South Carolina UNIFORM APPLICATION FY 2022/2023 Community Mental Health Services Block Grant Plan COMMUNITY MENTAL HEALTH SERVICES BLOCK GRANT
OMB - Approved 04/19/2019 - Expires 04/30/2022 (generated on 07/21/2021 12.38.42 PM) Center for Mental Health Services Division of State and Community Systems Development State Information
State Information
Plan Year Start Year 2022
End Year 2023
State DUNS Number Number 043980093
Expiration Date
I. State Agency to be the Grantee for the Block Grant Agency Name South Carolina Department of Mental Health
Organizational Unit Office of the State Director
Mailing Address 2414 Bull Street/P. O. Box 485
City Columbia
Zip Code 29202
II. Contact Person for the Grantee of the Block Grant First Name Kenneth M.
Last Name Rogers, MD
Agency Name South Carolina Department of Mental Health
Mailing Address 2414 Bull Street/P. O. Box 485
City Columbia
Zip Code 29202
Telephone 803-898-8319
Fax 803-898-1383
Email Address [email protected]
III. Third Party Administrator of Mental Health Services Do you have a third party administrator? Yes No First Name
Last Name
Agency Name
Mailing Address
City
Zip Code
Telephone
Fax
Email Address
IV. State Expenditure Period (Most recent State expenditure period that is closed out) From
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Revision Date
VI. Contact Person Responsible for Application Submission First Name D. Stewart
Last Name Cooner, MHA
Telephone 803-898-8632
Fax 803-898-2206
Email Address [email protected]
OMB No. 0930-0168 Approved: 04/19/2019 Expires: 04/30/2022
Footnotes:
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Chief Executive Officer's Funding Agreement - Certifications and Assurances / Letter Designating Signatory Authority
Fiscal Year 2022
U.S. Department of Health and Human Services Substance Abuse and Mental Health Services Administrations Funding Agreements as required by Community Mental Health Services Block Grant Program as authorized by Title XIX, Part B, Subpart II and Subpart III of the Public Health Service Act and Tile 42, Chapter 6A, Subchapter XVII of the United States Code
Title XIX, Part B, Subpart II of the Public Health Service Act
Section Title Chapter
Section 1911 Formula Grants to States 42 USC § 300x
Section 1912 State Plan for Comprehensive Community Mental Health Services for Certain Individuals 42 USC § 300x-1
Section 1913 Certain Agreements 42 USC § 300x-2
Section 1914 State Mental Health Planning Council 42 USC § 300x-3
Section 1915 Additional Provisions 42 USC § 300x-4
Section 1916 Restrictions on Use of Payments 42 USC § 300x-5
Section 1917 Application for Grant 42 USC § 300x-6
Title XIX, Part B, Subpart III of the Public Health Service Act
Section 1941 Opportunity for Public Comment on State Plans 42 USC § 300x-51
Section 1942 Requirement of Reports and Audits by States 42 USC § 300x-52
Section 1943 Additional Requirements 42 USC § 300x-53
Section 1946 Prohibition Regarding Receipt of Funds 42 USC § 300x-56
Section 1947 Nondiscrimination 42 USC § 300x-57
Section 1953 Continuation of Certain Programs 42 USC § 300x-63
Section 1955 Services Provided by Nongovernmental Organizations 42 USC § 300x-65
Section 1956 Services for Individuals with Co-Occurring Disorders 42 USC § 300x-66
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Certain of these assurances may not be applicable to your project or program. If you have questions, please contact the awarding agency. Further, certain Federal awarding agencies may require applicants to certify to additional assurances. If such is the case, you will be notified.
As the duly authorized representative of the applicant I certify that the applicant:
1. Has the legal authority to apply for Federal assistance, and the institutional, managerial and financial capability (including funds sufficient to pay the non-Federal share of project costs) to ensure proper planning, management and completion of the project described in this application. 2. Will give the awarding agency, the Comptroller General of the United States, and if appropriate, the State, through any authorized representative, access to and the right to examine all records, books, papers, or documents related to the award; and will establish a proper accounting system in accordance with generally accepted accounting standard or agency directives. 3. Will establish safeguards to prohibit employees from using their positions for a purpose that constitutes or presents the appearance of personal or organizational conflict of interest, or personal gain. 4. Will initiate and complete the work within the applicable time frame after receipt of approval of the awarding agency. 5. Will comply with the Intergovernmental Personnel Act of 1970 (42 U.S.C. §§4728-4763) relating to prescribed standards for merit systems for programs funded under one of the nineteen statutes or regulations specified in Appendix A of OPM's Standard for a Merit System of Personnel Administration (5 C.F.R. 900, Subpart F). 6. Will comply with all Federal statutes relating to nondiscrimination. These include but are not limited to: (a) Title VI of the Civil Rights Act of 1964 (P.L. 88-352) which prohibits discrimination on the basis of race, color or national origin; (b) Title IX of the Education Amendments of 1972, as amended (20 U.S.C. §§1681-1683, and 1685-1686), which prohibits discrimination on the basis of sex; (c) Section 504 of the Rehabilitation Act of 1973, as amended (29 U.S.C. §§794), which prohibits discrimination on the basis of handicaps; (d) the Age Discrimination Act of 1975, as amended (42 U.S.C. §§6101-6107), which prohibits discrimination on the basis of age; (e) the Drug Abuse Office and Treatment Act of 1972 (P.L. 92-255), as amended, relating to nondiscrimination on the basis of drug abuse; (f) the Comprehensive Alcohol Abuse and Alcoholism Prevention, Treatment and Rehabilitation Act of 1970 (P.L. 91- 616), as amended, relating to nondiscrimination on the basis of alcohol abuse or alcoholism; (g) §§523 and 527 of the Public Health Service Act of 1912 (42 U.S.C. §§290 dd-3 and 290 ee-3), as amended, relating to confidentiality of alcohol and drug abuse patient records; (h) Title VIII of the Civil Rights Act of 1968 (42 U.S.C. §§3601 et seq.), as amended, relating to non-discrimination in the sale, rental or financing of housing; (i) any other nondiscrimination provisions in the specific statute(s) under which application for Federal assistance is being made; and (j) the requirements of any other nondiscrimination statute(s) which may apply to the application. 7. Will comply, or has already complied, with the requirements of Title II and III of the Uniform Relocation Assistance and Real Property Acquisition Policies Act of 1970 (P.L. 91-646) which provide for fair and equitable treatment of persons displaced or whose property is acquired as a result of Federal or federally assisted programs. These requirements apply to all interests in real property acquired for project purposes regardless of Federal participation in purchases. 8. Will comply with the provisions of the Hatch Act (5 U.S.C. §§1501-1508 and 7324-7328) which limit the political activities of employees whose principal employment activities are funded in whole or in part with Federal funds. 9. Will comply, as applicable, with the provisions of the Davis-Bacon Act (40 U.S.C. §§276a to 276a-7), the Copeland Act (40 U.S.C. §276c and 18 U.S.C. §874), and the Contract Work Hours and Safety Standards Act (40 U.S.C. §§327-333), regarding labor standards for federally assisted construction subagreements. 10. Will comply, if applicable, with flood insurance purchase requirements of Section 102(a) of the Flood Disaster Protection Act of 1973 (P.L. 93-234) which requires recipients in a special flood hazard area to participate in the program and to purchase flood insurance if the total cost of insurable construction and acquisition is $10,000 or more. 11. Will comply with environmental standards which may be prescribed pursuant to the following: (a) institution of environmental quality control measures under the National Environmental Policy Act of 1969 (P.L. 91-190) and Executive Order (EO) 11514; (b) notification of violating facilities pursuant to EO 11738; (c) protection of wetland pursuant to EO 11990; (d) evaluation of flood hazards in floodplains in accordance with EO 11988; (e) assurance of project consistency with the approved State management program developed under the Costal Zone Management Act of 1972 (16 U.S.C. §§1451 et seq.); (f) conformity of Federal actions to Printed: 7/19/20217/21/2021 3:263:2812:38 PM PM - -South South Carolina Carolina - OMB No. 0930-0168 Approved: 04/19/2019 Expires: 04/30/2022 PagePage 4 2 of of 222 19 State (Clear Air) Implementation Plans under Section 176(c) of the Clear Air Act of 1955, as amended (42 U.S.C. §§7401 et seq.); (g) protection of underground sources of drinking water under the Safe Drinking Water Act of 1974, as amended, (P.L. 93-523); and (h) protection of endangered species under the Endangered Species Act of 1973, as amended, (P.L. 93-205). 12. Will comply with the Wild and Scenic Rivers Act of 1968 (16 U.S.C. §§1271 et seq.) related to protecting components or potential components of the national wild and scenic rivers system. 13. Will assist the awarding agency in assuring compliance with Section 106 of the National Historic Preservation Act of 1966, as amended (16 U.S.C. §470), EO 11593 (identification and protection of historic properties), and the Archaeological and Historic Preservation Act of 1974 (16 U.S.C. §§469a-1 et seq.). 14. Will comply with P.L. 93-348 regarding the protection of human subjects involved in research, development, and related activities supported by this award of assistance. 15. Will comply with the Laboratory Animal Welfare Act of 1966 (P.L. 89-544, as amended, 7 U.S.C. §§2131 et seq.) pertaining to the care, handling, and treatment of warm blooded animals held for research, teaching, or other activities supported by this award of assistance. 16. Will comply with the Lead-Based Paint Poisoning Prevention Act (42 U.S.C. §§4801 et seq.) which prohibits the use of lead based paint in construction or rehabilitation of residence structures. 17. Will cause to be performed the required financial and compliance audits in accordance with the Single Audit Act of 1984. 18. Will comply with all applicable requirements of all other Federal laws, executive orders, regulations and policies governing this program. 19. Will comply with the requirements of Section 106(g) of the Trafficking Victims Protection Act (TVPA) of 2000, as amended (22 U.S.C. 7104) which prohibits grant award recipients or a sub-recipient from (1) Engaging in severe forms of trafficking in persons during the period of time that the award is in effect (2) Procuring a commercial sex act during the period of time that the award is in effect or (3) Using forced labor in the performance of the award or subawards under the award.
