Mental Health and Addiction Ad Hoc Agenda 09/10/2019Mental Health and Addiction Ad Hoc Committee Workshop
September 10, 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
8. New Business
8.1. Group Workshop
8.1.1. Final review of August 13 work products for each Priority.
8.1.2. Define short-term (1 year) and intermediate to long term (2-5 year) outcomes for
each Objective within each Priority
8.1.3. Define how we will accomplish each Objective within each Priority
(Inputs/Resources required, Activities, Outputs)
8.1.4. Description of final product including narrative and logic model
9. Old Business
10. Public Comment
11. Announcements
12. Committee Member Discussion
13. Next Meeting Time, Date and Location
12.1. September 24, 2019 – 8:30 am – Collier County Museum
14. Adjournment
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MINUTES OF THE REGULAR MEETING OF THE COLLIER COUNTY
Mental Health and Addiction Ad Hoc Committee Meeting
August 27, 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 3331 Tamiami Trail East, Main Campus Museum,
Naples, Florida with the following Members Present:
Mental Health Committee
Present: Dale Mullin
Lt. Leslie Weidenhammer
Scott Burgess
Council Member Michelle McLeod
Pat Barton
Trista Meister
Janice Rosen
Dr. Paul Simeone
Caroline Brennan
Dr. Jerry Godshaw (Phone)
Dr. Michael D’Amico
Michael Overbay
Not Present: Dr. Thomas Lansen
The Honorable Janeice Martin
Dr. Pam Baker
Susan Kimper
Russell Budd
Reed Saunders
Christine Welton (resigned)
Staff Present: Sean Callahan – Executive Director-Corporate Business Operations
Heather Cartwright-Yilmaz – Sr. Operations Analyst
1. Call to Order & Pledge of Allegiance
Chairman Scott Burgess called the meeting to order at 8:36 A.M. and led the Pledge of
Allegiance.
3. Roll Call – Committee Members
Twelve (12) members of the Mental Health and Addiction Ad Hoc Committee were present,
representing a quorum.
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4. Adoption of the Agenda
A motion was made for the adoption of the agenda and it was approved.
5. Public Comment
There was no public comment.
6. Adoption of Minutes from Previous Meeting
A motion was made and minutes from the previous meeting were approved.
7. Staff Reports
Senator Passidomo lead discussion around comprehensible plan to give legislature what Collier
County vision is for the future to mitigate Mental Illness and Addiction in our community. She
noted that there was a complete rewrite of Mental Health a few year ago; however, no funding
allocation was set. She indicated that we have an opportunity to legislate for funding.
Discussion ensued around mental health being an illness, lack of state funding and ranking.
She wanted to note that there is a lot of pressure around gun control with the recent gun
violence without strengthening case that mental illness could be the cause.
The Senator then lead discussion around Senate Bill 12 (SB 12) for state services. The Central
Receiving facility is a major focus and element for supportive services in the plan with an
extremely lean budget. Educating Legislatures is a key for getting funding.
Sean Callahan discussed his trip to Washington D.C. The treatment programs were given
320M, collaborative data. One of 16 counties chose for medically assisted treatment for
evidence-based practice. The program uses different drugs to help stabilize patient; however,
must work to reduce stigma around program. Some of these drugs have a 65 plus success rate.
Much higher than treatment for diabetes. Fighting stigma that we are treating drug addiction
with a drug is a major hurdle. The pilot program for Collier County will include medical
treatment, including drugs.
Discussion ensued around Johnson and Johnson 572M lawsuit. The funds will be disbursed
for medical funding treatment programs. There is more funding from other smaller companies
that settle outside of court. Potential partnership to help, the majority is 100% federal funded
program. It is in the technical assistance program currently and is a 9-month process at this
time.
Sean Callahan will send out 20-minute clip to all Committee members.
8. New Business
8.1 August 13 Workshop Product and Next Steps
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Chairman Burgess introduced Chet Bell.
The group proceeded into a workshop on the strategic plan. The attached MHAAHC Next
Steps Memo in the agenda packet summarizes next steps and will serve as a recorded record
of the business of the August 27 Mental Health and Addiction Ad Hoc Committee meeting.
Priority 7: Dr. Mike De Amico was involved in this priority. Not Dr. Lansen.
Word smiting to Mission Statement. CRS
The CRS will be a receiving facility for Marchman and Baker Act clients. Part of the Surtax
funding is for brick and mortar. Next challenge is the Operations and maintenance part of it.
Housing and Homeless is major issue in the community. Increased availability for chronically
homeless that has mental illness or substance abuse disorder. Address mental health and
substance abuse and the focus is in these areas.
