Baltimore Mental Health Systems, Inc. (BMHS)
Description
History:
In 1986, the Baltimore City Health Department (BCHD) received a five-year, $2.5 million grant from the Robert Wood Johnson Foundation (RWJ) Program on Chronic Mental Illness. The application to the Robert Wood Johnson Foundation described a need for a local mental health authority to develop a coordinated and comprehensive network of services responsive to the needs of the clients.
The grant established Baltimore Mental Health Systems, Inc. (BMHS), as the local mental health authority for Baltimore City. BMHS is a public nonprofit entity, which maintains an accountability to government. BMHS's focus has been on expanding the range of services, improving continuity of care, developing new affordable housing opportunities, creating new financing initiatives, and promoting community acceptance and public education.
BMHS is the manager, funder, coordinator, and local authority for mental health services in Baltimore City. BMHS is not a direct service provider. Mental health services are provided by a network of nonprofit agencies (including general hospitals) and private practioners. In fiscal year 1999 (July 1, 1998 to June 30, 1999) approximately 30,000 Baltimore City residents were authorized for publicly funded mental health services.
Accomplishments
Over the past thirteen years, BMHS has been very successful in developing a system of care for adults with serious and persistent mental illness and children with serious emotional problems. The accomplishments include but are not limited to the following:
A. Initiated a citywide planning process that produced major changes and enhancements in the City's psychiatric crisis system. Based on the recommendations of the planning group, BMHS established Baltimore Crisis Response, Inc. (BCRI), in 1992, as a separate nonprofit entity to provide a range of crisis interventions to the citizens of Baltimore City. BCRI, the city's first community based, comprehensive crisis service provides mobile crisis services, community-based crisis residential alternatives, and a hotline and an information and referral service. BCRI has become an essential part of Baltimore's mental health system.
B. In 1998 BMHS facilitated the development of Baltimore Adolescent Response System (B-CARS) to provide a full range of psychiatric crisis services to children, adolescents and their families.
C. Created a Mental Health Information System (MHIS) which serves as a management, administrative, and billing tool that has been very valuable to mental health providers.
D. Developed affordable housing through the efforts of its housing nonprofit Community Housing Associates, Inc. (CHA). CHA has spurred the development of affordable housing in Baltimore City for more than 600 adults with mental illness through various programs. These programs include managing 325 Section 8 certificates (federal government rent subsidies) and 170 Shelter Plus Care vouchers (a federal rent subsidy program for the homeless); serving as a housing developer that provides affordable rental units to 100 individuals using a combination of state and federal grants and loan funds, tax credits, and tenant rents; and, developing a partnership with the local Alliance for the Mentally Ill (AMI), which is a family education and advocacy organization.
E. Over the past eight years, BMHS has expanded the range of services to individuals who have a serious mental illness and are homeless or at great risk of becoming homeless. During this time, BMHS has increased the capacity of the mental health services through several initiatives. These initiatives have included partnerships with the City's Office of Homeless Services (OHS), mental health providers, and the academic community. Services developed have included outreach, mobile treatment, affordable housing, and a specialized shelter.
F. Developed and implemented a demonstration capitation program which provides innovative flexible services to individuals who have been long-term state hospital patients or who have not been well served by the mental health system. The total capacity for the program is 300 individuals. This is a specially designed managed care program for individuals with serious and persistent mental illnesses.
G. In collaboration with the Baltimore City Public Schools, Office of Economic Development and Baltimore City Health Department fund, manage, and coordinate mental health services in 80 of the city's 180 schools.
Organization of public mental health services
State Level
A. In 1997 the Department of Health and Mental Hygiene (DHMH) through its 1115 waiver application received approval from the federal government's Health Care Financing Administration to establish its Medicaid managed care program.
B. The state's design enrolls all Medicaid recipients in a Managed Care Organization (MCO) for all of their health care including substance abuse treatment but not for speciality mental health care.
C. Mental health services are carved out in a system managed by the Mental Hygiene Administration (MHA) and the local Core Service Agencies (CSA). BMHS is the CSA for Baltimore City.
D. MHA contracts with an Administrative Services Organization, Maryland Health Partners (MHP), to perform utilization review, pay claims, and maintain a data base for the public mental health system.
E. Individuals eligible for services in the Public Mental Health System (PMHS) are those on Medicaid, Medicare, or are uninsured.
F. The system offers a range of services including but not limited to outpatient treatment, inpatient treatment, targeted case management, mobile treatment, psychiatric rehabilitation programs, residential programs, crisis residential and partial hospitalization.
G. Providers are primarily reimbursed on a fee for service system. The reimbursement rates are proposed by the Mental Hygiene Administration and approved by the General Assembly.
City Level
A. BMHS is responsible for developing the mental health plan, identifying service needs, identifying funding opportunities, and managing the local system.
B. BMHS interfaces regularly with MHA and MHP for planning, problem solving, and funding issues.
C. In FY'99 the total expenditures for Baltimore City residents was approximately $130 million. About $110 million is through the fee for service system and the additional $20 million are state and federal block grant dollars managed by BMHS.
1. Approximately 30,000 City residents were authorized for a service through the public mental health system.
2. The majority of individuals received an outpatient service.
3. BMHS contracts with City mental health providers with the $20 million. The contract agencies provide a range of services including but not limited to:
(a) Psychiatric crisis services
(b) The intensive services through the Baltimore Capitation program.
(c) A range of services to homeless mentally ill individuals.
(d) School based services.
(e) Family support.
(f) Community support to high risk youth and victims of trauma in consultation with the Baltimore Police Department.
(g) Emergency room services.
(h) Development of affordable housing for individuals with a serious mental illness.
(i) In-home interventions for children, adolescents, and their families at risk for out of home placements.