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The undersigned (authorized official signing for the applicant organization) certifies to the best of his or her knowledge and belief, that the applicant, defined as the primary participant in accordance with 2 CFR part 180, and its principals: a. Agrees to comply with 2 CFR Part 180, Subpart C by administering each lower tier subaward or contract that exceeds $25,000 as a "covered transaction" and verify each lower tier participant of a "covered transaction" under the award is not presently debarred or otherwise disqualified from participation in this federally assisted project by: a. Checking the Exclusion Extract located on the System for Award Management (SAM) at http://sam.gov b. Collecting a certification statement similar to paragraph (a) c. Inserting a clause or condition in the covered transaction with the lower tier contract
2. Certification Regarding Drug-Free Workplace Requirements
The undersigned (authorized official signing for the applicant organization) certifies that the applicant will, or will continue to, provide a drug-free work-place in accordance with 2 CFR Part 182by: a. Publishing a statement notifying employees that the unlawful manufacture, distribution, dispensing, possession or use of a controlled substance is prohibited in the grantee's work-place and specifying the actions that will be taken against employees for violation of such prohibition; b. Establishing an ongoing drug-free awareness program to inform employees about-- 1. The dangers of drug abuse in the workplace; 2. The grantee's policy of maintaining a drug-free workplace; 3. Any available drug counseling, rehabilitation, and employee assistance programs; and 4. The penalties that may be imposed upon employees for drug abuse violations occurring in the workplace; c. Making it a requirement that each employee to be engaged in the performance of the grant be given a copy of the statement required by paragraph (a) above; d. Notifying the employee in the statement required by paragraph (a), above, that, as a condition of employment under the grant, the employee will-- 1. Abide by the terms of the statement; and 2. Notify the employer in writing of his or her conviction for a violation of a criminal drug statute occurring in the workplace no later than five calendar days after such conviction; e. Notifying the agency in writing within ten calendar days after receiving notice under paragraph (d)(2) from an employee or otherwise receiving actual notice of such conviction. Employers of convicted employees must provide notice, including position title, to every grant officer or other designee on whose grant activity the convicted employee was working, unless the Federal agency has designated a central point for the receipt of such notices. Notice shall include the identification number(s) of each affected grant; f. Taking one of the following actions, within 30 calendar days of receiving notice under paragraph (d) (2), with respect to any employee who is so convicted? 1. Taking appropriate personnel action against such an employee, up to and including termination, consistent with the requirements of the Rehabilitation Act of 1973, as amended; or 2. Requiring such employee to participate satisfactorily in a drug abuse assistance or rehabilitation program approved for such purposes by a Federal, State, or local health, law enforcement, or other appropriate agency;
g. Making a good faith effort to continue to maintain a drug-free workplace through implementation of paragraphs (a), (b), (c), (d), (e), and (f).
3. Certifications Regarding Lobbying
Per 45 CFR §75.215, Recipients are subject to the restrictions on lobbying as set forth in 45 CFR part 93. Title 31, United States Code, Section 1352, entitled "Limitation on use of appropriated funds to influence certain Federal contracting and financial transactions," Printed: 7/19/20217/21/2021 3:263:2812:38 PM PM - -South South Carolina Carolina - OMB No. 0930-0168 Approved: 04/19/2019 Expires: 04/30/2022 PagePage 6 4 of of 222 19 generally prohibits recipients of Federal grants and cooperative agreements from using Federal (appropriated) funds for lobbying the Executive or Legislative Branches of the Federal Government in connection with a SPECIFIC grant or cooperative agreement. Section 1352 also requires that each person who requests or receives a Federal grant or cooperative agreement must disclose lobbying undertaken with non-Federal (non- appropriated) funds. These requirements apply to grants and cooperative agreements EXCEEDING $100,000 in total costs.
The undersigned (authorized official signing for the applicant organization) certifies, to the best of his or her knowledge and belief, that 1. No Federal appropriated funds have been paid or will be paid, by or on behalf of the undersigned to any person for influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with the awarding of any Federal contract, the making of any Federal grant, the making of any Federal loan, the entering into of any cooperative agreement, and the extension, continuation, renewal, amendment, or modification of any Federal contract, grant, loan, or cooperative agreement. 2. If any funds other than Federally appropriated funds have been paid or will be paid to any person for influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with this Federal contract, grant, loan, or cooperative agreement, the undersigned shall complete and submit Standard Form-LLL, "Disclosure of Lobbying Activities," in accordance with its instructions. (If needed, Standard Form-LLL, "Disclosure of Lobbying Activities," its instructions, and continuation sheet are included at the end of this application form.) 3. The undersigned shall require that the language of this certification be included in the award documents for all subawards at all tiers (including subcontracts, subgrants, and contracts under grants, loans and cooperative agreements) and that all subrecipients shall certify and disclose accordingly.
This certification is a material representation of fact upon which reliance was placed when this transaction was made or entered into. Submission of this certification is a prerequisite for making or entering into this transaction imposed by Section 1352, U.S. Code. Any person who fails to file the required certification shall be subject to a civil penalty of not less than $10,000 and not more than $100,000 for each such failure.
4. Certification Regarding Program Fraud Civil Remedies Act (PFCRA) (31 U.S.C § 3801- 3812)
The undersigned (authorized official signing for the applicant organization) certifies that the statements herein are true, complete, and accurate to the best of his or her knowledge, and that he or she is aware that any false, fictitious, or fraudulent statements or claims may subject him or her to criminal, civil, or administrative penalties. The undersigned agrees that the applicant organization will comply with the Public Health Service terms and conditions of award if a grant is awarded as a result of this application.
5. Certification Regarding Environmental Tobacco Smoke
Public Law 103-227, also known as the Pro-Children Act of 1994 (Act), requires that smoking not be permitted in any portion of any indoor facility owned or leased or contracted for by an entity and used routinely or regularly for the provision of health, daycare, early childhood development services, education or library services to children under the age of 18, if the services are funded by Federal programs either directly or through State or local governments, by Federal grant, contract, loan, or loan guarantee. The law also applies to children's services that are provided in indoor facilities that are constructed, operated, or maintained with such Federal funds. The law does not apply to children's services provided in private residence, portions of facilities used for inpatient drug or alcohol treatment, service providers whose sole source of applicable Federal funds is Medicare or Medicaid, or facilities where WIC coupons are redeemed.
Failure to comply with the provisions of the law may result in the imposition of a civil monetary penalty of up to $1,000 for each violation and/or the imposition of an administrative compliance order on the responsible entity.
By signing the certification, the undersigned certifies that the applicant organization will comply with the requirements of the Act and will not allow smoking within any portion of any indoor facility used for the provision of services for children as defined by the Act.