Correction: 10% is for seniors not just for mental health or substance abuse disorders.
Disability and seniors are included. Change title to include transitional housing.
Transitional housing start then moves through for permanent supportive housing. Great step
for prioritizing this model. The language with HUD has changed back to more supportive and
permanent housing. The goal is to provide adequate opportunity to be safe and move into
permanent and addresses entire need for crisis stabilization. “Permanent and Supportive
Housing” continuous permanent supportive housing. “Transitional and permanent supportive
housing…”
Transitional and Supportive Housing is the verbiage and will massage as needed.
Priority 3:
Priority 4: Everyone collects data points, hospital, jail, and no central place to store data. We
are going to make an investment to identify high level users. There is a statute that funds data
collaborative. This could be a county function to aggregate the different data to be more
affective. Will have to create MOU or release for the various entities. The IT challenge is not
difficult.
Most systems that are accessing case management, release of information needs to be there.
David Lawrence Center has data and it is locked down for only them. Mike Overbay data
warehouse collective. Policy procedures, DCF on homeless and real time data and how they
move across geographical boundaries. Do not want to limit it to boundaries. It is aggregated
data to start with. Transient nature of the clients and what, where they are going. DCF given
off the record support for data warehouse.
What Data to Collect?
Report Dashboard?
What Data to Share?
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Reentry from the jail. Community partners is big on referrals. Closing the coordinated entry.
Funding, participation and engagement from partners. Conjoined effort. Approached school
district, youth haven is envolved and jail. Converted March 2017. 122 participant programs
now. Reporting data to tell the next relevant story. The savings can be measured over time.
Commissioner Solis said we already have pieces that is already working. USF Mark Englehart
in Pinellas County is already done, so we can begin with what they have. We do not have to
reinvent the wheel. The programs are very successful. NYU has nonprofit that can set it up.
They exist. Must get buy in and participate. MOU or Release
Priority 5: Participation and inclusion. Certain sets of folks that make them feel included.
Talking about the inclusion and not just the participation. Working very hard for various
populations and should have inclusion wording in there.
Discuss with Judge further on capacity when she gets back.
State Guidelines having trouble with qualified peers. Inclusion into courts, treatment, in
recovery. Try to utilize young people and this is what is being provided. They do include
successful people as mentors.
Rapid response team is having tremendous success and is recognized by courts. The courts
are not being funded. Money not necessarily from grant, but from the state. Funding probation
officer, continuity of care. Need dedicated people to do job. Need funding to run the court
side for staffing. We only have one judge for example.
Each entity is not being funded to staff public defender, David Lawrence, probation officer etc.
The wrong place to house people in jail, has suffered from mental illness and need to get out
of jail and get treatment.
It is partly education for the clients and attorneys. Clients do not want or deny treatment.
What are the actions that we need to pursue? That should be our focus.
Priority 6: Stroke of a pen to make a commitment to do this. Making it now that law
enforcement is not called. There are already systems in place at those organizations.
Priority 7: Blue Zones as a similar model not necessarily Blue Zones. What we can take on
effectively over the next three years. What are the activities that we want to pressure within
this priority?
Services to Veterans: Motion on the floor to add Services to Veterans as number 8 Priority.
The title needs more action. Design and Implement enhanced services to meet the ….
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Unique transitional housing is needed for Veterans. Open it up as Priority. Grant per diem
programs around Florida. Need community voice and as a priority it will become focus area
in Collier County.
13% in Collier County are veterans. 40-50% are not even registered at the VA. Education and
awareness within population and are getting there.
The Chairman started discussion around the suicide prevention, hotline. We need to
specifically layer into actions and prevention. Trauma informed care in evidence-based
practices. CRS, Housing and add in suicide etc.
Mr. Bell then started discussion around memorandum. Background statement to why this is
important in our community. He asked to jot down or note overview. Write paragraph to Sean
no later than September 3rd to use in Workshop on September 10th.
Looking forward to Workshop in two weeks. What are some of the activities we want to bring
forward in our community, Veterans, Housing? Identify specific activities we are
recommending to community. Plan to implementation. What are the activities that flow from
priority over the next three years?
8.2 September 10 Workshop
The Committee members agreed to submit updates to Sean Callahan on or before 09/03/2019.
8.3 Florida Council on Homelessness Annual report (Previous Request)
The Chairman began discussion around topic. There is a Trust that has been established in
Florida. There are millions of dollars that were appropriated and not being used. This is an
area of advocacy, dollars that can be utilized for what it was intended.
Statewide advocacy: Priority number one per Michael Overbay.
PP. 45. We are leaving money on the table. If the county is inaccurate then we are leaving
money on the table. The HUD NOFA gives a scoring on number of applications coming in.
