Department of Behavioral Health and Mental Retardation Services: Results Achieved

CITY OF PHILADELPHIA
BEHAVIORAL HEALTH SYSTEM

Results Achieved

How is the new Department of Behavioral Health and Mental Retardation Services working? Since it was launched in February 1997, the Philadelphia Department of Behavioral Health and Mental Retardation Services (DBH/MRS) has had a number of significant achievements. In October 1998, after its first year-of operation, the Pennsylvania Department of Public Welfare favorably evaluated both CBH and the City's implementation of a unified system of care.

The evaluation team noted that: "CBH works with a large number of persons with serious and complex mental health and/or substance abuse disorders, many of whom experience difficult social and environmental challenges."

Their report states that CBH is "working closely with providers to develop an internal infrastructure, training, and quality management system to ensure providers are prepared to delivery high quality services." They praised the "extensive involvement from and interface with other components of the Philadelphia public behavioral system," noting that, "CBH's senior management demonstrated a solid understanding of the need to balance service to consumers with fiscal responsibility."

SIGNIFICANT SAVINGS HELP SAFEGUARD THE FUTURE

Among its most significant achievements, the Department of Behavioral Health and Mental Retardation Services has realized substantial savings as a result of a more effective coordination of all funding streams. In its original HealthChoices proposal, the state looked to counties to reinvest any savings they realized into enhancement or expansion of treatment services.

Philadelphia has vigorously pursued this goal, while at the same time maintaining a relatively conservative fiscal posture. This is crucial in order to safeguard the long-term viability of the Department of Behavioral Health and Mental Retardation Services, for the sake of the fiscal health of the city and the well-being of citizens who will depend upon it long into the future. "Our cities and its communities depend on us providing service to the most vulnerable members of society, and we cannot afford to let them down", says Estelle B. Richman, Pennsylvania's Secretary of Public Welfare

Because new managed care organizations typically realize their greatest earnings in the first several years, the Department of Behavioral Health and Mental Retardation Services has adopted the industry standard which calls for setting aside a 90-day, risk and contingency fund. Such a fund can be used to handle unforeseen fluctuations in utilization that may result from changes in welfare law, funding changes and other factors. DBH/MRS is working toward this goal. To further protect the city, DBH/MRS has purchased reinsurance coverage to minimize the risk of liability.

REINVESTING IN THOSE WHO NEED IT MOST

As a result of savings realized in the first 21 months of operation, the Department of Behavioral Health and Mental Retardation Services has been able to set aside funds to:

meet Pennsylvania's required contractual reserve;

build the corporation's 90-day Risk and Contingency Fund and

target $21 million for reinvestment activities.

One example of how DBH/MRS funds have been reinvested is the development of new and vitally needed services to people living on city streets who have behavioral health problems. In the winter of 1998, the Behavioral Health System initially committed $500,000 for a six-month period in order to create new outreach and case management positions, additional mental health beds and rental subsidies, and help hard-to-reach individuals access appropriate treatment, rehabilitation and housing services.

The Department of Behavioral Health and Mental Retardation Services is now committing millions of savings to additional year-round homeless services. These services are particularly critical in light of a recently passed City Council ordinance that prohibits persons from occupying space on public sidewalks for extended periods of time. An estimated 400-500 homeless persons live on the street and about 90 percent of this number have substance abuse problems and/or mental illnesses.

These initiatives were developed with extensive input from consumers, family members, advocates and staff from the Department of Behavioral Health and Mental Retardation Services and other city agencies, as well as a diverse group of public and private organizations.

Many other reinvestment proposals for the use of Department of Behavioral Health and Mental Retardation Services savings for both adults and children have been developed in conjunction with consumers, family members and professionals from all sectors of the behavioral health and human service systems. The State is currently reviewing these proposals, including:

Expanding a continuum of housing for special populations
Increasing mobile outreach services
Hiring more substance abuse case managers
Establishing a special fund to assist providers with start-up costs or costs to create special services
Enhancing services to the city's Southeast Asian community
Vocational training with an emphasis on leadership and management skills
Increased support for families coping with children in crisis
Support groups for children living with an adult with mental illness
Support groups for adolescents with emotional disorders
Increased case management for children and adolescents with drug and alcohol problems and mobile outreach and prevention
Special grants to behavioral health agencies and deployment of special consultants to assist public school students, teachers and staff in better strategies for reducing challenging behaviors and handling emotional crises.