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Mental Health and Addiction Ad Hoc Agenda 05/28/2019Mental Health and Addiction Ad Hoc Committee Meeting May 28, 2019 – 8:30 am Collier County Museum – Main Campus 3331 Tamiami Trail E. Naples, FL 34112 1.Call to Order 2.Pledge of Allegiance 3.Roll Call 4.Adoption of the Agenda 5.Public Comment 6.Adoption of Minutes from Previous Meeting 7.Staff Reports 7.1. Attendance Requirement Discussion 7.2. Committee Member Outreach Results 8.New Business 8.1. Priority 3 – Data Collaborative (Larry Allen) 8.1.1. Review of Larry Allen Presentation – Committee Comments 8.1.2. Further Discussion of Data Collaborative 8.2. American Foundation for Suicide Prevention Information (Trista Meister) 9.Old Business 9.1. Future Meeting Schedule – Timeline Discussion 10.Public Comment 11.Announcements 12.Committee Member Discussion 13.Next Meeting Time, Date and Location 12.1. June 11, 2019 – 8:30 am 14.Adjournment 1 | P a g e MINUTES OF THE REGULAR MEETING OF THE COLLIER COUNTY Mental Health and Addiction Ad Hoc Committee Meeting May 14, 2019 Naples, Florida LET IT BE REMEMBERED that the Collier County Mental Health and Addiction Ad Hoc Committee met on this date at 8:30 A.M. at 3299 Tamiami Trail East, Building F, 5th Floor Training Room, Naples, Florida with the following Members Present: Mental Health Committee Present: Dale Mullin Lt. Leslie Weidenhammer Scott Burgess Dr. Pam Baker Susan Kimper The Honorable Janeice Martin Council Member Michelle McLeod Janice Rosen Dr. Michael D’Amico Pat Barton Dr. Paul Simeone Caroline Brennan Christine Welton Trista Meister Reed Saunders (by phone) Not Present: Janice Rosen Dr. Thomas Lansen Russell Budd Dr. Emily Ptaszek (resigned) Dr. Jerry Godshaw Also Present: Sean Callahan – Executive Director, Corporate Business Ops Heather Cartwright-Yilmaz – Sr. Operations Analyst 1. Call to Order & Pledge of Allegiance Chairman Scott Burgess called the meeting to order at 8:34 A.M. and led the Pledge of Allegiance. 3. Roll Call – Committee Members 2 | P a g e Thirteen (13) members of the Mental Health and Addiction Ad Hoc Committee were present, representing a quorum. 4. Adoption of the Agenda A motion was made for the adoption of Agenda and it was approved. 5. Public Comment There was no public comment. 6. Adoption of Minutes from Previous Meeting Following discussion with changes, a motion was made and minutes from the previous meeting were approved as amended. 7. Staff Reports 7.1 Attendance Requirements/Enforcement Sean Callahan reviewed Committee Ordinance and attendance requirements with Committee members. The Committee reviewed the summary of absences and discussion ensued around attendance and the importance of attending meetings. Committee members asked Sean to reach out to high absence members to confirm commitments. 7.2 Resignations Dr. Emily Ptaszek sent in her resignation, which filled the licensed psychologist position. Discussion ensued around filling this position. The Committee agreed to move Dr. Simeone into Licensed Psychologist position and leave one at large position. Committee members agreed to ask Mr. Campbell to fill position and appoint him if able to commit to attending meetings every other week for the entire time. Sean Callahan will reach out to Mr. Campbell. 7.3 Introduction of New Committee Member – Trista Meister Ms. Meister introduced herself to the Committee. 8. New Business 8.1. Review of Committee Priorities (Chairman or designee) 3 | P a g e Mr. Burgess reviewed the committee priorities and explained how they were derived. The draft strategic plan has been in development for over 2 years with the assistance of academics, including Mark Engelhardt, that are well versed in the area. Best practice models were then formalized into recommended priorities into the strategic plan. The Committee voted on the key priorities, strategic plan and recognized as they moved forward that additional items could be added. Committee discussion ensued around prevention as an important issue. An estimate was given that every $1 invested in prevention could save $9 in treatment. Ms. Barton pointed out that Informed Families out of Dade County, lost approximately $700,000 in substance abuse and prevention funding. Committee members agreed that it would be good to put prevention into discussion for strategic plan and possibly add to priorities. The Committee members agreed community business and leaders need to be involved in the engagement of the strategy. Committee members discussed the strong advocacy plan Sarasota has in place. Dr. Simeone shared that Lee County is starting to go up to Sarasota and will share learnings from these visits. He will also get contact information and provide information to Sean Callahan for the Committee. 