Great collaboration with the Sheriff Department. The Homeless Coalition did not do a good
job last year. Need to bring more volunteers on board to do this. The HUD NOFA gives a
scoring on number of applications coming in. Bonus projects and only have one underwriter.
They have a capacity issue. They must put value on bringing in partnerships. Funding
screening for homeless. Application since July 17th. Bonus programs have wide opportunity.
We need to get resources. Need to get measurements. It is important that we have plans to
bring agencies along. Manage additional resources, engage their industry in continuum of
care. Community collaborations to get more resources. Due by September 30th.
Committee discussion ensued around housing and the homeless being a major issue in the
community. The need for increased availability for chronically homeless that has mental
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illness or substance abuse disorder. The housing program sets aside 10%, which includes
seniors, handicapped and those suffering from mental illness and addiction.
9. Old Business
There was no business on the agenda besides the workshop agenda.
10. Public Comment
11. Announcements
There were no announcements.
12. Committee Member Discussion
There was no further discussion.
13. Next Meeting Time, Date and Location
September 10, 2019 – 8:30 am – Collier County Main Museum
Homework: Overview paragraphs to Sean by September 3rd.
14. Adjournment
The meeting adjourned at 10:34 pm 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 September 10, 2019, “as
submitted” [ ] or “as amended” [ ]
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Collier County Mental Health and Addiction Ad Hoc Committee
Mission Statement (Revised)
The Committee will collaboratively plan for and coordinate a full array of evidence
informed services and supports to improve the lives of individuals with mental health
and substance use disorders and overall quality of life in the Collier County community.
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Priority #: 1
Central Receiving Facility (System)
Priority Statement: Design, build and operate a Centralized Receiving Facility for
those in acute crisis as a result of a mental health and/or substance use disorder.
Goal: Ensure that there is a coordinated system and adequate capacity to assure that
citizens in crisis will be able to access emergency mental health and substance use
disorder services over the next 20 years.
Objectives:
• Design, build, staff and operate Central Receiving Services by XXXXX
• Assure sustainable funding to ensure ongoing Central Receiving operations over
the next 20 years.
• Provide both Baker Act and Marchman Act services as part of Central Receiving
Services.
Outcome/Impacts:
• Program: Successful bridging from Central Receiving to community-based
outpatient services
• Program: Law enforcement processing time at Central Receiving
• Program: Transfer time from local hospitals to Central Receiving
• Population: Patient satisfaction with access to and quality of care in Central
Receiving Services.
Data:
• Episode of care data, law enforcement time in drop off data, hospital transfer
referral data, patient satisfaction questionnaire at discharge.
Workgroup: Scott Burgess, Susan Kimper
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Priority #: 2
Permanent Supporting Housing
Priority Statement: Increased availability of scattered site permanent supportive
housing based on the Housing First model for chronically homeless persons diagnosed
with a mental health disorder and increased availability of transitional housing for
persons in recovery from substance use disorders.
Overview: For people with mental health and substance use disorders, housing is
considered a ‘golden thread’, providing the foundation through which all aspects of
treatment and recovery are possible. When this basic need isn’t met, people cycle
tragically in and out of homelessness, jails, shelters, and hospitals at a high cost to
individuals and society.
Unfortunately, due to low incomes (less than $800 per month), discrimination, and
difficulties in daily functioning, persons with serious mental illnesses and substance use
disorders generally cannot compete for market rental housing. Additionally, affordable
housing units and supported housing programs have long wait lists and few in need can
access them.
To be successful, housing supports should follow evidence-based and evidence-
informed practices, including a ‘Housing First’ philosophy in which housing is a right, not
a privilege; eligibility is not dependent on psychiatric treatment compliance and sobriety;
and housing units are integrated within the community. An array of options should
include rental assistance vouchers, rapid re-housing, recovery housing, transitional
housing, peer run respite, and permanent supportive housing, each bundled with
appropriate levels and choices of services and supports.
Persons experiencing homelessness should have immediate access to low-barrier
emergency shelter to address basic needs while receiving supports to secure long-term
housing through rapid rehousing or similar means.
(See also narrative from Strategic Plan draft)
Goal 1: Increase availability and accessibility of a variety of housing options for
persons with mental health and substance use disorders.
Objectives:
• 100% of all Collier County approved affordable housing will include required
10% set aside for persons with a mental health and/or substance use
disorder.
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• Supported housing options are available to 100% of those in need
• Increase number of private landlords accepting rental assistance vouchers.
• Increase number of supported housing and supported employment provider
agencies.
• Increase individual incomes beyond disability amounts to ensure long term
stability.
• Supported housing rents are limited to 30% of the individual’s income.