The applicant organization agrees that it will require that the language of this certification be included in any subawards which contain provisions for children's services and that all subrecipients shall certify accordingly.
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HHS Assurances of Compliance (HHS 690)
ASSURANCE OF COMPLIANCE WITH TITLE VI OF THE CIVIL RIGHTS ACT OF 1964, SECTION 504 OF THE REHABILITATION ACT OF 1973, TITLE IX OF THE EDUCATION AMENDMENTS OF 1972, THE AGE DISCRIMINATION ACT OF 1975, AND SECTION 1557 OF THE AFFORDABLE CARE ACT
The Applicant provides this assurance in consideration of and for the purpose of obtaining Federal grants, loans, contracts, property, discounts or other Federal financial assistance from the U.S. Department of Health and Human Services.
THE APPLICANT HEREBY AGREES THAT IT WILL COMPLY WITH:
1. Title VI of the Civil Rights Act of 1964 (Pub. L. 88-352), as amended, and all requirements imposed by or pursuant to the Regulation of the Department of Health and Human Services (45 C.F.R. Part 80), to the end that, in accordance with Title VI of that Act and the Regulation, no person in the United States shall, on the ground of race, color, or national origin, be excluded from participation in, be denied the benefits of, or be otherwise subjected to discrimination under any program or activity for which the Applicant receives Federal financial assistance from the Department. 2. Section 504 of the Rehabilitation Act of 1973 (Pub. L. 93-112), as amended, and all requirements imposed by or pursuant to the Regulation of the Department of Health and Human Services (45 C.F.R. Part 84), to the end that, in accordance with Section 504 of that Act and the Regulation, no otherwise qualified individual with a disability in the United States shall, solely by reason of her or his disability, be excluded from participation in, be denied the benefits of, or be subjected to discrimination under any program or activity for which the Applicant receives Federal financial assistance from the Department. 3. Title IX of the Education Amendments of 1972 (Pub. L. 92-318), as amended, and all requirements imposed by or pursuant to the Regulation of the Department of Health and Human Services (45 C.F.R. Part 86), to the end that, in accordance with Title IX and the Regulation, no person in the United States shall, on the basis of sex, be excluded from participation in, be denied the benefits of, or be otherwise subjected to discrimination under any education program or activity for which the Applicant receives Federal financial assistance from the Department. 4. The Age Discrimination Act of 1975 (Pub. L. 94-135), as amended, and all requirements imposed by or pursuant to the Regulation of the Department of Health and Human Services (45 C.F.R. Part 91), to the end that, in accordance with the Act and the Regulation, no person in the United States shall, on the basis of age, be denied the benefits of, be excluded from participation in, or be subjected to discrimination under any program or activity for which the Applicant receives Federal financial assistance from the Department. 5. Section 1557 of the Affordable Care Act (Pub. L. 111-148), as amended, and all requirements imposed by or pursuant to the Regulation of the Department of Health and Human Services (45 CFR Part 92), to the end that, in accordance with Section 1557 and the Regulation, no person in the United States shall, on the ground of race, color, national origin, sex, age, or disability be excluded from participation in, be denied the benefits of, or be subjected to discrimination under any health program or activity for which the Applicant receives Federal financial assistance from the Department.
The Applicant agrees that compliance with this assurance constitutes a condition of continued receipt of Federal financial assistance, and that it is binding upon the Applicant, its successors, transferees and assignees for the period during which such assistance is provided. If any real property or structure thereon is provided or improved with the aid of Federal financial assistance extended to the Applicant by the Department, this assurance shall obligate the Applicant, or in the case of any transfer of such property, any transferee, for the period during which the real property or structure is used for a purpose for which the Federal financial assistance is extended or for another purpose involving the provision of similar services or benefits. If any personal property is so provided, this assurance shall obligate the Applicant for the period during which it retains ownership or possession of the property. The Applicant further recognizes and agrees that the United States shall have the right to seek judicial enforcement of this assurance.
The grantee, as the awardee organization, is legally and financially responsible for all aspects of this award including funds provided to sub-recipients in accordance with 45 CFR §§ 75.351-75.352, Subrecipient monitoring and management.
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I also certify that the state or territory will comply with the Assurances Non-Construction Programs and Certifications summarized above.
Name of Chief Executive Officer (CEO) or Designee: Kenneth M. Rogers, MD
Signature of CEO or Designee1:
Title: State Director of Mental Health Date Signed:
mm/dd/yyyy
1If the agreement is signed by an authorized designee, a copy of the designation must be attached. Please upload the states American Rescue Plan funding proposal here in addition to the other documents.
OMB No. 0930-0168 Approved: 04/19/2019 Expires: 04/30/2022
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Disclosure of Lobbying Activities
To View Standard Form LLL, Click the link below (This form is OPTIONAL). Standard Form LLL (click here)
Name
Title
Organization
Signature: Date:
OMB No. 0930-0168 Approved: 04/19/2019 Expires: 04/30/2022
Footnotes:
Not Applicable
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Step 1: Assess the strengths and organizational capacity of the service system to address the specific populations.
Narrative Question: Provide an overview of the state's M/SUD prevention, early identification, treatment, and recovery support systems of care, including the statutory criteria that must be addressed in the state's Application. Describe how the public M/SUD system of care is currently organized at the state and local levels, differentiating between child and adult systems. This description should include a discussion of the roles of the SMHA, the SSA, and other state agencies with respect to the delivery of M/SUD services. States should also include a description of regional, county, tribal, and local entities that provide M/SUD services or contribute resources that assist in providing the services. The description should also include how these systems of care address the needs of diverse racial, ethnic, and sexual and gender minorities, as well as American Indian/Alaskan Native populations in the states.
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South Carolina Department of Mental Health - Community Mental Health Services Block Grant Application
Planning Steps – Step 1– Assess the Strengths and Organizational Capacity of the Service System to Address the Specific Populations
Assessing Strengths and Organizational Capacity In order to assess the strengths and organizational capacity of the service system to address the specific populations of children with SED, adults with SMI, and older adults with SMI, among other identified groups, the South Carolina Department of Mental Health (SCDMH, DMH) systematically reviews its programs and services throughout the fiscal year. As a result of such reviews, SCDMH is able to determine the areas in which it particularly excels and subsequently share such excellence with its partners and stakeholders. Similarly, SCDMH is also able to determine the areas in which gaps or needs have arisen and subsequently address such shortages with its Senior Leadership and staff. Based on data-driven analyses, performance measurements, and feedback mechanisms, SCDMH is able to articulate its competence as the mental health authority in the State of South Carolina while continually evaluating, assessing, and refining its programs, services, and service delivery systems for its patients.
The Strength of SCDMH is its Structure, Comprehensiveness, and Affect over the Continuum of Care In the 18th century, what to “do” with a mentally ill person depended upon the individual’s status, domestic situation, location, and medical condition. Insanity was viewed as a private matter and family responsibility, and it was expected that family would render care or pay someone else to do it. It was not uncommon for the mentally ill to live in workhouses or debtors’ prisons.
The History of Mental Health in South Carolina Colonel Samuel Farrow, a member of the South Carolina House of Representatives, and Major William Crafts, a member of the South Carolina Senate, worked zealously to sensitize their fellow lawmakers to the needs of the mentally ill. On December 20, 1821, the South Carolina State Legislature passed a statute-at-large approving $30,000 to build the SC Lunatic Asylum. This legislation made South Carolina one of the first states in the nation (after Virginia and Maryland) to provide state funding for the care and treatment of people with mental illnesses. Renowned architect Robert Mills was enlisted to design the new SC Lunatic Asylum, the cornerstone for which was laid in July of 1822. It featured such innovations as central heating and fireproof ceilings. ➢ South Carolina's asylum was one of the first in the nation built expressly for the mentally ill. ➢ South Carolina’s mental health system was the third in the U.S., as well as the third funded by a state government. ➢ The asylum did not reach its full capacity of 192 until 1860 – more than 30 years after opening its doors. Many families preferred to care for mentally ill relatives at home, while others wanted them closer to home even if it meant they lived in the county jail or the work house.
