What's Inside

Section E. Issues and Priorities

I. Introduction

This section sets out the major issues currently facing the MHMRA of Harris County. Concerns associated with issues will be discussed briefly. The issues and concerns identified in this discussion will support a later section of this strategic plan that will be concerned with the major aims and objectives of the MHMRA of Harris County.

The conclusion of this section reflects institutional priorities as established by the Board of MHMRA of Harris County.

II. Issues Confronting the MHMRA administration

a. Budget Issues

Issue II.a.1. Current Deficits

Concern: MHMRA’s current deficits are intolerable.

Discussion: The authority administration has been working to end current deficits, and needs to make up for three years of losses. Steps are being taken to reduce expenditures by consolidating operations, eliminating redundancy, and reducing staff. The statewide budget crisis is compounding the authority’s difficulties.

Steven B. Schnee to All PAC Members, etc., “MHMRA Budget Situation.” Memo (29 January 2003).

Issue II.a.2. Imminent Cutbacks

Concern: Public mental health budgets are expected to contract, substantially and imminently.

Discussion: The 78th Texas Legislature now in session faces a budgetary shortfall of at least ten billion dollars, the largest deficit in state history.

Issue II.a.3. Lack of External Funding

Concern: Public and private money may be available, but these are currently under-explored resources.

Discussion: The current budgetary crisis follows recent expectations by the Legislature that MHMRA earn more of its own financing. The Harris County Commissioners Court contributes funds to local mental health, but it cannot make-up the coming state shortfalls.

Karen F. Hale to Sandy Skelton, “FY 03 Immediate Spending Reductions.” Memo (24 January 2003). Polly Hughes and Armando Villa Franca, “Funding cuts could leave disabled, needy in limbo,” Houston Chronicle (Jan. 12, 2003).
The Center for Public Policy Priorities, an advocacy group for the needy, has estimated that, if adjustments were made for inflation and population growth, the shortfall would be in excess of $15 billion. Polly Ross Hughes and R.G. Ratcliffe, “‘Grim’ fiscal news greets lawmakers: State down $9.9 billion,” Houston Chronicle (Jan. 13, 2003).
MHMRA of Harris County, Local Plan for FY 2002-2003 (August 2001), Figure 3.
Margaret Downing, “Reality Check,” Houston Press (July 25, 2002). MHMRA Ex. Dir. Reports 11/01; Accountability II. MHMRA Ex. Dir. Reports 2/02; A Work In Progress.

Issue II.a.4. High Cost of Medications

Concern: Pharmacy services, especially costs for the New Generation medications, constitute a large and growing share of the MHMRA budget.

Discussion: The attitude that newer is better has led to the expectation among consumers as well as providers that New Generation medications are nearly always best for the patient. This is not always the case. Even older medications, however, can be costly. Also, options for controlling costs for New Gen medications are limited because TDMHMR establishes targets for usage. Finally, samples that are now made available by pharmaceutical companies may not be available in the future.

MHMRA Ex. Dir. Reports 11/01; Accountability II. MHMRA of Harris County, Local Plan for FY 2002-2003 (August 2001). (Priority self-identified through MHPAC and Nguyen).

b. Other Management Concerns

Issue II.b.1. Bloated Administrative Infrastructure.

Concern: The existing organizational structure has been neither as efficient nor as effective as it must become in order to address the fiscal realities.

Discussion: Top-heavy management ranks continue to consume too many scarce assets that could be devoted to the mission. Performance standards are not in place for organizational outcomes, leading to a basic lack of accountability. Past organizational reforms have been too limited and hence unsatisfactory. The organization has been slow to respond to changed conditions.

Issue II.b.2. Inefficient Use of Facilities

Concern: The MHMRA has too much of its budget and administrative overhead committed to the maintenance of unnecessary physical plant.

Discussion: The authority should examine the patterns of use of its existing facilities and perform a cost versus benefits analysis to establish the need to close and/or sell physical assets such as buildings.