Goal 2: Homelessness among persons with mental health and substance use disorders
is rare, brief and one-time.
Objectives:
• 100% of chronically homeless who are diagnosed with a severe mental health
disorder will be housed within x days of enrollment in coordinated entry.
• 100% homeless individual will have immediate access to low-barrier
emergency shelter
• 100% of persons with a serious mental health disorders identified annually
during the Point in Time count will not meet the definition of chronically
homeless.
• Increase number of SOAR (SSI/SSDI Outreach, Access and Recovery)-
trained staff and # dedicated staff hours to facilitate attainment of Social
Security benefits for eligible individuals.
Outcomes/Impact:
• # of affordable housing units available to persons with a mental health and/or
substance use disorder.
• # of persons receiving rental assistance/low income housing/housing voucher
• # persons attaining SSI/SSD and accompanying Medicaid or Medicare benefits
• # peer specialists employed in variety of roles in mental health and substance
use programs
• # days in the community
• # days worked for pay
Data:
• # of agencies, # of providers, increased capacity/#units, # of hours of service, #
persons or months on housing wait lists, # chronic homelessness at Point in
Time count, County annual report, state SAMH data system, Drug Court Case
management system, local data collaborative reports.
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Workgroup: Dr. Pam Baker, Dr. Jerry Godshaw, Cormac Giblin
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Priority #: 3
Increased Use of Evidence Informed (Evidence-based) and Best Practices
Priority Statement: Increase use of evidence informed and best practices in all
programming for persons with mental health and substance use disorders.
Overview:
Evidence-based practice (EBP) began as a movement when the concept was formally
introduced in medicine in 1992. Since then, it has been adopted in various allied health
disciplines, along with spreading to other fields such as management, education and
law. At its most basic level, EBP bases systematic decision-making-in operations and
clinical practice-on existing science to reduce variation, improve outcomes and reduce
cost. Moreover, wherever possible, it also takes into consideration critical population
parameters, extant values, preferences, and available resources, along with
environmental and organizational contexts relevant to EBP implementation. A distinction
is often drawn between “evidenced- based” practices, where the benefits of a process
or treatment are delivered under highly controlled conditions, versus “evidenced-
informed”, which describes the modification of EBP to be used under less ideal
circumstances. The latter represents the modal use of EBP practices and is regarded as
a sensible place to start when such ideal circumstances do not exist. The
Transdisciplinary EBP model (Satterfield et al., 2009) depicted below illustrates an
optimal process where decision-making (and clinical practice) takes all of these
variables in to account, against the backdrop of the best available research evidence, to
deliver context-relevant, “best practices”.
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Goal: Whenever possible, implement evidence based or informed practices and
services to enhance quality and cost effectiveness for targeted mental health and/or
substance use disorders
Objectives:
Population:
Decreased symptoms per targeted disorder; decreased lost productivity, absenteeism,
arrests; decreased number and severity of medication related co-morbidities (CHF,
Diabetes); decreased number and severity of negative social determinants of health
(housing, income, safety, education, access to health services); increased patient
satisfaction
Performance:
# of staff trained in evidence based treatment/practices; # and % of patients referred to
evidence based treatment as opposed to treatment as usual; treatment completion rates
of patients in evidence based treatment as opposed to treatment as usual; % of no
show rates in evidence based treatment as opposed to treatment as usual; patients
screened for various mental health/substance use disorder problems;
admission/readmission rates pre/post implementation of evidence based practices; # of
ED visits pre/post; length of stay in outpatient treatment; medication compliance; # of
case management contacts.
Data:
Workgroup: Dr. Paul Simeone, Nancy Dauphinais
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Priority #: 4
Data Sharing, Collection and Outcomes Reporting
Mental Health and Substance Use Disorder Data Collaborative
Priority Statement: Develop a mental health and substance use disorder data collaborative
focused on data collection, data sharing, and outcomes reporting
Objectives:
Multiple sources collect internal data and share with other entities in limited ways, but there is
not a process for comprehensively using relevant data, both at the system and clinical levels, to
inform the planning and delivery of behavioral health care among all related community
organizations.
The data could be aggregated for use in planning, quality improvement, program evaluation,
and grant applications. A repository, along with staff, would be needed to maintain, aggregate,
and disseminate reporting on the data collected.