Dr. Fred Williams, who served as SC State Hospital superintendent from 1915 to 1945, realized that South Carolina’s mental health system needed community mental health clinics. As such, he encouraged a program to educate the public about mental illness, its causes, and methods of prevention. The first clinic to provide services for the mentally ill who did not need hospitalization was opened at the SC State Hospital in 1920. The first permanent outpatient clinic opened in Columbia in 1923. The success of this clinic inspired the opening of traveling clinics in Greenville and Spartanburg in 1924. By 1927, clinics were established in Florence, Orangeburg, and Anderson. In 1928, a clinic opened in Charleston, with plans for one in Rock Hill. Reopening of the clinics, which had closed as staff served in WWII, was delayed until late 1947 due to a lack of adequately trained personnel. As clinics continued to grow throughout the state, the need for state and federal funding increased. Help came in 1946 with the passage of Federal Public Law 487.
The Mental Health Act provided for a Mental Health Commission to be in charge of all mental health facilities. Communities were required to contribute one third of the cost of clinic or center operation and the state would furnish the remaining two thirds. The South Carolina Mental Health Commission is still in place to this day and meets monthly. By 1957, clinics were in operation in six counties. Major functions of these clinics included:
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cooperation and consultation with other agencies and professional people in the community; evaluation and treatment of emotional disturbances in adults and children; public education; and training psychiatric and pediatric resident doctors from the Medical College Hospital. The 1960s ushered in the beginnings of the community mental health movement. The introduction of Medicaid and other improvements in the social welfare system underwrote the treatment of patients in their own communities, and the 1963 Federal Community Mental Health Centers Act provided matching federal funds for construction of community mental health centers.
In 1967, the Columbia Area Mental Health Center became the first comprehensive community mental health center in the Southeast. In that same year, William S. Hall, MD, the first “South Carolina State Commissioner of Mental Health,” participated in a ceremony in which part of the wall surrounding the State Hospital came down. During Dr. Hall's 21-year tenure as commissioner, DMH made strides in community-based care. A comprehensive, statewide mental health care delivery system emerged, and grew to encompass 10 major inpatient facilities and 17 community mental health centers, providing services in all of the state's 46 counties, with more than 6,000 employees.
During the 1970s, South Carolina experienced a number of firsts, including the establishment of a transitional living project to help patients return to the community after long hospital stays, a facility for psychiatric patients who needed long-term care, an alcohol and drug addiction treatment center, and a patient advocacy system to protect the rights of those DMH served.
In 1983, DMH adopted a plan calling for the development of community-based services, the decentralization of hospital services, and a significant decrease in the population of its psychiatric facilities in Columbia. This is what we often hear referred to as “deinstitutionalization.”
Joseph J. Bevilacqua, Ph.D., who became state commissioner of Mental Health in 1985, led with the view that patients treated in the community progress better clinically; people with mental illnesses need and benefit from family and community support. Patients recover faster and stay well longer when receiving services in their communities if such programs are reasonably funded, well organized, and readily available.
In 1989, the SC Department of Mental Health, with support from the National Institute of Mental Health, hosted a national conference to explore how other states shifted to community-based services, how they defined priority populations, and how they planned and located services. It was determined that the services necessary for the successful transition of patients into communities did not exist and must be developed. It was also clear that some patients could not be safely discharged into the community and should continue to be cared for in DMH facilities until appropriate services could be created.
Some communities struggled to develop community-care programs at first. Patients faced a shortage of appropriate housing options, a lack of crisis care for short-term acute situations, and a lack of employment opportunities. Still, the Agency moved forward. In 1993, 127 patients from the South Carolina and Crafts-Farrow State Hospitals, moved into seven customized programs in Aiken, Charleston, Columbia, Lexington, Orangeburg, and Sumter. They were provided with appropriate housing, medication monitoring, psychiatric and medical services, supportive community services, meaningful activity, and employment assistance. In two separate moves between 1992 and 1995, 265 patients were discharged from inpatient facilities to Toward Local Care projects in community mental health centers across the state.
The State Hospital, or “Bull Street” campus is closed. The DMH system now comprises 16 community mental health centers (each with clinics and satellite offices), three psychiatric hospitals one of which is used for treatment of substance use disorders, three veterans’ nursing homes, one community nursing home, and a Sexually Violent Predator Treatment Program.
Did You Know? ➢ The mission of the South Carolina Department of Mental Health is “to support the recovery of people with mental illnesses”.
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➢ Since opening its first hospital in 1828, DMH has served approximately 4 million South Carolinians. o Approximately 3 million patients have been served in DMH outpatient community mental health centers and clinics; approximately 1 million patients have been served in DMH inpatient facilities (hospitals and nursing homes).
➢ DMH is one of the largest hospital- and community-based systems of care in South Carolina: o Each year, DMH provides more than 500,000 inpatient bed days. o Almost half of DMH inpatient bed days are for nursing home residents. o 774 veterans resided in veterans’ nursing homes during FY 2019, resulting in 79,608 bed days at Campbell, 32,163 bed days at Stone, and 79,243 bed days at Veteran’s Victory House, for a total of 191,014 bed days.
South Carolina Department of Mental Health Organizational Chart
DMH’s System of Care The South Carolina Department of Mental Health: ➢ Comprises 16 community-based, outpatient mental health centers and dozens of associated clinics and satellite offices, serving all 46 counties in our state; ➢ Provides services to approximately 100,000 patients per year, approximately 30,000 of whom are children; ➢ Operates three licensed hospitals, including one for treatment of substance use disorders;
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➢ Operates four nursing homes, including three for veterans; ➢ Is one of the largest hospital- and community-based systems of care in South Carolina; ➢ Includes operation of a large Forensics program for defendants referred from the state’s criminal courts; and ➢ Includes operation of a Sexually Violent Predator Treatment Program.
Community mental health centers (CMHCs) provide comprehensive mental health services, offering outpatient, home-based, school, and community-based programs to children, adolescents, adults, and families throughout South Carolina. Each CMHC covers a geographic catchment area; together, they provide services to all 46 SC counties. All 16 DMH CMHCs are accredited by the Commission on Accreditation of Rehabilitation Facilities (CARF), an independent, nonprofit accreditor of health and human services. Each DMH community mental health center has an advisory board, with 9 to 15 members, including at least one medical doctor. Center boards meet monthly.
DMH’s Inpatient Services comprises three hospitals, one community nursing care center, three veterans’ nursing homes, and a Sexually Violent Predator Treatment Program. Each of DMH’s psychiatric hospitals is accredited by the Joint Commission, which aims to improve healthcare by evaluating healthcare providers and inspiring them to excel in the provision of safe, effective care of the highest quality and value. Morris Village Treatment Center, the Agency’s inpatient drug and alcohol treatment facility, is licensed by the South Carolina Department of Health and Environmental Control (DHEC) and accredited by the Commission on Accreditation of Rehabilitation Facilities (CARF), an independent, nonprofit accreditor of health and human services. Each of DMH’s four nursing homes is licensed by the SC DHEC and certified by the Centers for Medicare & Medicaid Services. Three of the Agency’s four nursing homes serve veterans exclusively and are certified by the Department of Veterans Affairs. ➢ G. Werber Bryan Psychiatric Hospital (Columbia) – G. Werber Bryan Psychiatric Hospital (Bryan) provides inpatient psychiatric treatment to adults and children. It is licensed by the State of South Carolina as a Specialized Hospital and is accredited by The Joint Commission, and has three distinctive parts: o Adult Services – Bryan’s Adult Services patients are admitted primarily from the 33-county Midlands, Pee Dee, and Lowcountry regions of South Carolina. The majority of patients are civil involuntary admissions. o Forensics – The Forensics Division provides inpatient evaluation and treatment, rehabilitation, and outpatient services. Admissions are court-ordered from across SC through the state’s criminal justice system. o William S. Hall Psychiatric Institute at Bryan Psychiatric Hospital (Hall) – Hall provides inpatient treatment for children and adolescents aged 4-17. It has three inpatient programs: Adolescent Acute, Child Acute, and a program for adolescents with both substance use and psychiatric disorders. ➢ Patrick B. Harris Hospital (Anderson) – Harris Hospital provides inpatient treatment to adults. It is licensed by the State of South Carolina as a Specialized Hospital and is accredited by The Joint Commission. Patients are admitted from the 13 Upstate counties of South Carolina, and the majority are civil involuntary admissions. In 2015, Harris was recognized as a 2014 Top Performer on Key Quality Measures by The Joint Commission. The award recognizes accredited hospitals and critical access hospitals that attain and sustain excellence in accountability measure performance. Recognition in the program is based on an aggregation of accountability measure data reported during the previous calendar year. ➢ Morris Village Alcohol & Drug Addiction Treatment Center (Columbia) – Morris Village provides inpatient treatment for adults with alcohol and drug use disorders, and, when indicated, addiction accompanied by psychiatric illness, often referred to as “dual diagnosis.” It is licensed by the State of South Carolina and is accredited by the Commission on Accreditation of Rehabilitation Facilities. Patients are admitted to Morris Village from throughout the state, with referrals from community mental health centers, county alcohol and drug commissions, community hospitals, and the judicial system. The patient population includes both individuals who are voluntarily admitted and individuals who are civil involuntary admissions.