Karen F. Hale to Sandy Skelton, “FY 03 Immediate Spending Reductions.” Memo (24 January 2003). Polly Hughes and Armando Villa Franca, “Funding cuts could leave disabled, needy in limbo,” Houston Chronicle (Jan. 12, 2003).

Issue II.b.3. Demand for versus Delivery of Services

Concern: Services provided are often broader than required to meet obligations.

Discussion: Demand for services and support for the priority population continues to grow. The authority is called upon to deliver services to more consumers than it is contractually obligated to serve, and more than it can accommodate within constraints imposed by the available resources. The result is that MHMRA is failing to meet contracted service targets in other areas.

MHMRA Ex. Dir. Reports 2/02; A Work In Progress.

c. Personnel Issues Confronting MHMRA

Issue II.c.1. ODHR standards and procedures

Concern: ODHR lacks clear metrics for employee performance, and lacks consistent procedures for documenting and reviewing performance issues.

Discussion: Performance issues cannot be addressed and corrected without standards and procedures.

Issue II.c.2. Staff Retention versus Staff Turnover

Concern: Staff attrition is neither an efficient method of reorganization, nor an effective form of cost savings.

Discussion: Technical and managerial expertise is in short supply, so professional staff retention is highly important. Lack of developmental opportunities and low compensation undermine staff retention efforts. It is hoped that recently hired managers will stabilize the personnel situation with a reorganization of all of the authority’s divisions.

Employee satisfaction can be impacted negatively both by low salaries relative to the private market place, and by the level of anxiety throughout the organization. Unfortunately, salaries may compress and anxiety may rise during the state’s budget crisis.

MHMRA Ex. Dir. Reports 2/02; A Work In Progress.
MHMRA of Harris County, Local Plan for FY 2002-2003 (August 2001). MHMRA Ex. Dir. Reports 2/02; A Work In Progress. MHMRA Ex. Dir. Reports 11/01; Accounability II.

Issue II.c.3. Cultural Diversity

Concern: Cultural and language differences raise barriers to obtaining services.

Discussion: Bureaucratic processes, if compounded by language and cultural barriers, may lead to frustration among consumers and families. Increased staff diversity may reduce frustration and increase consumer and family satisfaction with services being delivered.

Training in culturally appropriate customer service, if complemented by consumer and family orientation, would lead to more effective delivery of services.

Issue II.c.4. Volunteerism potential is not realized

Concern: Volunteers lack direction and motivation.

Discussion: The energy and enthusiasm of volunteers, including recovering consumers, family members, and community advocates, are continually untapped resources.

MHMRA of Harris County, Local Plan for FY 2002-2003 (August 2001).
MR PAC Focus Group; 7 January 2003. MHMRA Ex. Dir. Reports 2/02; A Work In Progress.

III. Issues Related to MHMRA Delivery of Services

a. Limitations on Ability to Deliver Current Services

Issue III.a.1. Barriers to System Access

Concern: Entry into MHMRA system can be difficult.

Discussion: Consumer expectations and requirements for prompt delivery of services are intensifying. The MHMRA informational and marketing materials tend to oversell the available services. Basic misunderstanding of bureaucracy procedure, tight entry criteria, and waiting lists result in denials or delays in access, which lead to dissatisfaction, frustration, and “giving up.”

Issue III.a.2. Waiting Lists

Concern: Waiting lists for services are thousands deep.

Discussion: There are more than 20,00 Texans with mental retardation waiting for support services. During the past four years, the waiting list for community-based mental health services has more than doubled, from around 7,000 to at least 19,000. At more than 2,700 in need of services, Harris County’s waiting list for community-based mental retardation care is the largest statewide.

Consumer and family representatives report, however, that, once consumers are in the system, MHMRA does well in providing services and support. MR PAC Focus Group; 7 January 2003.
MHMRA of Harris County, Local Plan for FY 2002-2003 (August 2001), Figure 2.

Waiting lists will almost certainly grow as lawmakers confront a multibillion-dollar budget shortfall. However, countervailing pressure arose recently, when consumers filed a class-action suit against the state. The plaintiffs to the suit claim that the long waiting lists violate federal laws that require access to Medicaid services be provided to the mentally disabled.