Outcomes/Data:
A centralized data collaborative could collect information from entities including the David
Lawrence Center, hospitals, courts, law enforcement, community providers, including but not
limited to:
• Numbers and demographics of persons served by each provider
• Demonstration of cost avoidance in criminal justice through diversion activities
• Justification for efficient distribution of public funding
• Number of days acute care units are at or over capacity
• Other metrics used to gauge effectiveness and efficiencies of community health system
Action Items:
1. Start with a list of data points we would like to report on – including frequency,
granularity, and sophistication of data;
2. Work backward to outline who was needed to participate in the collaborative and what
specific data was necessary;
3. Draft MOUs for each participating entity surround collection and distribution of data;
4. Establish a steering committee to guide the project development;
5. Design a project plan to establish the database to house collaborative data;
6. Begin to collect data and report on a routine basis.
Workgroup: Sean Callahan, Michael Overway, Dr. Gerry Godshaw
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Priority #: 5
Increasing the Effectiveness and Capacity of Treatment Courts
Justice System Response
Priority Statement: Expand, improve and sustain the responses of the justice system
to persons with mental health and substance use disorders.
Goal: Expedite the diversion of persons with mental health and/or substance use
disorders from jail to treatment, thereby reducing recidivism, improving community
safety and directing resources to optimize outcomes.
Objectives:
Population:
• Reduce number of arrests; improve symptoms; improve child and family
reunifications with supports; # employed; # receiving additional education and
training; increased independence and self-reliance; maintenance of sobriety - #
of days sober; reduce returns to use
Performance:
• Reduce time between arrest and connection with treatment; increased stable
housing; reduced # of arrests/rearrests; increased # of treatment services;
increased # of appropriate referrals into diversion; increased capacity of each
diversionary court program; increased graduation rates; increased pathways to
treatment (new programs)
Outcomes/Data
• Jail days; CSU reports; Drug Court case management system; Misdemeanor
mental health diversion data; CCSO data; Community Drug Response Team
data (EMS Captain is leader); Units of service from treatment providers
Workgroup: Janice Rosen, Honorable Judge Janeice Martin, Trista Meister
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Priority #: 6
Non-Emergency Baker Act and Marchman Act Transportation
Priority Statement: Establish non-emergency Baker Act and Marchman Act transportation
plans
Goal: Whenever possible, the transportation of an individual under the Baker Act or the
Marchman Act from a medical facility to receiving facility will be completed by a non-
emergency transportation provider
Objectives:
• Implement a transportation plan that utilizes non-emergency transportation companies
(Ambitrans, MediCab, David Lawrence Center approved staff, or hospital-approved
transportation) to transfer individuals under the Baker Act or Marchman Act from a
medical facility to a receiving facility.
• Establish safety provisions that include appropriate medical equipment or safety
equipment to meet client needs
• Establish appropriate level of supervision to ensure safety and prevent elopement
Outcome/Impacts:
• Population: Provides a dignified, humane, and streamlined method of transportation to
and from acute care facilities.
• Population: Patient satisfaction with quality of care between receiving facilities
• Program: Enhances the ability to fully utilize the capacity of acute care services in the
county and reduces the unnecessary delay of transfers between facilities.
• Performance: Reduce the time that law enforcement is interrupted in providing
emergency services to the community due to transporting a Baker Act or Marchman Act
individual between receiving facilities
• Performance: Law enforcement and Collier County EMS will continue to transport
Emergency Baker Act or Marchman Act individuals to the appropriate receiving facility
• Performance: Ensures continuity and coordination of care among providers
Data:
• Collier County Sheriff's Office non-emergency Baker Act and Marchman Act transport
calls for service to David Lawrence Center
• Collier County Transportation Plan 2017-2020/Suncoast Region Substance Abuse and
Mental Health MOU
Workgroup:: Lt. Leslie Weidenhammer (? Scott Burgess, Susan Kimper ?)
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Priority 7
Community Prevention, Education, and Advocacy
Priority Statement: Enhance and augment community prevention, education and
advocacy efforts to reduce stigma and discrimination around mental health and
substance use disorders, while increasing access and community engagement.
Overview: In 2017 4.5 percent (11.2 million) of Americans 18 years or older had a
serious mental illness and 19.7 million people reported having a substance use disorder
in the past year1. Many individuals with a mental health or substance use disorders do
not know they have one and do not seek help. For almost all mental disorders, people
delayed getting help, the median delay is 10 years, and of those who have been
diagnosed with a mental illness, only 41 percent use mental health services in a given
year.2 Collaborative and coordinated community efforts to provide awareness,
education, prevention and advocacy are critical to reducing the stigma associated with
and the myths surrounding mental illness and substance use disorders. A greater
understanding of mental illness and substance use interventions can offer the
community invaluable information on availability and access to resources and better
ways to support those who may be experiencing these challenges. The implementation
and supportive delivery of evidence based educational opportunities will allow
individuals, community and family members and businesses to better identify when
someone may be experiencing mental health and substance abuse issues and seek
help sooner. Targeted public service information and resources around mental illness
and substance abuse will further contribute to stigma reduction and expand awareness
of educational opportunities offered in the community.