Anticipating a growing veteran population, DMH applied for funds in 2015 to construct additional State Veterans nursing homes. With guidance from the State's Joint Bond Review Committee, DMH identified areas with a significant need for new veterans' nursing homes. DMH submitted additional State Veterans nursing home construction grant applications to the Department of Veteran’s Affairs. DMH awarded the construction contracts in
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April, 2019, and site preparation began in May, 2019. The new State Veterans Nursing Homes will each comprise 104 beds, and are expected to open in the Summer of 2021. The Florence facility will be called Veteran Village and the Gaffney facility will be called Palmetto Patriots Home.
A System of Care Designed for Patients: The Right Treatment, at the Right Time, at the Right Level South Carolina is one of the only states in the US with a state-operated, comprehensive mental health system, resulting in numerous benefits for South Carolinians in need of services. For example, this structure means DMH: ➢ Comprises a network of community mental health centers (CMHCs) and associated clinics, covering geographical catchment areas, that provide an inclusive, uniform array of core mental health services; ➢ Provides and/or coordinate the necessary vital, non-medical supports for successful recovery, e.g., care coordination, tailored to each patient’s needs; ➢ Provides transition services to and from inpatient care, including non-clinical services, to support long-term recovery; ➢ Facilities are able to provide support as needed to patients of other DMH centers and hospitals, e.g., sharing psychiatrist time via telehealth, providing services to anyone in need following a natural disaster; ➢ Is a Trauma-Informed System, supporting the development and implementation of policies, procedures, and practices that do not create, or recreate, traumatizing events for patients. The Agency ensures all patients are offered evidence-based trauma assessments and offers evidence-based treatment options to patients experiencing trauma-related symptoms. ➢ Utilizes a system-wide, secure, electronic medical record, allowing all clinical components access to patient information and providing seamless access to care for patients who may move to a new area in SC but wish to continue services with DMH; ➢ Operates according to uniform policies and procedures.
This unique design also results in decreased costs compared to systems that utilize privatization and contracting out of services.
DMH: A True System of Care The programs, services, and divisions highlighted in this document are designed to ensure that South Carolinians in need receive the right treatment, at the right place, at the right time. They work together to ensure that South
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Carolina’s public mental health system is a robust, interconnected, evidence-based system of care that supports the recovery of people with mental illnesses.
Today, we know: ➢ Patients treated in the community fare better clinically. ➢ People with mental illnesses need family and community support. ➢ Patients recover faster and stay well longer when receiving services in their communities.
Hence, the need for a continuum of services providing safe, effective, cost-efficient care, including: ➢ Early identification, and prevention. ➢ Intensive community treatment, when needed. ➢ Community crisis response, intervention, and stabilization. ➢ Diversion from unnecessary emergency department visits, hospitalizations, and incarcerations. ➢ Inpatient commitment for only those who need it.
DMH’s Community Services Array A robust system of community-based services, serving children, adolescents, adults and families, are vital to successful early identification and intervention, stable community placement, and successful recovery. To that end, DMH provides core mental health services at all 16 of its community MHCs, including: ➢ Psychiatric services ➢ Individual and family counseling ➢ Services for children, adolescents, adults, and families ➢ Peer support ➢ Clinical care coordination ➢ Housing assistance ➢ Vocational services
Highlighted below are several community-based services.
Child and Family Services – CAF Services develops and aspires to implement a seamless statewide system of caring for the children, adolescents, and families of South Carolina including ensuring the use of best practices when appropriate and possible. Best Practice programs, which vary among DMH locations, include: Multi-Dimensional Family Therapy, Trauma-Focused Cognitive Behavioral Therapy, Dialectic Behavioral Therapy, Parent-Child Interaction Therapy, Attachment and Biobehavioral Catchup, Motivational Interviewing, and the National Adoption Competency Mental Health Training. The CAF Division assumes a leadership role and provides staff support to the Joint Council on Children and Adolescents in the development of a system of care to increase access to services and supports for families living with mental health, substance abuse, and co-occurring concerns.
School Mental Health Services – The mission of SMHS is to promote academic and personal success by identifying and intervening at early points and to support social and emotional/behavioral well-being of children and youth in South Carolina. Services include prevention, early intervention, clinical assessment, individual/family/group therapy, crisis intervention, psychiatric assessment and evaluation, care coordination, and mental health awareness. In 2019, the University of South Carolina launched the John H. Magill School Mental Health Certificate Program. This paid internship aims to develop a well-qualified workforce of school mental health clinicians. The first group of students included 7 master’s level students from 6 degreed programs working in 5 DMH mental health centers.
Intensive Community Treatment – Some DMH patients need a higher level of care to prevent hospitalization. These patients can be referred to Centers’ Intensive Community Treatment (ICT) Teams. ICT Teams: ➢ Deliver services from multidisciplinary teams made up of mental health professionals, nurses, psychiatrists, care coordinators, nurse practitioners, and peer support specialists. ➢ Provide a wide range of therapeutic services. ➢ Patients are offered appointments at least weekly and can likely receive multiple services weekly.
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➢ Each ICT mental health professional has no more than 35 patients. ➢ ICT services can be delivered in patients’ homes or other community locations at times that work best for patients.
Office of Transition Programs – In 2019, DMH created the Office of Transition Programs to assist patients who have been hospitalized in DMH facilities for longer-term treatment to move from a hospital setting to the community and toward independent living. The office assists patients with their identified needs so they can access community resources in an effective and efficient way post-discharge. Transition Specialists work with patients to determine their recovery needs, their preference of where they want to live in the community, and to collaborate with stakeholders to ensure continuous communication as it relates to the patient’s discharge plans. Transition Specialists ensure effective communication between inpatient/outpatient staff regarding patients’ discharge needs and coordinate with all stakeholders (patient, family, clinical care coordinators, certified peer support specialists), streamlining the discharge process and improving the chance for successful transition to the community.
Clinical Care Coordination and Community Long-Term Care – In 2013, DMH launched the Office of Clinical Care Coordination with internally transferred staff, with the goal of improving outcomes for patients and reducing healthcare costs. Care Coordinators help patients find and access resources such as primary care, housing, entitlement programs, etc. Provision of Care Coordination services results in decreased re-hospitalizations and emergency room visits, and increased utilization of primary care physicians. Key features of the service include in-home visits and reporting and monitoring of patients’ progress in collaboration with referral sources. A special program under this division is Community Long-Term Care. It provides in-home support to participants eligible for nursing home care who opt to remain in their homes. Services may include home-delivered meals, personal care aides, incontinence supplies, adult day care, ramps, pest control, and other similar services. As of January 2021, 12 case managers provide services statewide, and case managers served 705 participants with an average of 10-15 new cases added monthly.
Community Placement – DMH sponsors or supports a variety of living arrangements for patients transitioning out of psychiatric hospital settings or receiving mental health services from one of its 16 community mental health centers. DMH community residential options include: ➢ Housing & Homeless Services, which has funded the development of more than 1,600 housing units across the state for people with mental illnesses. ➢ The TLC Program, which includes community care residences, Homeshare, supported apartments, rental assistance, and supportive services. ➢ Community Residential Care Facilities (CRCFs), DHEC-licensed facilities that offer room, board and a degree of personal care for 2 or more people.
Individual Placement and Supported Employment Program (IPS) – This supported employment evidence-based program is located in all 16 DMH community mental health centers. Each center partners with the local Vocational Rehabilitation Department to provide opportunities for people with serious mental illnesses to become gainfully employed in the community. In fiscal year 2019, DMH supported employment programs achieved a 60% average competitive employment rate for people with severe mental illness. During this period, IPS had a total of 497 new people enroll in its programs and placed 346 people in competitive employment. In fiscal year 2019, IPS received 1,302 new referrals and provided employment services to 913 patients. Nationally, among the 22 states participating in the IPS Dartmouth/Johnson & Johnson studies, South Carolina was ranked third in the highest average employment rate.