Issue III.a.3. Need for Specialized Training

Concern: Improved training programs are needed for staff, social workers, and in-home trainers.

Discussion: Training must include not only available services but steps necessary to access services. Program can maximize the impact by identifying, archiving, and incorporating educational materials (videos, workbooks, pamphlets, websites, or videos) already developed by other advocacy groups such as NAMI, MHA, and NIMH.

Polly Hughes and Armando Villa Franca, “Funding cuts could leave disabled, needy in limbo,” Houston Chronicle (Jan. 12, 2003).
MR PAC Focus Group; 7 January 2003.
MHMRA of Harris County, Local Plan for FY 2002-2003 (August 2001), Figure 3.

b. Issues Confronting MHMRA Consumers and Families

Issue III.b.1. Consumer Rights Protections

Concern: Changes in MHMRA services must not lead to reduced commitment to protecting consumer rights.

Discussion: Authority efforts to bring services within budget realities must take into account statutory mandates and contract compliance issues.

Issue III.b.2. Consumer Services Orientation

Concern: Orientation programs are needed for family and aging population of consumers and caregivers.

Discussion: Establishing initial infrastructure would be costly and time-consuming. Also, community education and information activities that are needed to gain support may be prevented by TDMHMR rules. Orientation must include not only available services but also steps necessary to access services.

MR PAC Focus Group; 7 January 2003.
MHMRA of Harris County, Local Plan for FY 2002-2003 (August 2001), Figure 3.

Issue III.b.3. Customer Empowerment

Concern: Consumers may be able to take more control of finances, employment, and housing.

Discussion: If not merely a pretext for diminished access to services, “empowerment” can contribute to recovery and rehabilitation. This should be an ongoing process that recognizes the nature of mental illness, including potential for relapses.

c. Issues Related to Insurance and Providers

Issue III.c.1. Medicaid and Social Security (SSI)

Concern: MHMRA lags in SSI and Medicaid enrollment.

Discussion: In addition to funding from the county and state, MHMRA receives reimbursement from the federal Medicaid and Medicare programs. Consumers enrolled in Medicaid and Medicare can receive medication, supportive, and rehabilitative services. About 50 percent of MHMRA clients are not enrolled in these programs and thus receive only medication and education benefits. This is a general problem in the state of Texas, which, in 2001, had the lowest enrollment rate in the country.

MHMRA of Harris County, Local Plan for FY 2002-2003 (August 2001).
MHMRA of Harris County, Local Plan for FY 2002-2003 (August 2001), Figure 2.
Steve McVicker, “Dangerous Deficits,” Houston Press (August 19, 1999).

In response, MHMRA established an outreach program to help people with mental illness enroll in disability insurance programs. Unfortunately, a sizeable percentage of people cannot qualify.

Even prior to the current budget shortfalls, the Legislature had announced expectations that agencies such as MHMRA must work to increase the numbers of uninsured consumers accessing federally funded and state matched insurance, such as SSI and Medicaid, the federal health care programs for the disabled and poor. The state agencies that oversee these programs require an increasing use of already stretched MHMRA resources to assist consumers in gaining coverage.

Yet, MHMRA has not been effective in enrolling eligible consumers, in part because the state’s administrative rules make it difficult to gain coverage for potential clients. The state recently attempted to end this limitation—which some critics had called “rationing by hassling”—by beginning the process of simplifying Medicaid, but the current budget concerns might bring to an end or even reverse this progress. It has been predicted that the new U.S. Congress, which like the Texas legislature is confronting a large budget shortfall, will push to require more frequent in-person interviews for parents renewing benefits under Medicaid.

Leslie Gerber, Beyond Crisis: Adult Mental Health Service Needs in Harris County, A Report of the Mental Health Association of Greater Houston (October 2002).
MHMRA Ex. Dir. Reports 2/01; Sometimes - it’s simply not enough. Margaret Downing, “Reality Check,” Houston Press (July 25, 2002).
Polly Hughes and Armando Villa Franca, “Funding cuts could leave disabled, needy in limbo,” Houston Chronicle (Jan. 12, 2003).