Deaths to suicide and substance use disorders in our community are rising at a
terrifying level leaving behind a devastating tragedy for our family members and friends
to bear. The tidal wave effect is rushing widespread in our community.
Every ___ days _____ people die of suicide or substance use disorder in Collier
County.
This crisis is recognized as a significant public health problem in our county and has
been declared a county wide priority.
Medical, legal, financial and other professionals along with community leaders and the
population at large who are asked to come to the aid in these situations do not have the
proper knowledge and/or tools to assist in the prevention of this crisis.
Information, education, treatment, and resources are essential to preventing further loss
of life to suicide and substance use disorders.
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To reduce the stigma and discrimination of these conditions, every member of our
community should understand that mental illness is a chronic brain disease not a moral
failure.
With appropriate evidence base treatment and recovery support services, suicide can
be prevented, and recovery can come to those with substance use disorders.
Goal: Provide evidence based education and training on mental health and substance
use disorders to the community at large.
Objectives:
• Create an ongoing educational program that would certify community businesses
and organizations to increase knowledge and public awareness
• Make available ongoing education available to 100% of the population to
increase access and reduce stigma relation to mental health and substance use
disorders
Outcomes/Impact:
• Develop prevention and education activities with Blue Zones or similar concept
• Increase knowledge and awareness of mental illness and substance use
disorders
• Increase awareness and access to resources and services
• Increased awareness and education can also increase availability of funding for
programs (private donor, grants, etc)
Data:
• Number of participating or certified agencies in Collier County
• Number of educational programs provided
• Number of attendees
Activities:
• Establish or identify the evidence based programs to utilize for trainings and
certification processes (ex. Adult and Youth Mental Health First Aid, Trauma
Informed Care, Suicide Awareness and Prevention, Substance Abuse Prevention
and Treatment)
• Identify collaborative organizations/agencies and staff to provide education and
awareness programs and materials
• Determine levels of participation toward certification (requirements)
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• Identify businesses, organizations, professionals and communities for role out
(stages, communities, workplaces)
• Identify PSA areas and methods of delivery (TV, social media, brochures, town
halls, ads)
• Develop and disseminate materials (how, where, to whom)
• Evaluate effectiveness of programs/materials (how will and what data to be
collected, pre/posts/surveys ???)
1 Substance Abuse and Mental Health Services Administration. Results from the 2017 National Survey on Drug Use
and Health. 2018.
2 Youth Mental Health First Aid. 2016 National Council for Behavioral Health 4th. Ed. Melbourne: Mental Health First
Aid International.
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Services to Veterans
Priority Statement: Design and Implement services to meet the unique needs of
veterans experiencing mental health and/or substance abuse disorders in including
post-traumatic stress disorder, traumatic brain injury and military sexual trauma.
Overview: Veterans make up 13% (28,000) of our population in Collier County and an
estimated 2,500 are Post Gulf War Veterans. As a country, and community, we have a
responsibility to help these Veterans and their families, who from time to time, are in
need of an array of programs and services that cannot be totally provided by the
Veterans Administration. This issue is not unique to Collier County. Veterans receive
the best care when local communities work with the VA .
The #1 issue today in America today is Veteran suicide. Twenty (20) Veterans a day
commit suicide, which is twice the rate of the non veteran population. Today’s
estimates are over 40% of Veterans are returning home with PTSD & TBI. The primary
reason is due to multiple tours of duty which are unique to this generation of warriors,
and the exposure to “Blast” trauma to the body. These invisible wounds of war present
create unique health and transitional issues for Veterans, that may result in, mental
health and substance abuse issues. The impact can be devastating for the Veterans
and their families.
There is a need in our community to design and implement services and programs to
meet the unique needs of our Veteran population.
Goal: Make the public and the veteran community aware of the transitional, mental
health, housing, and employment needs of post-combat veterans and mobilize
resources to address these issues for veterans and their families.
Objectives:
Population:
• Reduce veteran suicides – no data available for Collier County
• Reduce veteran substance abuse – 274-500 Collier vets treated by VA in 2018
• # of veterans arrested in Collier County – 100 per year. Typically, 10 veterans in
veteran treatment court
• 40+ homeless vets in Collier County per 7/19 count
Performance:
• Combat related unique treatment – prolonged vs multiple therapies
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• Education and advocacy to community and professionals regarding size and
demographics of this group in our region – this data will become self-
demonstrated
• Make veterans and their families aware of and engaged in the programs and
services. A social worker at the CRF to interact and refer. Possible physical
facility outside CRF.