DMH Crisis Programming South Carolina Mobile Crisis – SC Mobile Crisis is a program created by DMH in partnership with SC Health and Human Services to enhance the Agency’s crisis services array by providing statewide capacity for on-site, emergency, psychiatric screening and assessment. Mobile Crisis provides services 24/7/365. The Program’s goals are to provide access and link those experiencing psychiatric crises to appropriate levels of care, reduce hospitalizations, and reduce unnecessary emergency department visits. Mobile Crisis builds partnerships with local law enforcement,
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hospitals, judges, community providers, and other mental health providers. Mobile Crisis provides an extension of DMH community mental health center services: ➢ During business hours, DMH mental health centers serve patients by appointment, during walk-in hours, and via phone. ➢ Mobile crisis provides mobile response to patients in the community who cannot or are unable to access services. ➢ After hours, weekends, and on holidays, teams of 2 mental health professionals respond in person, remotely, or by phone to those experiencing psychiatric emergencies.
Highway 2 Hope Mobile Response Program – In 2020, DMH received a federal grant of $6,403,686 to provide support to South Carolinians in rural areas who are experiencing mental health and substance use crises or have unmet treatment needs. The primary focus of the initiative is a Mobile Response Program serving nine counties beginning in 2021, called the Highway to Hope Mobile Response Program (H2H). H2H will serve both adults and children in some of the most rural areas of South Carolina, utilizing nine RVs operated by DMH staff from the three DMH mental health centers that serve those areas: ➢ Pee Dee Mental Health Center (Florence, Darlington, and Marion counties) ➢ Tri-County Mental Health Center (Chesterfield, Dillon, and Marlboro counties) ➢ Waccamaw Center for Mental Health (Horry, Georgetown, and Williamsburg counties)
H2H is based on a long-running, highly successful model for rural patients operated by DMH’s Charleston- Dorchester MHC since 2010. The program will offer both mental health treatment and some basic primary care services directly to those in need who may not have transportation to services otherwise. Based on the patient’s assessment, the professional care staff will also make referrals to other community resources. The RVs will be equipped with telehealth equipment, and the services available will be delivered both in-person and virtually.
Crisis Stabilization – The Tri-County Crisis Stabilization Center (TCSC) opened in 2017. It is a 10-bed, voluntary, adult unit designed to stabilize individuals with increased psychiatric symptoms and divert people from inpatient hospitals, emergency departments, or jails. The Center accepts residents from Charleston, Dorchester, and Berkeley counties 24/7/365 from local emergency departments, law enforcement, outpatient providers, and self-referrals. The TCSC was opened through a funding partnership comprising MUSC, Roper Saint Francis, Charleston Center, the Charleston County Criminal Justice Coordinating Council, the Charleston County Sheriff's Office, and DMH’s Berkeley Mental Health Center and Charleston-Dorchester Mental Health Center. In addition to providing intensive psychiatric and clinical services, the TCSC also offers adjunct services on site including peer support, care coordination, and vocational services, as well as referrals for entitlements. In 2019, TCSC also started receiving referrals from Trident Hospital.
The Ray C. Eubanks, Jr. Support Center opened in 2018. This peer drop-in, “living room”-concept hospital diversion program in Spartanburg is staffed and operated by DMH’s Spartanburg Area MHC in space donated by the Spartanburg Regional Healthcare System. The Eubanks Center: provides individuals with mental illnesses an additional support system outside of clinical settings; includes 3 Peer Support Specialists, 2 clinicians, 1 part-time care coordinator; has resulted in the diversion of 55 individuals from emergency rooms or hospitals from its opening to the start of the COVID-19 pandemic; and, is gradually reopening as the pandemic recedes. Services include: housing subsidies; an automated appointment reminder system; Individual Placement and Support; access to Advance Practice Registered Nurses; Intensive Care Teams; and, Intensive Family Support.
DMH Telepsychiatry Programs DMH has seven telepsychiatry programs: Emergency Department Telepsychiatry; Community Telepsychiatry; Inpatient Services Telepsychiatry; EMS Telehealth Pilot Project; Deaf Services Telepsychiatry; School Telehealth; and, Nursing Home Telepsychiatry.
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DMH Specialty Programs and Services As part of its treatment continuum, DMH offers programs and services to reach populations with particular needs that require specialized care. These initiatives are designed to ensure those in need receive appropriate services, at the right time, in the right place, from the most appropriate provider, helping preventing avoidable emergency department visits, hospitalizations, and incarcerations. They focus on: Prevention; Diversion; Early Identification & Intervention; Education & Support for Special Populations. The following describes some these programs and services within DMH.
Office of Suicide Prevention – The DMH Office of Suicide Prevention’s (OSP) efforts include: ➢ A comprehensive school suicide prevention program. ➢ Provision of extensive information, resources, and trainings statewide to multiple organizations and groups. ➢ Best-practice suicide safety policy and protocol development in DMH mental health centers and hospitals. ➢ Follow-up/aftercare planning and development. ➢ De-stigmatization and awareness training. ➢ Tiered, comprehensive best-practices for community members and multi-disciplinary audiences. ➢ Cultural competency trainings focused on high risk populations (e.g., LGBTQI+, individuals living with serious mental illnesses, trauma-informed care, etc.). ➢ Post-intervention consultation following loss to suicide. ➢ Coalition and taskforce development, statewide. ➢ Engagement with statewide resource provision, i.e., National Suicide Prevention Lifeline, Crisis Text Line, etc. ➢ Creation and provision of the first statewide interactive screener for mental health and substance use for those over 18, in partnership with the SC Department of Alcohol and Other Drug Abuse Services.
Mental Health Courts – Mental Health Courts aim to divert non-violent, adult offenders with serious mental illness from the criminal justice system. These Courts generally function as partnerships comprising an assigned judge (frequently a Probate Court judge), the local DMH mental health center, and the Solicitor’s Office. South Carolina currently has Mental Health Courts in the following counties: Aiken, Berkeley, Charleston, Greenville, Horry, Richland, and York. In 2017, DMH received a grant from The Duke Endowment to increase the number of Mental Health Courts and/or increase the capacity of existing courts, and to evaluate the outcomes of existing Courts. In addition, DMH receives $400,000 in recurring State appropriations from the General Assembly to increase the number of mental health courts and the capacity of exiting courts.
Embedded Mental Health Professionals – Embedded Mental Health Professionals (MHPs) support individuals, families, and communities by working with organizations outside of the DMH system to identify people who need referral to community-based resources and connection to mental health care. DMH has embedded MHPs in: ➢ Law enforcement agencies o 7 Victims of Crime Act-funded MHPs serve child and adult victims of crime throughout Charleston and Dorchester counties. o 5 MHPs with the Mental Health/Law Enforcement Alliance Project support victims of trauma. ➢ Detention Centers & Jail Liaisons o These MHPs identify detained offenders in need of referrals to mental health care and continuity of care in the community. ➢ 911 Consolidated Dispatch o 1 MHP in Charleston County, who helps take calls that are mental health-related and supports Dispatch in determining the appropriate response. ➢ Local Hospital Emergency Departments o 10 DMH community mental health centers have MHPs embedded in local hospital EDs to support the mental health needs of patients in the ED, including referral to community treatment and determining the need for inpatient admission. ➢ Non-DMH Crisis Intervention Team
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o In 2021, DMH is embedding an MHP with the Richland County Sheriff’s Office who will respond alongside an ununiformed officer to calls involving mental health situations for de-escalation and crisis response.
Behavioral Health for First Responders – In 2013, DMH joined the South Carolina State Firefighters’ Association, the South Carolina Fire Academy, and the National Fallen Firefighters Foundation, in launching a pilot program to provide behavioral health support to South Carolina’s 17,500 firefighters. The goal is to ensure that behavioral health supports are available to firefighters when needed and that the care provided represents best-practices. The Program provides clinical intervention, firefighter peer teams provide first-tier response, and DMH provides second-tier clinical support. The Program is the first of its kind in the nation, and serves as a national and international model. Appropriately trained DMH staff are available at the following centers under this regional pilot program: Beckman CMHS, Berkeley MHC, Charleston/Dorchester MHC, Columbia Area MHC, and Pee Dee MHC.
First Responders-Support – DMH’s First Responder Support Team (FRST) provides clinical support statewide to support the mental health needs of first responders. FRST began in Charleston County with services from the Charleston-Dorchester Community Mental Health Center in 2007. In 2020, FRST expanded statewide. DMH provides support to the SC Law Enforcement Assistance Program (SC LEAP). SC LEAP is a partnership including SLED, the South Carolina Department of Natural Resources, the South Carolina Department of Public Safety, and the South Carolina Department of Probation, Parole, and Pardon Services, to provide support to law enforcement and other first responders statewide. DMH MHPs provide support in local debriefings and post-critical incident seminars. Clinicians involved in this collaboration are trained in Eye Movement Desensitization & Reprocessing as well as Critical Incident Stress Management.