Many people with serious mental illness face a vicious cycle whereby they have qualified for SSI and received Medicaid benefits, but then lose those benefits, due to one or more disqualifying factors (for example, functional improvement, earning too much money). Due to the unavailability of services and supports, they destabilize and relapse into indigency. They become more impaired—until the cycle starts again.

Issue III.c.2. Third Party Insurance

Concern: Many consumers qualify for but do not seek appropriate third-party coverage.

Discussion: Even when private insurance covers mental illness, the policies usually are inadequate (e.g., low lifetime limits mean that people lose coverage). Many Texans lack insurance or are seriously under-insured. During the last decade, for example, more than 20 percent of Texans under age 65 have been without health insurance. Minorities are insured at an even lower rate. In 2000, African American and Hispanics together accounted for around 40 percent of the state’s population, but accounted for nearly 70 percent of the uninsured. Fortunately, due to coverage available under the auspices of the Medicare program, the rate of insurance was higher among persons aged 65 or older.

MHMRA Ex. Dir. Reports 12/01-1/02; Rationing Care.
MHMRA Ex. Dir. Reports 7-8/02; Continuing changes as FY ‘03 approaches
TDMHMR Strategic Plan for Fiscal Years 2003-2007 (May 2002).

At 30 percent, Harris County has the second highest rate in Texas of residents who lack insurance. It is estimated that 54 percent of MHMRA consumers are uninsured, and over 80 percent are unemployed. Because services are not profitable when delivered to uninsured patients, low rates of insurance probably contributed to the recent elimination of more than 500 private psychiatric beds in Harris County.

Unfortunately, where a consumer has any third party insurance, payments are increasingly expected to cover the total costs of service. Unless the use of public funds to supplement third party coverage can be justified, the state contribution is reduced.

Issue III.c.3. Transition to Local Authority Model

Concern: The MHMRA should examine potential for increasing efficiency and service by transitioning to a local authority model.

Discussion: Collaboration between public mental health systems and private providers is attractive, and MHMRA may benefit by contracting much of its services. Core functions can be identified for retention under a leaner, improved infrastructure. Non-core service functions are candidates for outsourcing.

MHMRA Ex. Dir. Reports 2/02; A Work In Progress. Leslie Gerber, Beyond Crisis: Adult Mental Health Service Needs in Harris County, A Report of the Mental Health Association of Greater Houston (October 2002).
Margaret Downing, “Reality Check,” Houston Press (July 25, 2002).
MHMRA Ex. Dir. Reports 7-8/02; Continuing changes as FY ‘03 approaches

Issue III.c.4. Potential Partnerships & Networks

Concern: It is becoming more difficult for agencies to provide service “safety valves” for one another.

Discussion: Partnership networks must be developed during a time of general economic distress and in an environment of increasing demands on but diminishing resources in public mental health systems.

Potential partners, whether public, private, volunteer, or community-based, are facing similar budgetary and other pressures. That is, services will not be available in the future at the level they have been. Approximately 500 private psychiatric hospital beds have been closed in Harris County over the past several years, thereby increasing pressure on the public mental health system, especially the HCPC.

TDMHMR Strategic Plan for Fiscal Years 2003-2007 (May 2002).
Leslie Gerber, Beyond Crisis: Adult Mental Health Service Needs in Harris County, A Report of the Mental Health Association of Greater Houston (October 2002). MHMRA Ex. Dir. Reports 9/02; The Crisis In Access.

Issue III.c.5. Public vs. Private Provider Relations

Concern: Managed care reforms may or may not increase access to private mental health care.

Discussion: Public healthcare will continue to evolve into an increasingly managed care environment, but these reforms do not ensure that MHMRA can refer consumers to providers with appropriately credentials and training. At the same time, providers continue to voice concerns about the slow pace of acceptance and payments. In addition, compliance issues currently lead to provider frustration. The audit process (necessary for quality assurance) can be disruptive.