Data:
# of homeless vets, # of veterans arrested, # of veterans enrolled in treatment, veteran
treatment outcomes
Workgroup: Dale Mullin and Dr. Thomas Lansen
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Q: What does the term “social determinants of health” mean?
Healthy People 2020 defines social determinants of health as conditions in the
environments in which people live, learn, work, play, worship, and age that affect a wide
range of health, functioning, and quality-of-life outcomes and risks. Conditions (e.g.,
social, economic, and physical) in these various environments and settings (e.g.,
school, church, workplace, and neighborhood) have been referred to as “place.” In
addition to the more material attributes of “place,” the patterns of social engagement
and sense of security and well-being are also affected by where people live.
Healthy People 2020 developed a “place-based” organizing framework, reflecting five
key areas of SDOH:
• Economic Stability
• Education
• Social and Community Context
• Health and Health Care
• Neighborhood and Built Environment
Resources that enhance quality of life can have a significant influence on population
health outcomes. Examples of these resources include safe and affordable housing,
access to education, public safety, availability of healthy foods, local emergency/health
services, and environments free of life-threatening toxins.
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General Input From Advisory Committee Members
AD HOC Committee Notes
September 3, 2019
Michael Overway
Priority 1:
Our community does not have a mobile crisis response team placing the burden of crisis intervention on
local sheriffs/PD. For those clients needing immediate acute care transport to Park Royal isn’t a realistic
demand on local law enforcement. Offering a crisis/trauma invention center for immediate stabilization
removes the longer-term engagement burden from local law enforcement and increases opportunity for
faster response to crisis situations which in turn offers earlier stabilization for the consumer.
Priority 2:
Almost goes without saying; the only way to end homelessness is via housing. Housing inventions come
in a variety of pathways with a focused goal of Housing First. Immediate crisis relief could come in the
form of emergency shelter or even transitional housing. Transitional housing partners would need to be
keenly aware of the community’s priority to permanent housing and move consumers into that mode of
permanent housing or permanent supportive housing under six months. Having no affordable housing
stock in Collier County and a Fair Market Rent Rate that is one of the highest in the state presents
challenges to resolving housing crisis.
Priority 3:
Our mental health providers, David Lawrence Center, CASL, NAMI, and many private practice affiliates,
are extremely good at focusing on evidence-based practices for treatment and early intervention.
Bringing their knowledge to the community at-large through Mental Health First Aid and alike trainings
would be valuable to long-term community buy-in.
Priority 4:
Data collaboration is the way we tell our story of our community successes and desperately needed
services yet to be implementation. Data is also the way we communicate on program thresholds and
performance measures via activities, outputs, and outcomes. Beyond story telling data Informs National
Policy, Informs Local Policy, enhances Coordinated Entry and Case Management AND helps us to analyze
patterns of homelessness or homeless prevention techniques.
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Priority 5:
With a doubt one of the greatest impacts the Judiciary can have on balancing a community’s approach
to resolving homelessness or working on early intervention methods is to be engaged. Know what the
community challenges are and advocate for change alongside of community partners. Courts know that
the longer crisis intervention is delayed the greater the risk that person is to themselves and others in
the community. Courts can put into action early intervention methods as come along supports with
other community providers to lessen the likelihood of return to homelessness and incarceration. The
fact that our court system is led by judges who have this vision is truly remarkable and speaks volumes
into our future successes! Partnering with our community treatment teams the courts can directly
impact entrance into services and program mandates the community teams themselves cannot often
do. These types of partnerships affect real change.
Priority 6:
Needed service without burdening local law enforcement – funding may be difficult but not impossible
to secure for this type project. I would need more information to comment intelligently beyond I know
we need this service.
Priority 7:
Having one voice carries clout. Selecting a few spokespersons for this committee that know the
language of “team” and community partnering is crucial with educational awareness. Developing not
only a media presentation package our representatives from the committee would use but also a
legislative “leave-behind” for Tallahassee and Washington representatives is extremely important to
success in a variety of ways; social acceptance of plans, funding, and future service deliver platforms
development and legislative change!
Priority 8:
The Hunger & Homeless Coalition has worked with the VA, Wounded Warriors and several other
Veteran groups to better understand the needs of homeless Veterans. Among our service/program
priorities homeless Veterans ranks in the top three. In cases where the appropriate veteran program
hasn’t performed as they should the Coalition stepped in to assist. Our strategy to end Veteran
homelessness in Collier County will be brought into sharper focus over the next year; dedication of
resources including funding is part of how the Coalition will work with this committee and others to
resolve the shortage of housing and other wrap around services in Collier. Collier County should be able
to achieve Functional Zero by 2021 with the cooperation of all community partnerships!