8.2. Priority 4 – Increased Use of Evidence Based Practices (Chairman or designee) Ms. Nancy Dauphinais presented the attached Evidence Based Practices to improve patient outcomes. Ms. Kimper informed the Committee that she was certified by American Psychiatric Nurses Association to teach Suicide Risk Assessment. The Ask program and Columbia method are the two most common methods. A published safety plan for the emergency room, which is inexpensive, easy and very powerful. and will be published. Ms. Brennan discussed implementation of safety plan for all low and moderate risk in schools, and that Collier County Public Schools has been using the Columbia method. David Lawrence Center has been certified and is a local resource twice per week in our community. Committee discussion ensued around legal enforcement for Narcan in the state of Florida in which the client can refuse transport by EMS after the drug has been administered. Efforts have been made to get a mandate in the state that if Narcan is administered then Marchman Act can be enforced. Additionally, clients with numerous uses of Narcan will impose automatic Marchman Act if approved. Judge Martin discussed clients that are revitalized with Narcan and the considerations for central receiving system for more aggressive enforced treatment by way of the Marchman Act. Enforcing the Marchman Act will then make the needs for more resources in the 4 | P a g e Judiciary and could place a heavy burden on the jail system if there is not a central receiving system in place. Suicide prevention and awareness education and prevention may be additional add. 8.3. Report: The Legalization of Marijuana in Colorado (Pat Barton) Ms. Barton reviewed the Legalization of Marijuana in Colorado report dated September 2018. The Committee was informed that NADACT just published paper on medical marijuana that has been propagated has not been researched. A question was made about Ms. Barton’s blog and if Committee members can join. Sean Callahan did not see a problem with it as it is a one-way communication. Drug Watch America is one entity that Ms. Barton reviews. Dr. Simeone recommended work by Kevin Hill on the subject and explained that the subject has seldom been discussed or written at a cultural level. Dr. Simeone thought it would be useful speak at community events and educate audiences about the cultural aspects of legalization of marijuana and suggested that a policy statement be added to the Strategic Plan. A comment was made that there is no other medication that we have actually voted on. Prohibition 9. Old Business 9.1. Future Meeting Schedule – Timeline Discussion October 1st and November 5th are available for the Workshop. The Committee asked Sean Callahan to ask for other dates later in October. 10. Announcements Larry Allen scheduled at next meeting for Data Collaborative and data sharing. 11. Committee Member Discussion Ms. McLeod asked about resources available to people who were contemplating suicide. Committee discussion ensued about the best methods to deal with a suicidal person, including calling 911. The Committee discussed an additional 8th priority for education and advocacy and agreed to discuss further during a future meeting. 12. Next Meeting Time, Date and Location 5 | P a g e May 28, 2019 – 8:30 am – Main Campus Museum Conference Room at 3331 Tamiami Trail E. 13. Adjournment The meeting adjourned at 10:18 am with nothing further left to discuss. Collier County Mental Health and Addictions Ad Hoc Advisory Committee Scott Burgess – Chairman The foregoing Minutes were approved by Committee Chair on May 28, 2019, “as submitted” [ ] or “as amended” [ ] Mental Health and Addiction Ad Hoc Committee Meeting May 28, 2019 Item 8.1.1 – Review of Larry Allen Presentation and Committee Comments From: CallahanSean Sent: Tuesday, April 16, 2019 8:55 AM To: THIS IS A ONE WAY COMMUNICATION. Good morning, Committee Members. Please find Larry Allen’s presentation attached. Respectfully, Sean Callahan Exec. Director of Corporate Business Operations Office of the County Manager 3299 Tamiami Trail E, Building F, Suite 202, Naples Florida 34113 Phone: 239.252.8383 Cell: 239.272.6516 E-mail: Sean Callahan@colliercountyfl.gov “HOW ARE WE