Dale Lezon, “Mental health care for poor `beyond crisis,’ report finds,” Houston Chronicle (October 8, 2002).
MHMRA Ex. Dir. Reports 2/02; A Work In Progress. MHMRA Ex. Dir. Reports 12/00-1/01; Do You Believe?
MR PAC Focus Group; 7 January 2003.

IV. Issues Related to Individual MHMRA Divisions

a. Adult Mental Health Division (AMH)

Issue IV.a.1. Expanded Psychosocial Services

Concern: There is an ongoing need to assist recovery by persons with co-occurring chemical dependency and mental illness.

Discussion: The AMH Division has identified priorities including improved counseling and psychotherapy, day treatment, and in-home and family support. Clinics lack funds to provide supportive and rehabilitative services that would keep indigent clients out of the crisis centers, hospitals, or jails.

MHMRA of Harris County, Local Plan for FY 2002-2003 (August 2001), Figure 2.
Leslie Gerber, Beyond Crisis: Adult Mental Health Service Needs in Harris County, A Report of the Mental Health Association of Greater Houston (October 2002). MHMRA Local Plan for FY 2002-2003 MH Information Supplement (TDMHMR, March 2001).

b. Child and Adolescent Services Division (CAS)

Issue IV.b.1. Crisis Services

Concern: There is an ongoing need to deliver authorized services appropriate to child’s condition.

Discussion: There is a gap in state’s recognizing and hence MHMRA serving the special needs of Children and Adolescents with dual diagnosis (i.e., Mental Illness as well as Mental Retardation). This is acute with regard to emergency counseling and early intervention or prevention services.

Issue IV.b.2. Children’s Health Insurance Program

Concern: Changing requirements for CHIP enrollment.

Discussion: Because some children using CHIP in the past could have been served through private means, eligibility requirements for CHIP will be tightened. Also, the Legislature may reduce CAS allocations in FY 2003, with an expectation that CHIP revenue will rise to make up the difference. Thus, CAS will be required to rely on earned revenues, and those CAS consumers with third party coverage (e.g., Medicaid) must be primarily supported by third party sources.

MHMRA Ex. Dir. Reports 7-8/02; Continuing changes as FY ‘03 approaches
MR PAC Focus Group; 7 January 2003. MHMRA Local Plan for FY 2002-2003 MH Information Supplement (TDMHMR, March 2001).
MHMRA of Harris County, Local Plan for FY 2002-2003 (August 2001), Figure 3.
MHMRA Ex. Dir. Reports 7-8/02; Continuing changes as FY ‘03 approaches . Polly Hughes and Armando Villa Franca, “Funding cuts could leave disabled, needy in limbo,” Houston Chronicle (Jan. 12, 2003).

c. The Neuro Psychiatric Center (NPC)

Issue IV.c.1. Demand for Crisis Services

Concern: NPC resource limitations lead to de facto rationing of care.

Discussion: Based upon population, Harris County should have at least six public emergency psychiatric facilities, not just Ben Taub and the NPC. After MHMRA opened the NPC in 1999 it rapidly exceeded its planned target of 600 patients per month. Currently, it averages about 1100 patients per month. The NPC has operated on drive-by status when the demand greatly exceeds capacity. When the NPC is on drive by, there are few other options for people in acute mental health crisis.

Ben Taub’s emergency room psychiatric services are also frequently on drive-by status. The Harris County Psychiatric Center (HCPC) remains at capacity, with variable ability to accept patients from NPC and the probate courts. Increases in charges at the Rusk state hospital have reduced access by 30 percent for Harris County residents. The result is that people are becoming more ill before they receive crisis care.

Margaret Downing, “Reality Check,” Houston Press (July 25, 2002).
Leslie Gerber, Beyond Crisis: Adult Mental Health Service Needs in Harris County, A Report of the Mental Health Association of Greater Houston (October 2002).
Leslie Gerber, Beyond Crisis: Adult Mental Health Service Needs in Harris County, A Report of the Mental Health Association of Greater Houston (October 2002). MHMRA of Harris County, Local Plan for FY 2002-2003 (August 2001). Margaret Downing, “Reality Check,” Houston Press (July 25, 2002). “Crying Need,” Houston Chronicle (September 1, 2002).