First Responders-Training – Crisis Intervention Training (CIT): This 5-day training teaches law enforcement officers how to respond safely and appropriately to people with serious mental illness in crisis. Officers learn to recognize the signs of psychiatric distress, de-escalation techniques, and how to link people with treatment., avoiding officer injuries, consumer deaths, and tragedy for the community, as well as linking people with appropriate treatment. Classes are taught by a CIT Trainer from the National Alliance on Mental Illness-SC, DMH staff, law enforcement peers, and sometimes other community providers (e.g., county substance use disorder treatment providers).
Applied Suicide Intervention Skills Training (ASIST) – DMH Office of Suicide Prevention: LivingWorks ASIST is a two-day, face-to-face workshop that trains participants how to prevent suicide by recognizing signs, providing skilled intervention, and developing a safety plan to keep someone alive. Developed more than 35 years ago, ASIST is a continually updated, evidence-based training. DMH’s Office of Suicide Prevention Training Team provides this training to SC first responders of all types.
Metropolitan Children’s Advocacy Center - The Metropolitan Children’s Advocacy Center (Met CAC) is accredited through the National Children’s Alliance in Washington, DC. It is the only state-funded CAC in South Carolina. DMH collaborates with the USC School of Medicine’s Department of Pediatrics and Prisma Health Children’s Hospital to provide integrated services for children suspected of being sexually or physically abused. In partnership with the Children’s Law Center of the University of South Carolina School of Law, the Met CAC also provides ChildFirst, a training in forensic interviewing techniques provided quarterly for law enforcement and child protection professionals. The Met CAC, which is a program under DMH’s Columbia Area Mental Health Center, serves more than 1,000 children each year. The Metropolitan Children’s Advocacy Center provides: forensic interviews and medical exams; expert testimony in Family and Criminal Court; victim advocacy services; and, Coordination of the Richland County Child Abuse Investigation Multidisciplinary Team.
Deaf Services – DMH’s Deaf Services Program provides a continuum of outpatient and inpatient mental health services to persons who are Deaf and Hard of Hearing. The Program uses innovative technological and human service program initiatives to ensure all services are delivered in a cost-effective and timely manner, statewide. Services include:
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➢ Outpatient services for children, families, and adults, using itinerant counselors who are part of regional teams located across the state. ➢ School Mental Health services in collaboration with public school systems statewide. ➢ Residential services in supported apartments at locations statewide. ➢ Use of telemedicine across a variety of platforms to provide accessible services to rural areas. ➢ Inpatient services at Patrick B. Harris Hospital and William S. Hall at Bryan Hospital. ➢ A 24/7 crisis hotline (803) 339-3339 or [email protected] for Deaf and Hard of Hearing SC residents. ➢ Sign language interpreters and Communication Access Realtime Translation by request for DMH appointments and crisis interventions.
Additional Specialty Services at DMH – Additional specialty services include Dialectical Behavioral Therapy (DBT), Mental Health/Primary Health Integration, Multi-Dimensional Family Therapy (MDFT), Parent Child Interaction Therapy (PCIT), Trauma-Focused Cognitive Behavioral Therapy (TF-CBT), Eye Movement Desensitization and Reprocessing Therapy (EMDR), Infant and Early Childhood Mental Health Consultation (IECMHC), and First Episode Psychosis (FEP) Programming.
Collaborations and Affiliations The South Carolina Department of Mental Health has affiliations with more than 60 educational institutions in South Carolina and more than 5 other states. DMH works closely with independent advocacy organizations to improve the quality of life for people with mental illness, their families, and the citizens of South Carolina.
The DMH’s affiliation with the University of South Carolina includes activity therapy, clinical counseling, medical students, nursing students, social work, psychology interns, psychology graduate studies, and residents and fellows in psychiatry.
DMH has contracts with the University of South Carolina’s School of Medicine (USCSOM) and Department of Neuropsychiatry and Behavioral Science. There has been a long collaborative relationship between DMH and the Department of Neuropsychiatry and Behavioral Science at the USCSOM, which provides clinical consultation and training delivery to DMH staff on a range of clinical topics. DMH provides clinical rotation for 1st-, 2nd-, 3rd-, and 4th- year medical students from the School of Medicine. The students are assigned DMH physician preceptors and rotate through DMH’s centers and facilities. There are 4 fully accredited Psychiatric Residency Fellowship Training Programs (Child, General, Forensics and Gero-Psychiatry) that rotate through DMH centers and facilities, which the Agency supports via contract.
Residents from the MUSC Residency Training Program receive educational experiences and supervision in Psychiatry through scheduled rotations at the Charleston Dorchester Mental Health Center (CDMHC). CDMHC is involved with learning collaborative including DMH, the Crime Victim’s Center at MUSC, and the Dee Norton Lowcountry Children’s Center. This initiative revolves around Trauma-Focused Cognitive Behavioral Therapy. Residents train with CDMHC’s First Responder Support Team and Mobile Crisis. Medical students rotate regularly though CDMHC throughout the academic year. DMH has a contract with MUSC to provide forensic evaluation of adult criminal defendants in 10 counties in South Carolina.
Emergency Preparedness and Response – DMH is part of the SC Emergency Planning Committee for People with Functional Needs, a committee comprising organizations and agencies that came together after Hurricane Hugo. The Committee was among the first organized in the U.S. to act as a resource for state leadership in planning and providing resources for people with functional needs. It Committee holds daily conference calls whenever the State Emergency Operations Center (SEOC) is activated. When activated, DMH staff at the SEOC allocate available resources to meet the needs of affected communities. As the State Mental Health authority, DMH is eligible to apply for Crisis Counseling Program grants. These programs engage communities and individuals with services designed to facilitate recovery following disasters.
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Internal Oversight and Quality Assurance Compliance – The South Carolina Mental Health Commission and the South Carolina Department of Mental Health built and implemented a Compliance Program consistent with the procedural and structural guidance provided by the Office of Inspector General (OIG) of the Department of Health and Human Services to advance the prevention of fraud, abuse, and waste and the Federal Sentencing Guidelines. The goal of the Program is to implement a process for the continuous development, implementation, and refinement of internal controls and practices that promote adherence to applicable federal and state laws, identify, address and correct areas of risk, and further relevant policies of the Department, particularly those that support compliance activities. The South Carolina Mental Health Commission and the DMH expect all staff to conform to the standards of conduct as stated in its Code of Ethics and Conduct.
DMH’s Compliance program: ➢ is ongoing and the objectives are consistent with the Agency’s mission; ➢ provides employees education regarding Compliance; ➢ includes lines of communication for dissemination of information related to compliance and for the reporting of suspected violations of federal and state laws and regulations; ➢ includes a system to investigate allegations of noncompliance; ➢ regularly monitors and audits activities; and, ➢ enforces appropriate conduct and discipline.
DMH’s Compliance Officer provides the South Carolina Mental Health Commission with timely and accurate information at least twice a year, so they may make informed judgments concerning compliance with law and business performance. DMH’s Compliance Committee comprises the state director, the director of Quality Management and Compliance (QMC), and directors of divisions and other key staff of the Department who are responsible for assisting and advising the QMC director in implementing and maintaining the integrity of the Compliance Program and ethical conduct of employees. Committee members are also responsible for the prevention, identification, monitoring, and control of risks in coordination with the director of QMC.
Quality Management Advisory Committee – DMH’s Quality Management Advisory Committee (QMAC) includes compliance and quality assurance. Compliance promotes and monitors DMH’s adherence to state and federal laws and regulations, as well as to requirements of third-party payors for the delivery and billing of quality services. Quality Assurance establishes methods and procedures to ensure that services provided are of the highest quality; and, systematically monitors performance against established standards for practice and implements actions for improvements as needed to ensure that service delivery is appropriate and meets the needs of DMH’s patients.
QMAC’s primary focus is addressing challenges and opportunities for improving efficiency and effectiveness of the compliance program by: routinely identifying opportunities for improvement in the delivery of services; ensuring the Agency’s clinical programs meet the current requirements; and, remaining alert about the ever-changing reimbursement standards for providers of clinical services. Over time, QMAC began to broaden its focus to include compliance and identifying opportunities for improvement in the delivery of services.