DOING?” Please CLICK HERE to fill out a CUSTOMER SURVEY. We appreciate your feedback! County Collaboration and Data Sharing Collaborating for Excellence Shared Outcomes Change in pre and post measures •Days in jail •Days in acute care setting –CSU/Detox –inpatient •Number of arrests •Employment status •Benefits screening •Linkage to primary care physician •Assessment to Hillsborough County Health Plan •Aligning outcomes reduces costs and improves overall compliance Data Sharing •Our process •Programs currently underway •Sheriffs’ Departments Arrest Data •Hillsborough, Pasco, Pinellas, Polk, and Sarasota •Manatee expect soon. •High Need High Utilization Program and Care Coordination •Youth At Risk Committees •Hillsborough, Pasco •County Health Plans •DCF Parents in Child Welfare •School and LEO Based Threat Assessment Teams Mental Illness in Jails and Prisons A National Issue This equals 383,200 total individuals -while there are only 38,000 state hospital beds! Not only are those with SMI incarcerated in larger numbers -they are incarcerated for longer periods In Orange County, Florida, average inmate length of stay is 26 days -for those with SMI it is 51 In New York’s Riker’s Island, average length of stay is 42 days -for those with SMI it is 215 The Treatment and Advocacy Center reports on the prevalence of individuals with Serious Mental Illness (SMI) in Jails and Prisons In 2016 it was estimated that 15%of the prison population and 20%of jail populations met the criteria for SMI. What the Data Tells USPinellas County Jail Booking Data A B B/A C C/B D D/B D(1)D(2)E E/B E(1)E(2)F G Persons Arrested Served Percent Served (Homeless)Percent CSU-unique admits Percent CSU Beddays CSU non-unique admits DTX-unique admits Percent DTX Beddays DTX non-unique admits Total Acute Care Admits Co-Occurring 16/17 25,739 3,082 11.97% 1,097 35.59%810 26.28% 18,179 4,153 351 11.39% 5,130 1,279 1,092 69 17/18 28,054 3,151 11.23% 1,157 36.72%792 25.13% 18,233 4,158 311 9.87% 6,210 1,475 1,034 69 18/19 23,948 2,438 10.18% 1,005 41.22%656 26.91% 12,891 3,025 234 9.60% 5,154 1,008 838 52 Arrested vs Served with CSU Fiscal Year Response from CFBHN Pinellas Integrated Care Alliance –Funded through a grant from the Foundation for a Health St. Petersburg, the Sheriff’s Department, Pinellas County and CFBHN –Marchman Act Project Helping HANDS began addressing this issue and is a program before it’s time –Started before the Governor's Executive order –Governor has directed ME’s work with the Sheriff Departments to find ways to provide services and re-integrate individuals into the community. –Reinvestment Grant Hillsborough County –Coordinating services with Jail and developing project to leverage funding with County Health Plan. –Developing Short-Term Housing Project. We wanted to do something better. Outcomes Pinellas Integrated Care Team •Pre and Post contact with LEO –67 Pre program contact (100%) of participants –4 Post program contact 94% improvement. •Change in CSU and Detox –62 admissions to CSU and 29 to detox –Pre program contact –13 admissions to CSU and 4 to detox –Post program contact –79% improvement to CSU and 86% improvement to detox •Marchman Act Project –62% received services following screening Outcomes Polk County Helping Hands Project –Number of participants •69 Screened and 62 served •62 or 87% received peer services •45 of 62 or 72.5% opened to program •31 of 45 or 69% engaged with behavioral health provider. •5 of the 45 or 11% arrested after start of program •100% of clients screened for benefits Evaluation Project and County CollaborationHillsborough County Project to evaluate the effectiveness of the Substance Abuse Treatment Services Integrated Care Pilot Program •Combining Hillsborough County Health Plan data with the CFBHN to determine overlap. –Data showed 78.9% Received an ancillary service –Treatment Plan, HIV Education, Mental Health Service or TB Testing. –Providers were able to leverage 49.8% or $2.2 million of addition funding to supplement the county funding. Funding was from DCF/CFBHN or other funding. –Data showed a reduction in expense to the community (pre and post measure) •Jail costs -$2.0 million or 55.2% reduction jail day costs. •Acute care (CSU/Detox) -$375,469 or 75.6% in reduced acute care bed days. Social Determinants of Health Range of factors impact individual and population health and include: •Quality education •Stable employment •Safe homes and neighborhoods •Access to preventive services and healthy food How does