V. Issues Related to Limitations on or Extension of Services

a. Current Services to be Improved.

Issue V.a.1. Best Practices

Concern: In a time of increasing demand and diminishing resources, public mental health systems may not be able to apply evidence-based practices, use state-of-the-art procedures, or exploit technology.

Discussion: Services and programs based on latest scientific advances in treatment are not routinely available. Local authorities usually cannot afford to provide experimental services or exploit technology to meet the needs of individuals with mental illnesses.

Issue V.a.2. Consumers with Dual-diagnoses

Concern: Nearly 2/3 of MHMRA consumers suffer from substance abuse as well as mental illness.

Discussion: State-mandated “silo” approach to care keeps funding for different problems separate, making it difficult to commingle and leverage resources. There is a general lack of necessary cross-training for mental health professionals. Also, lingering philosophical and clinical biases regarding treatment and support for consumers with dual-diagnoses limits care.

MHMRA Ex. Dir. Reports 2/02; A Work In Progress.
Source: U.S. Department of Health and Human Services. Mental Health: A Report of the Surgeon General. Rockville, MD: U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Mental Health Services, National Institutes of Health, National Institute of Mental Health, 1999. Source: TDMHMR STRATEGIC PLAN FOR FISCAL YEARS 2003-2007 (May 2002).
MHPAC discussion, 14 January 2003.

b. Desirable Services to be Added in the Future

Issue V.b.1. Residential Services

Concern: Services that prepare MHMRA consumers for living and functioning in the community continues to be one of the crucial problems for persons with mental illness.

Discussion: Development of a county-wide plan for supported housing programs would meet needs ranging from in-home support to independent living.

Issue V.b.2. Transportation

Concern: Consumers need transportation alternatives.

Discussion: Harris County’s large and diverse (urban, suburban, and rural) geographic area is served by few facilities relative to the high number of residents in the priority population. The absence of readily available, affordable, and flexible transportation options may lead to consumer cancellations or no-shows, which in turn contributes to relapse. Cost of transportation programs would have to be weighed against cost to establish and operate additional satellite sites.

MHMRA Local Plan for FY 2002-2003 MH Information Supplement (TDMHMR, March 2001). MHPAC discussion, 14 January 2003.
MHMRA of Harris County, Local Plan for FY 2002-2003 (August 2001), Figure 2.
Dale Lezon, “Mental health care for poor `beyond crisis,’ report finds,” Houston Chronicle (October 8, 2002). Accountability will be needed: a 1997 investigation discovered MHMRA failed to use effectively federal housing funds received from 1993 to 1996. Margaret Downing, “Reality Check,” Houston Press (July 25, 2002).

Issue V.b.3. Respite Programs

Concern: Respite is necessary to provide time and place for consumer and/or family recovery after longtime or intensive care, a crisis episode, or hospitalization.

Discussion: Infrastructure for increased respite (such as temporary alternative residential support) would be costly to establish and maintain. It would be helpful to collaborate with the Harris County task force and to convince the private sector to develop more capacity.

Issue V.b.4. Day Treatment and Day Programs

Concern: Outpatient care does not always include programs to provide shelter during crisis and programs to transition recovering persons after crisis or hospitalization.

Discussion: Infrastructure for day programs (such as new facilities and staff) would be costly to establish and maintain. Few day or outpatient programs exist for persons with mental illness and, where they are available, they may be restricted to consumers eligible for Medicaid.

MR PAC Focus Group; 7 January 2003.
MR PAC Focus Group; 7 January 2003.
MHPAC discussion, 14 January 2003. MHMRA of Harris County, Local Plan for FY 2002-2003 (August 2001), Figure 4.
MR PAC Focus Group; 7 January 2003.
MHPAC discussion, 14 January 2003.

Issue V.b.5. Intensive Job Skill Development

Concern: Job skills would increase economic and financial independence of consumers.

