
Intensive Outpatient/
Partial Hospitalization
Services
Residential
Inpatient
Services
Medically Managed
Intensive Inpatient
Services
Early
Intervention
Intensive
Outpatient
Services
Partial
Hospitalization
Services
Clinically
Managed
Low-Intensity
Residential
Services
Clinically Managed
Population-Specific
High-Intensity
Residential Services
Clinically
Managed
High-Intensity
Residential
Services
Medically
Monitored
Intensive
Inpatient
Services
…Rethink
Everything…
New 24/7 Behavioral Health
Services Center
• Acute Treatment Unit (ATU)
Acute mental illness stabilization when
hospitalization not required
12 beds / 990 admissions
• Withdrawal Management
(f/k/a detox)
Medically monitored
12 beds / 820 admissions
• Short Intensive Residential (SIR)
For substance use disorder treatment
11 beds / 300 admissions
• Thorough Assessments
Professionals skilled in both MI and SUD
Connection to appropriate community
service
7,600 assessments
• Client Assistance
Help paying for transportation,
medications, co-pays, and deductibles
1,600 clients
Services Needed: Facility
In the community…
Encourage Others to Expand Provide
90 day for Substance Use Disorders
52 beds, 190 admissions
• Increase Intensive Outpatient
& Outpatient Services
• 24/7 Certified Addictions
Counselors
• Client Assistance with Costs
When living in Permanent Supportive Housing
• Long-term Low Intensity Residential
• For Those with Complex Needs
Care Coordination (250 people)
Support Services (100 people)
…….……….
………………………..
Summary, Increased Capacity for Critical Services
Estimate: Up to 4,700 individuals served, some duplicated
Capacity Total Utilization
Assessments 7,655
Focused Client Services (people) 1,970
Client Assistance 1,620
Care Coordination 250
Support Services, PSH 100
Admissions (admissions) 2,304
Acute Treatment Unit 986
Withdrawal Management 822
Short-term Intensive Residential 305
Low-Intensity Residential 191
TOTAL 11,929
Estimated Costs
OPERATING
Personnel $ 8.6 million
Client Assistance $ 2.4
Other $ 4.8
TOTAL: $15.8 million
Less Revenues $ 4.0
Needed Annual Funding: $ 11.8 million
Facility: 51,000 square feet, $20.4 million
Treatment Works:
Effectiveness Compared to Other Serious Chronic Diseases
National Institutes of Health, 2012
Outcomes
Value of the Investment
Immeasurable
Save lives!
Maintain and restore health, healthy families, workplaces
Target $$ to effective treatment
Proven Outcomes in Study after Study
Avoided use of health care system
- Health Care Costs: ED, hospital, ambulance, primary care
- Mental health care
Avoided crime; lowered recidivism
- Criminal justice system: law enforcement, prosecution, incarceration, etc.
- Victim losses: bodily and emotional harm, property theft/damage
Increased chances of employment; contributing taxes
Significant increases in years of healthy life lived
A Sound Investment
Studies Consistently Show Significant Economic Impact
• Every dollar spent on addiction treatment programs yields
a return of between $4 and $7 in reduced health, crime, and
criminal justice costs, and impaired work (NIH, 2012)
[= $40M return locally]
• CA state treatment system: on average, substance abuse
treatment cost $1,583 and is associated with a monetary
benefit to society of $11,487 (>7:1 ratio) – mostly due to
reduced costs of crime and increased employment
earnings
• Kaiser (CA): matched control group; those in substance use
treatment had 35% less inpatient cost, 39% less ER cost,
26% lower total medical cost.
“Like every other health condition, we need to
be sure we have adequate services available
right here in our community so that we can
give our families, friends and co-workers
a fighting chance at recovery.”
Anne Hudgens, Partnership Chair
• Potential reductions in calls
vary by type from 5-15%
• Efficiencies could be
realized within police for
avoided calls
• Most impact would come
from time saved responding
to frequent utilizers
20
-
2,000
4,000
6,000
2011 2012 2013 2014 2015
Annual Call Volume
Alcohol Drug Suicide Welfare
Quantitative Benefits
FCPS Response Hours & Cost
• Social Sustainability Department Strategic Plan: Foster increased availability and
access to mental and behavioral healthcare through numerous objectives.
• Social Sustainability Gaps Analysis: Residents are able to rapidly access and
receive the depth of treatment needed for mental health, physical health, and
substance abuse needs.
• City’s 2016 Strategic Plan includes: Leverage and improve collaboration with
other agencies to address homelessness,
poverty issues, and other high priority
human service needs.
Alignment with Strategic Plans
21
Other Qualitative Benefits may include:
• Housing retention and reduction in emergency services
• Coordination of services of the non-profit service providers who receive
funding from the City’s Human Service Program funds.
• Immediate referral options for Municipal Court, Special Agency
Session, and Outreach Fort Collins
Complements City Investments
22
Backup
23
24
Front Range Community
Tax Rate Comparison & Considerations
• Fort Collins is still lower than
average with additional county tax
• FC Considerations:
• Renewal of KFCG
• Other possible discussions
• Revenue diversification
• Climate Action
• Transit / Vine & Lemay
0.00%
1.00%
2.00%
3.00%
4.00%
5.00%
6.00%
7.00%
8.00%
9.00%
10.00%
Critical
BH Srvcs
Cultural
County
RTD
City
State
1. Does Council have any questions
about or feedback on the
proposed recommendations for
expanding critical behavioral
health services in Larimer County?
2. Does Council have direction on
City support for these
recommendations?
Council Direction Sought