CFBHN help communities recognize and respond to gaps? Housing Projects Sun Coast Region and C-10 Housing is the #1 identified need in 2016 CFBHN needs assessment Developing housing •Polk County –Blue Sky Communities and CASL (in collaboration with CFBHN, City of Lakeland and Polk County Government) submitted application to Florida Housing Finance Corp. •Lee County –housing project is in the development phase •Sarasota County –Arbor Village will open in August 2019 •Projects add approximately 240 housing units Vision for Meeting Housing Needs •Housing Projects are developed as Private/Public Partnerships. –CFBHN facilitates project development for for-profit developers and non-profit housing management companies. –The goal has been to develop a sustainable model that can be replicated across all 14 counties of the Sun Coast Region. •Projects are designed to; –Provide the housing and support services to improve success –Finding way to fund 400 to 500k per project service funding is the required gap funding needed for supports (e.g. case management, transportation, etc.) –CFBHN works through legislative budget requests, grants, or local government support to secure needed service funding. Thank You Mental Health and Addiction Ad Hoc Committee Meeting May 28, 2019 Item 8.2 – American Foundation for Suicide Prevention Information (Trista Meister) From: Trista Meister <trista@mindfulmarketingfl.com> Sent: Thursday, May 16, 2019 3:35 PM To: CallahanSean <Sean.Callahan@colliercountyfl.gov> Subject: For the Ad Hoc Committee: #RealConvo from the American Foundation for Suicide Prevention Sean: This was something Michelle McCleod mentioned wanting more information about at this week’s mental health and addiction ad hoc committee meeting. This is information from the American Foundation for Suicide Prevention about how to talk to someone who is thinking about suicide. If Someone Tells You They’re Thinking About Suicide: A #RealConvo Guide from AFSP • https://afsp.org/if-someone-tells-you-theyre-thinking-about-suicide-a-realconvo-guide-from- afsp/?utm_source=All+Subscribers&utm_campaign=2ebec6f1fa- Research_Connection_July_COPY_01&utm_medium=email&utm_term=0_3fbf9113af- 2ebec6f1fa-380455449 Thought it might be something the committee would like to see. Thanks. Trista Meister, President 239-785-3362 | Trista@MindfulMarketingFL.com If Someone Tells You They’re Thinking About Suicide: A #RealConvo Guide from AFSP Let’s say you’re having an open, honest conversation with someone about mental health – you can find tips on how to do that here – and they feel comfortable enough with you to reveal that they’re having thoughts of suicide. You probably feel an immense amount of pressure. How should you respond? What can you do to connect them to help? First of all, realize that someone opening up in this way is a positive thing, because it’s an opportunity to help. Here are some ways you can respond. Let them know you’re listening First of all, reassure them you hear what they’re saying, and that you’re taking them seriously. “I’m so glad you’re telling me about how much has been going on, and how you’re feeling. Thank you for sharing this with me.” Show your support In your own way, make sure they know you’re there with them, and that you care. “I’m right here with you.” “Nothing you’re going through changes how I feel about you, and how awesome I think you are.” “I love you no matter what, and we’re going to get through this together.” Encourage them to keep talking – and really listen Let them know you want to hear more about how they’re feeling, and what they’re going through. Listen actively by expressing curiosity and interest in the details. “Wow – that situation sounds really difficult.” “How did that make you feel when that happened?” Ask them about changes in their life and how they are coping Find out how long it’s been that the person has been feeling this way, and any changes it’s caused in their life. “How long have you felt this way? When did these feelings start?” “Have these thoughts led to any specific changes in your life, like trouble sleeping, or keeping up with work?” “Have you been getting out as much as before? Are you isolating yourself?” Be direct if you suspect they’re thinking about suicide If you think someone’s thinking about suicide, trust your gut and ask them directly. Research shows it will not put the idea in their head, or push them into action. Often, they’ll be relieved someone cares enough to hear about their experience with