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Require DSHS to work with the Court of Criminal Appeals to develop training to inform the judiciary about alternatives to inpatient mental health treatment.

Agency Response to 1.1

DSHS supports this recommendation. Increasing judges’ awareness and confidence in using alternate treatment settings will increase their use for forensic patients and reduce the demand on the state hospital system. (Kyle Janek, M.D., Executive Commissioner – Health and Human Services Commission and David Lakey, M.D., Commissioner – Department of State Health Services)

For 1.1

John Davidson, Senior Policy Analyst – Center for Health Care Policy, Texas Public Policy Foundation, Austin

Cindy Hielscher, President and Ken Pool, M.D., Vice President – Texas e-Health Alliance, Austin Lee Johnson, Deputy Director – Texas Council of Community Centers, Austin

Kathryn Lewis, Attorney – Disability Rights Texas, Austin Bob Libal, Executive Director – Grassroots Leadership, Austin

Steven Williams, Director – Houston Department of Health and Human Services, Houston

Against 1.1

None received.

Modification

1. Require training under this recommendation regarding alternatives to inpatient mental health treatment to inform not only the judiciary, but all players in the system in both criminal and civil courts, including judges, prosecutors, district attorneys, defense attorneys, public defenders, court-appointed attorneys, sheriffs, and probation and parole staff. (Kathryn Lewis, Attorney – Disability Rights Texas, Austin; Janie Metzinger, Public Policy Director – Mental Health America of Greater Dallas, Dallas; and Gyl Switzer, Public Policy Director – Mental Health America of Texas, Austin)

Recommendation 1.2

Direct DSHS to develop a guide for alternatives to inpatient mental health treatment in the state mental health hospital system.

Agency Response to 1.2

DSHS supports this recommendation. Over the past six years, DSHS has focused on crisis mental health services and alternatives to inpatient treatment. The agency will continue to collaborate with local mental health authorities, consumers and their families, and other providers on the delivery of these important services to Texans, and specifically to develop and maintain this guide. (Kyle Janek, M.D., Executive Commissioner – Health and Human Services Commission and David Lakey, M.D., Commissioner – Department of State Health Services)

For 1.2

John Davidson, Senior Policy Analyst – Center for Health Care Policy, Texas Public Policy Foundation, Austin

Cindy Hielscher, President and Ken Pool, M.D., Vice President – Texas e-Health Alliance, Austin Lee Johnson, Deputy Director – Texas Council of Community Centers, Austin

Kathryn Lewis, Attorney – Disability Rights Texas, Austin Bob Libal, Executive Director – Grassroots Leadership, Austin

Steven Williams, Director – Houston Department of Health and Human Services, Houston

Against 1.2

None received.

Modification

2. Instead of directing DSHS to develop the guide directly, require DSHS to contract out to a private firm with expertise in website design and development. (John Davidson, Senior Policy Analyst – Center for Health Care Policy, Texas Public Policy Foundation, Austin)

Recommendation 1.3

Direct DSHS and HHSC to immediately review and streamline hiring processes and improve other personnel actions needed to ensure state mental health hospitals are appropriately staffed.

Agency Response to 1.3

DSHS supports this recommendation and recognizes that processes relating to hiring can be improved. Although the complex nature of the state hospital system necessitates, at times, additional review of job candidates, HHSC and DSHS will work to review these issues immediately. (Kyle Janek, M.D., Executive Commissioner – Health and Human Services Commission and David Lakey, M.D., Commissioner – Department of State Health Services)

For 1.3

John Davidson, Senior Policy Analyst – Center for Health Care Policy, Texas Public Policy Foundation, Austin

Cindy Hielscher, President and Ken Pool, M.D., Vice President – Texas e-Health Alliance, Austin Lee Johnson, Deputy Director – Texas Council of Community Centers, Austin

Kathryn Lewis, Attorney – Disability Rights Texas, Austin

Steven Williams, Director – Houston Department of Health and Human Services, Houston

Against 1.3

None received.

Sunset Member Modification

3. Clarify that agency efforts to streamline hiring processes and improve personnel actions should allow local state hospital leadership to take a more active role in recruitment, hiring and retention of state hospital staff at their campus. Local involvement in these human resources functions should follow standards developed by HHSC in consultation with DSHS. (Senator Jane Nelson, Chair and Representative Four Price, Vice Chair – Sunset Advisory Commission)

Modification

4. Direct Sunset staff to review hiring processes at state hospitals associated with human resources changes directed by House Bill 2292 (78R) that diminished local, facility-based human resources leadership and support functions. (Lee Johnson, Deputy Director – Texas Council of Community Centers, Austin)

Recommendation 1.4

Direct DSHS to continue expanding state mental health hospital system capacity for both forensic and civil patients by contracting with mental health providers in local communities whenever possible.

Agency Response to 1.4

DSHS supports this recommendation as it is consistent with the agency’s ongoing practice of utilizing community and academic facilities to augment the state hospital system. (Kyle Janek, M.D., Executive Commissioner – Health and Human Services Commission and David Lakey, M.D., Commissioner – Department of State Health Services)

For 1.4

Representative Ruth Jones McClendon, Member – Texas House of Representatives

John Davidson, Senior Policy Analyst – Center for Health Care Policy, Texas Public Policy Foundation, Austin

Lee Johnson, Deputy Director – Texas Council of Community Centers, Austin Kathryn Lewis, Attorney – Disability Rights Texas, Austin

Steven Williams, Director – Houston Department of Health and Human Services, Houston

Against 1.4

None received.

Sunset Member Modification

5. Clarify that DSHS should expand contracting with local communities for inpatient beds. When assessing adequacy of inpatient capacity in local communities, DSHS shall consider the capacity of community-based hospital alternatives as well as community, local, private and university hospitals, in addition to capacity at state hospitals. In implementing this recommendation, DSHS shall consider the State Hospital System Long-Term Plan as well as input of the HB 3793 (83R) Task Force. DSHS must provide rationale for including or excluding recommendations of the Task Force. (Senator Jane Nelson, Chair and Representative Four Price, Vice Chair – Sunset Advisory Commission)

Modifications

6. Direct DSHS to ensure that the information collected by contracted facility providers and reported to the agency are efficient and meaningful, of sound depth and quality, and equal to or better than the information being gathered at the state-operated facilities. This data reporting model needs thorough review and revision so that it reflects the effectiveness of the services in addition to efficiency measures. (Representative Ruth Jones McClendon, Member – Texas House of Representatives)

7. Direct DSHS to maintain a waiting list for potential civil and voluntary state mental health hospital patients to better manage capacity issues. (John Davidson, Senior Policy Analyst – Center for Health Care Policy, Texas Public Policy Foundation, Austin)

8. Direct DSHS, in developing the common data set for state-operated and state-contracted facilities, to take into consideration the differences in scope of responsibility that may exist among state-operated facilities and locally-purchased inpatient services. (Lee Johnson, Deputy Director – Texas Council of Community Centers, Austin)

9. In addressing gaps in data currently reported by contracted facilities, direct DSHS to track the use of other behavioral interventions, including emergency medication, and track outcomes by committing offense and offense classification, if applicable, to allow for better assessment of individuals using inpatient beds. (Kathryn Lewis, Attorney – Disability Rights Texas, Austin)