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COMMENTS
DATE: 9/3/19
TO: Chet Bell
From: Pat Barton, Member MHAAHC, Collier County
With apologies for starting out with a disclaimer, I think you know that SI am a citizen member
of this group, with a lot of volunteer service on both substance abuse and mental health boards at local,
state and national levels, but with limited experience of putting together the type of report you are
requesting. However, I do have some thoughts/questions/comments , some of which are general in
scope. Let’s start with those.
Much of this effort is driven by money, specifically a one-cent increase in county sales
Tax. This is what is addressed in Priorities #1, 2, 4, and 6.
The original document did not use the words elderly, youth, prevention, education or
advocacy. Nor, until Priority 6, did one find much mention of “transportation”, there
relative to Baker and Marchman Act, yet, for decades transportation as been the major
deterrent to accessing services in Collier County.
PRIORITIES
I have no comments on Nos. 1 and 8, as they seem to be quite thoroughly covered by their support
groups.
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#2 Permanent Supporting Housing – There is a need to provide available & affordable daily
Private or public transportation to meet medical, therapeutic, restorative and basic needs.
Encourage partnerships to work on purchasing property (know of one right now).
#3. Aren’t Evidence-based/best practices the standard for all? What’s the price?
#4. Data Sharing… My opinion: valid statistics, data are the best marketing tool available.
#5. Treatment Courts – Judge Martin has one of the best treatment court systems in FL, and
works closely with Judge Leifman who is nationally respected. At one point I thought
they were working with youth offenders/ DJJ. Can this be included, enhanced?
#6. Baker &Marchman Act Transportation – This is obviously not working well. We need to
Continue researching other successful transportation programs operating in larger counties
Nationwide. Also consider privatization or self-funding of this service
#7 Community Prevention, Education & Advocacy – Drug-Free Collier is probably the only
Organization in the County actively involved in this work, and for some reason they have
been somewhat low profile – still apparently not invited to this group for their input. We
have undergone a transformation in this country around the issue of marijuana, begun in
part due to the U.S. Dept. of Justice allowing legalization of marijuana by individual states
without any oversight on product development. Add to that the overwhelming marketization
of a variety of associated products (CBD, vaping dabs, hemp to name a few) and we now
have essentially added a third quasi-legal drug (after alcohol and marijuana) to the American
popular culture. Vaping is a part of that, along with marijuana, embraced both the alcohol
and tobacco industries – just look at the ads, takes one back to the 40’s and 50’s.
Today, young people are the fastest growing population to enter treatment for mental health
and substance use disorder, much of it induced by reactions to marijuana with high potency
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tetrahydracannibinol (THC), developed in recent years by the marijuana market.
In recent reports (Sean will have) from the U.S. Surgeon General, The Federal Trade Comm.,
FDA, JAMA and others, the practice of vaping and use of marijuana in general puts youth
and the offspring of pregnant users in special concern. Finally they are putting on their big
boy pants. And finally they will perhaps encourage the so-quiet majority of our elected
officials (at all levels), medical docs and personnel, and even clergy to break their silence on
third, and most dangerous substance facing the health and future of our children.
I could go on here forever about what we could do, but it’s not likely that there will be any flow
of interest in prevention.l It is mostly grassroots, and we probably could use some support form the
community to bring in programs , support self-help groups, childrens’ programs and Drug-
Free Collier, maybe reestablish parent peer groups and continue to support Project Graduation and Red
Ribbon Week.
But, prevention really begins in utera, with potential parents and continues with their role as parents
going forward. People who can help begin that process are pre-marital counselors,
OB/GYNs, Pediatricians, the clergy and other parents.
Finally, about 10 years ago the ADM Office of the Florida Dept. of Children of Families gave
a quote in a meeting I attended that said this, “One dollar spent in prevention saves $7 in treatment”.
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Input from Janice Rosen:
I only have a few points that I’d like to raise.
Re: The Judicial Response Priority
Are there other areas where a heightened sensitivity to those with mental health and substance use
issues are being implemented? Judge Martin mentioned that clerks are on alert for those perpetual
litigants who file numerous nuisance suits, go on rants etc.
Should we mention that Medication Assisted Therapy can be part of treatment courts as its efficacy is
well documented?
Re: Misc.
How do we get favorable press about what we are doing? Is there a specific contact at the Naples Daily
News?
Most importantly from a PR standpoint, it occurs to me that during my months on this committee I have
seen over and over (as illustrated by innovative programs in the US and Canada) that when we do the
RIGHT THING (caring for the most vulnerable among us), it is also THE SMART THING, in terms of
reduction in costs.
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