suicidal thoughts. “Are you thinking about killing yourself?” “Does it ever get so tough that you think about ending your life?” Make sure not to sound like you’re passing judgment (DON’T say: “You’re not thinking of doing something stupid, are you?”) or guilt-trip them (DON’T say: “Think of what it would do to your parents.”) Instead, reassure them that you understand and care. “I really care about you, and I want you to know you can tell me anything.” What can you say if they tell you they’re thinking about killing themselves? Stay calm – just because someone is having thoughts of suicide, it doesn’t mean they’re in immediate danger. Take the time to calmly listen to what they have to say, and ask some follow- up questions. “How often are you having these thoughts?” “When it gets really bad, what do you do?” “What scares you about these thoughts?” “What do you need to do to feel safe?” Reassure them that help is available, and that these feelings are a signal that it’s time to talk to a mental health professional. “The fact that you’re having these thoughts tells me something significant is going on for you right now. The good news is, help is out there. I want to help you get connected to resources that can help.” Follow their lead, and know when to take a break This is a tough conversation to have, so make sure the other person knows they can stop if it feels like talking about it is too hard for them at the moment. “Are you okay with continuing to talk about this?” “I want to support you, and I’ll be here if you want to talk more later.” How to suggest they could benefit from professional help You are being a great person in having this supportive conversation – but you’re not a mental health professional. If the person you care about has told you they’re thinking of suicide, it’s a warning sign that they should speak with a mental health professional. Here’s how you can broach the subject. “I hear you that you’re struggling, and I think it would really be helpful for you to talk to someone who can help you get through this.” “You know, therapy isn’t just for serious, “clinical” problems. It can help any of us process any challenges we’re facing – and we all face serious stuff sometimes.” “I really think talking to someone can help you gain some perspective, and keep things from getting worse.” “You’re in good company: the highest-performing executives and elite athletes lean on mental health professionals to hone their performance. Reaching out for professional guidance and therapy is a strong thing to do, and it can make all the difference.” Help them connect Sometimes making that first moment of contact to professional help can be the hardest. Offer to help them connect in whatever way you’re comfortable with. “I could call your insurance with you, or go online to find a mental health professional or substance use program. Or I could sit with you while you do it. We can figure it out together.” “I could drive or walk you to your appointment. Then we could have coffee afterwards.” If they’re concerned about privacy If the person is worried about others finding out that they’re getting treatment, let them know their worries are mostly unfounded. “Mental health treatment actually has even greater confidentiality safeguards than physical health treatment.” “Most people realize that mental health is an extremely important, valid part of health in general – and we all have various kinds of health issues. People who get support for their mental health are seen as strong, smart and proactive.” If they ask you not to tell anyone, tell them you want to help them get the support they need – and that that may involve enlisting the help of others. Encourage them to be part of the conversation that happens in reaching out for help, and reassure them you’ll be as discreet as possible in your effort to keep them safe. What if they refuse? Not everyone is ready right away. If someone you know is struggling refuses your suggestion of professional help (and if they aren’t in immediate danger, i.e. that they are not presently self- harming or about to), be patient and don’t push too hard. “It’s okay that it doesn’t sound like you’re ready yet. I really hope you’ll think about it. Just let me know if you change your mind, and I can help you connect with someone.” “I know you’re going through a lot, and I really believe it can make a big difference for your life, and your health. Just consider it for later, and know I’m here to help.” “If you’re not ready to