HJNO Jan/Feb 2023

LDH 2023 PLAN 26 JAN / FEB 2023 I  HEALTHCARE JOURNAL OF NEW ORLEANS  Behavioral Health (OBH) maintains two state psychiatric hospitals: Central Louisiana State Hospital (CLSH) in Pineville and the Eastern Louisiana Mental Health System (ELMHS) in Jackson. The hospital programs provide care to adults in need of longer-term inpatient psy- chiatric treatment, adult forensic services, and adult competency restoration services. Historically, OBH has limited community agreements that extend the number of state bed options. However, OBH has identified the need to improve the client flow through state- operated behavioral health facilities. With additional funding in the allocated FY22-23 budget from the Legislature, OBH is increas- ing the type and number of bed placement extensions to include community-based Fo- rensic Supervised Transitional Residential Af- tercare (FSTRA) beds. Increasing the number of FSTRA beds will support the overall flow of the forensic system, specifically an outflow from the inpatient hospital division of ELMHS, while providing a placement where the clients will be monitored and tracked by ELMHS with the goal of eventual conditional release into the community. Other community-based crisis support ser- vices have been implemented as an exten- sion of the telephonic response with 988. In FY22, the first three services of the new Loui- siana Crisis Response System — Mobile Cri- sis Response, Behavioral Health Crisis Care Centers, and Community Brief Crisis Support — were implemented for adults in regions showing readiness to deliver these services. In addition, each MCO set up a 24/7 crisis line as the access point for these more intensive crisis services. A growing mental health crisis among ad- olescents and teens both nationwide and in Louisiana raises the need for the extension of crisis support services to our younger resi- dents. Unlike adult service delivery, the effec- tive offering of crisis services to adolescents requires developmentally-attuned guidance for de-escalating children and adolescents, skills to navigate family systems, expertise in working alongside both caregivers and school staff who are oftentimes the initiators of youth-focused crisis calls, and understand- ing the array of child and adolescent supports and service delivery options. Goal 1: Increase access to crisis call services for individuals in suicidal crisis or emotional distress — maintaining a statewide, in-state answer rate of 90%. Strategy: For FY23, OBH will promote aware- ness of 988 among providers and the pub- lic, including through the development and launch of a paid media campaign which will have an emphasis on vulnerable populations including individuals who identify as LGBTQ+; being historically marginalized; Black, Indige- nous, and people of color (BIPOC); youth; and suicide attempt and loss survivors. Goal 2: Expand the behavioral health system’s capacity to meet the needs of people with mental illness by expanding bed availability. Strategy : The LDH 24-hour facilities section, ELMHS administration, and OBH will jointly improve the client flow and bed availability at ELMHS by securing agreement(s) with provid- ers and expanding psychiatric hospital place- ment options. Goal 3: Conceptualize a system to introduce child and adolescent crisis services to Medicaid members including a mechanism to select qualified organizations to act as early adopters. Strategy: In FY23 OBH will begin preparing the landscape to offer crisis services to Med- icaid members under the age of 21 in early adopter regions in FY24. OBH will develop the framework for expanding crisis services to ad- olescents, including drafting authority docu- ments (service definition, provider qualifica- tions, and licensing requirements) for policy changes and submission to CMS (where ap- plicable) in anticipation of securing funding for these services. OBH will work with Medic- aid to prepare a funding request to support child and adolescent crisis services being pro- vided in an early adopter region(s) by FY24. OBH will also develop a training curriculum in consultation with subject matter experts spe- cific to child and adolescent service delivery of Mobile Crisis Response and Community Brief Crisis Support, and research and devel- op the proper mechanism to select a qualified organization(s) interested in providing these services to children and adolescents. Commitment 1 / Initiative 4 / Goal 2 (cont.) depressive disorder in 2021. In 2018-2019, the share of adults in Louisiana with any mental ill- ness was 21.2% compared to 19.9% in the U.S. This equates to about 1 in 5 Louisianan adults living with mental illness each year. According to the CDC’s most current national data, Loui- siana ranked 35th among the 50 states and Washington, D.C. for its age-adjusted rate of suicide in 2020. Efforts by LDH to address these issues are multi-pronged and ongoing. In July 2022, LDH participated in the launch of the national 988 Suicide and Crisis Lifeline, a new three- digit number that replaces the National Sui- cide Prevention Lifeline, making it easier for people to receive assistance during a mental health crisis. 988 is a 24/7 national crisis care response system free of charge that links call- ers to certified, community-based telephon- ic crisis services located in Louisiana. LDH contracts with two Louisiana-based service providers for this service: The Louisiana As- sociation on Compulsive Gambling, located in Bossier City, fields calls in area codes 318 and 337 covering north, central, and south- west Louisiana, and VIA LINK, located in New Orleans, answers calls for southeast Louisi- ana, covering area codes 504, 225, and 985. LDH aims to match and maintain the national standard of 90% in FY23. The importance of increasing the in-state answer rate allows for Louisiana callers to receive crisis intervention support from a local call center that is both fa- miliar with the local community resources and culturally competent. 988 is a beacon of hope for many people experiencing a mental or behavioral health crisis, but it is not a cure-all solution. For in- dividuals who may be in need of more inten- sive hospital-based treatment, the Office of i I i i i l