Discussion: To increase employment of consumers would require building relationships with private sector and educational institutions. Unfortunately, the lingering stigma of mental illness, including the fear of relapse, discourages partnership with or other support by businesses. This indicates a need to involve medical teams and providers in helping employment partners to recognize early signs and symptoms or relapse.

VI. Summary of Issues

The preceding set out major issues currently facing MHMRA of Harris County. These can be summarized as follows:

• Current Deficits
• Imminent Budget Contraction
• Lack of External Funding
• High Costs of Medications

• Bloated Administrative Infrastructure
• Inefficient Use of Facilities
• Rising Demand for Services

MHPAC discussion, 14 January 2003.

• ODHR Procedures to be Rationalized
• Continuing Problems in Staff Retention/Turnover
• Need to Accommodate Increasing Cultural Diversity
• Volunteerism potential is not realized

• Problems in Access
• Lengthy Waiting Lists
• Need for Specialized Staff Training

• Need to Protect Consumers Rights to Services
• Need Expanded Orientation for Consumers and Families
• Need Expanded Customer Empowerment

• Need for Expanded Participation in Medicaid and SSI
• Need for Expanded Reliance on Third Party Insurance
• Need to Examine Potential to Transition to Local Authority
• Need for Expanded Partnerships & Networks
• Need for Improved Public vs. Private Provider Relations

• Need Expanded Psychosocial Services for AMH consumers
• Need Expanded Crisis Services for Children/Adolescents
• Negative Changes to Children’s Health Insurance Program
• Ongoing Demand for Psychiatric Crisis Services

• Limited Ability to Identify and Establish Best Practices
• Limited Availability of Supports for Dual-diagnoses

• Limited Availability of Residential Services
• Limited Availability of Transportation
• Limited Availability of Respite Programs
• Limited Availability of Day Treatment/ Day Programs
• Limited Availability of Intensive Job Skill Development

VII. Conclusion: Priorities

This section reflects institutional priorities as established by the Board of Trustees of MHMRA of Harris County.

A. Issues. This column sets out the issues currently facing MHMRA of Harris County. The issues identified are derived from the previous section of this strategic plan. Because some issues logically relate to issues given a higher priority, several issues stated above are not listed below as priorities.

B. Definitions of Priority Assignments. This column records the priority to be assigned to issues by the MHMRA Board of Trustees. The rankings are as follows:

1 = critically important, requires immediate resolution;
2 = very important, requires resolution within 1-2 months;
3 = important, but resolution can be deferred 3-6 months.

C. Definitions of Responsibility Assignments. This column records the individual or organization that is to be assigned primary responsibility for the resolution of a specific issue. The responsible parties are the following:

BOT = Board of Trustees; ED = Executive Director;
DED = Deputy Executive Director; AMH = Adult Mental Health; CAS = Child and Adolescent Services; MR = Mental Retardation; PC = Program Committee; AC = Audit Committee; RC = Resource Committee.

D. Date for Review. This section sets out the date by which specific issues are to be resolved or revisited.

Issue Priority* Responsible Party Date for Review
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Current Deficits 1
Imminent Cutbacks 1
Demand and Delivery of Services 1
High Cost of Medications 1
Medicaid and Social Security (SSI) 1
Third Party Insurance 1
Transition to Local Authority Model 1
Access 1
Consumer Rights 1
ODHR 1
Respite Programs 1

CHIP 2
Inefficient Use of Facilities 2
Crisis Services (includes CAS and NPC) 2
Staff Retention versus Staff Turnover 2

Best Practices 3
Consumer Services Orientation 3
Day Programs 3
Infrastructure redundancies 3
Job Skill Development 3
Lack of External Funding 3
Need for Specialized Training 3
PAC Role is Narrow 3
Potential Partnerships & Networks 3
Psychosocial Services 3
Residential Services 3
Staff Diversity 3
Transportation 3
Volunteerism potential 3

(* 1=critical, 2=very important, 3=important)

In subsequent sections of this strategic plan, these prioritized issues will form the basis of enumeration and discussion of aims to be set and objectives to be met by the MHMRA management or by the staff of various programs.