go in and meet with someone in person, you could call the National Suicide Prevention Lifeline at 1-800-273-8255, or if you don’t feel like speaking, just text TALK to the Crisis Text Line at 741741. They can tell you more about what it might be like to work with a doctor, counselor or therapist.” You can also offer to speak with their primary care provider as a gentle next step – family and friends can provide information to health care providers without expecting a call back or for the HCP to provide any confidential health information back. When the convo’s winding down… End the conversation by reiterating that you are so glad for the chance to connect on this deeper level about such meaningful things in life. Remind them that we all have challenges at times, and that you’ll continue to be there for them. * If they’re in immediate danger • Stay with them • Help them remove lethal means • Call the National Suicide Prevention Lifeline: 1-800-273-8255 • Text TALK to 741741to text with a trained crisis counselor from the Crisis Text Line for free, 24/7 • Encourage them to seek help or to contact their doctor or therapist Check out (and share) our other AFSP #RealConvo Guides: How to Start (and Continue!) a Conversation About Mental Health: A #RealConvo Guide from AFSP Reaching Out for Help: A #RealConvo Guide from AFSP How to Talk to a Suicide Loss Survivor: A #RealConvo Guide from AFSP ------ Like what you're reading? Go to our Sharing Your Story page, where you'll find resources for sharing your own story, including story ideas, blog submission guidelines, tips for sharing your story safely and creative exercises to help you get started, and assignments for upcoming topics. Write a blog post for AFSP! Click here for our Submission Guidelines. Mental Health and Addiction Ad Hoc Committee Meeting May 28, 2019 Item 8.3 – Addition of New Committee Priorities (Action Required) May 14, 2019 To Sean C. From Scott B. RE: Notes from today’s mtg Hi Sean, here are notes I wanted to forward from today’s meeting to make sure we were on the same page with what the Committee discussed. We are adding two new priorities to the list: 1) Community Engagement and Advocacy and 2) Prevention and Education. Topics under such: 1) Community Engagement and Advocacy- - Private and Public - Private = business leaders, businesses, Foundations, philanthropic communities, community leaders, faith-based communities, community-at-large to assist in advocacy efforts - Public = Local, State and Federal governmental entities 2) Prevention and Education - Prevention services in schools and other community settings - Education and screening in emergency rooms, primary care and other settings including safety planning and, most importantly, effective linking to supports to effective address issues long term - Education, awareness and diversion and deflection whenever possible via CIT training with law officers, EMS and other first-responders - NAMI education programs for clients and family members (e.g. Family-To-Family) - Mental Health First Aid (schools, colleges/universities, general public) - Home-Base Veterans training, awareness raising and linkage to specialized care - How do we raise the truth about the ill-effects of proliferation of marijuana in communities who have already done so (Colorado) and around the lack of credible, independent research on use of marijuana, to ensure we have a well-informed community on this matter - Suicide Prevention efforts (those in place and those still needed) - General community awareness raising of how to access care immediately in crisis (e.g. 24/7/365 live or phone consult/assessment via DLC, DLC walk-in clinic, Mobile Crisis intervention support, CCSO’s Mental Health Intervention Ream, call 911). How do we get word out on these options? Community PSA’s? Paul S also offered to draft up a statement on the cultural impacts that have strongly contributed to where we are as a society as it relates to the growing mental health and addictions challenges, reinforcing issues we must combat to be successful (Denial, Distraction, Dissociation and Drugs)? I think I got those right?? To underscore these influences did not appear over-night, they will not be changed overnight. We believe our strategic plan addresses the most salient of the issues from a treatment standpoint and we also believe it is equally important to tackle these larger, cultural influences as a parallel process to address significant components of the root causes of many issues.