Internal Audit – DMH’s Office of Internal Audit serves as an independent function to examine and evaluate Agency activities as a service to the South Carolina Mental Health Commission and the DMH state director. Internal Audit’s overall objectives are to: evaluate internal controls and safeguard Agency assets; test for compliance with State, Federal, and Agency requirements; identify opportunities for revenue enhancement, cost savings, and overall operational improvements; coordinate audit effects (when requested) with the South Carolina Office of Inspector General, State Auditor’s Office, Legislative Audit Counsel, and other external auditors; deter and identify theft, fraud, waste and abuse; and, protect the assets of the State of South Carolina. As a result, the Office of Internal Audit provides analyses, recommendations, counsel, and information about activities or processes reviewed, usually in the form of an audit report.
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Multi-Cultural Council and Chief Diversity & Inclusion Officer - The Department considers cultural competence part of its mission, believing that cultural competency is driven by leadership, and should be staff and patient-oriented. DMH understands that services are more effective when they are provided within the most relevant and meaningful cultural, gender-sensitive, and age-appropriate context for the people being served. The Department believes that multiculturalism should be embedded in all organizational units and that continuous efforts must be made to recruit, retain, and develop a culturally diverse workforce. The DMH Multicultural Council is charged with the responsibility of advising and guiding Agency leadership in the creation and maintenance of a linguistically and culturally competent workforce, service divisions, programs, and collaborative endeavors, reflective of the diversity of the population served and local communities. In 2020, DMH hired its first ever Chief Diversity and Inclusion Officer, who works as a member of Senior Management to help define the overarching vision, identity, and strategy of all Agency divisions and programs, and collaborates with Leadership to assess and remove existing policies, practices, procedures, and norms that may support unfair or biased delivery of services, hiring/promotional practices, and conduct/performance approaches.
Patient Advocacy – DMH’s Advocacy Program is designed to: prevent patient rights violations and advocate for the provision of quality of care in a humane environment; review, investigate and resolve patient rights complaints or issues; and, monitor the number and types of complaints to identify systemic areas of concern. All DMH inpatient and outpatient facilities have an assigned advocate. Advocates inform patients about their rights, help them speak for themselves, or speak on their behalf, assist patients with questions and complaints about rights and services, and bring issues to Agency officials for resolution. If a patient or a family member has a question or concern regarding rights, an assigned advocate will interview the patient, staff, and others, as necessary. The advocate will then review records, documents, or policies and attempt to negotiate a satisfactory result on behalf of the patient.
Patient Advisory Boards – Patient Advisory Boards (PABs) exist to provide mechanisms for positive collaboration and communication, and to empower patients at all Departmental levels. PABs provide unique and independent opportunities for input and involvement in the areas of planning, policy-making, program evaluation, and service provision. Most states have a statewide or regional PAB, but DMH is among just a few state systems that have mandated the establishment of PABs at every center and hospital.
Research and Institutional Review Board – DMH recognizes the need for safeguarding the rights and welfare of research subjects and their private health information. In accordance with Department of Health and Human Services regulations, the DMH has an established Institutional Review Board. The DMH’s online IRB manual, posted on the DMH web site, provides researchers with tools and information necessary to ensure these obligations are met and facilitates the research process. The DMH IRB meets monthly.
Coordination of the Mental Health/Substance Use State Systems SCDMH is the mental health authority in the State of South Carolina and the lead state agency in the provision of mental health services to the citizens of the State. SCDMH partners with the South Carolina Department of Alcohol and Other Drug Abuse Services (DAODAS) to support DAODAS’ role as the lead state agency for funding SUD services – services that are provided by local non-profits known as “301s” for ACT 301 that facilitated their establishment.
SCDMH and DAODAS share a long history of partnerships to address situations affecting people with mental illness, people with substance abuse, people with co-occurring disorders, and people in crisis. DAODAS is the cabinet agency charged with ensuring the provision of quality services to prevent or reduce the negative consequences of substance use and addictions. To accomplish this goal, the Department contracts with a broad network of service providers and recovery organizations, highlighted by a system of 32 public agencies that provide prevention, intervention, treatment and recovery services in all 46 counties of South Carolina.
As stated earlier, Community mental health centers (CMHCs) provide comprehensive mental health services, offering outpatient, home-based, school, and community-based programs to children, adolescents, adults, and families throughout South Carolina. Each CMHC covers a geographic catchment area; together, they provide
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services to all 46 SC counties. All 16 DMH CMHCs are accredited by the Commission on Accreditation of Rehabilitation Facilities (CARF), an independent, nonprofit accreditor of health and human services. Each DMH community mental health center has an advisory board, with 9 to 15 members, including at least one medical doctor. Center boards meet monthly.
Community services offered to adults and children ages 0-100+ include, but are not necessarily limited to, assessments, individual therapy, group therapy, family therapy, psychiatric medical assessment (PMA), nursing services, medication administration, medication monitoring, psychosocial rehabilitation services, certified peer support services, crisis intervention, and care coordination.
It is the mission of SCDMH to support Recovery Initiatives through the development of empowered patient leadership for persons served through the agency. SCDMH empowers patients by hiring them to be: planners; policy makers; program evaluators; service providers. SCDMH also supports recovery through training and education on recovery principles and recovery-oriented practice and systems, including the role of peers in care; required peer accreditation or certification; block grant funding of recovery support services; involvement of persons in recovery/peers/family members in planning, implementation, or evaluation of the impact of the mental health system; and measurement of the impact of consumer and recovery community outreach activities.
DMH’s Inpatient Services comprises three hospitals, among other facilities. Each of DMH’s psychiatric hospitals is accredited by the Joint Commission. Morris Village Treatment Center, the Agency’s inpatient drug and alcohol treatment facility, is licensed by the South Carolina Department of Health and Environmental Control (DHEC) and accredited by the Commission on Accreditation of Rehabilitation Facilities (CARF).. ➢ G. Werber Bryan Psychiatric Hospital (Columbia) – G. Werber Bryan Psychiatric Hospital (Bryan) provides inpatient psychiatric treatment to adults and children. o William S. Hall Psychiatric Institute at Bryan Psychiatric Hospital (Hall) – Hall provides inpatient treatment for children and adolescents aged 4-17. It has three inpatient programs: Adolescent Acute, Child Acute, and a program for adolescents with both substance use and psychiatric disorders. ➢ Patrick B. Harris Hospital (Anderson) – Harris Hospital provides inpatient treatment to adults. ➢ Morris Village Alcohol & Drug Addiction Treatment Center (Columbia) – Morris Village provides inpatient treatment for adults with alcohol and drug use disorders, and, when indicated, addiction accompanied by psychiatric illness, often referred to as “dual diagnosis.”
SCDMH maintains partnerships with the South Carolina Department of Education, South Carolina Department of Health and Human Services, South Carolina Department of Juvenile Justice, South Carolina Department of Social Services, South Carolina Department of Vocational Rehabilitation, South Carolina State Housing Finance and Development Authority, and many other state agencies, universities, non-profits, and other stakeholder organizations, such as counties – some of which provide funding to support SCDMH operations – to ensure a comprehensive mental health continuum and supporting services for the citizens SCDMH serves.
An unmet need and a gap in the current system is the inclusion of consultation sessions – government-to-government interaction – with the State of South Carolina's only federally recognized tribe: the Catawba Indian Nation. SCDMH has attempted, however, since 2012, to obtain, at least, tribal input – the South Carolina Mental Health State Planning Council secured representation from the State Commission for Minority Affairs by means of a state employee who is not only employed by the State Commission for Minority Affairs, but who also serves as a liaison to the Native American Indian Advisory Committee.
Regarding how these systems address the needs of diverse racial, ethnic, and sexual and gender minorities, as well as American Indian/Alaskan Native populations in the state – ➢ SCDMH tracks access or enrollment in services, types of services received and outcomes for said services by race, ethnicity, gender, gender identity, and age. It does not track sexual orientation. ➢ SCDMH has a data-driven plan to address and reduce disparities in access, service use, and outcomes for the above sub-populations.
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➢ SCDMH has a plan to identify, address, and monitor linguistic disparities. ➢ SCDMH has a workforce-training plan to build the capacity of mental health providers to identify disparities in access, services received, and outcomes and provide support for improved culturally and linguistically competent outreach, engagement, prevention, treatment, and recovery services for diverse populations. ➢ SCDMH has established directives related hereto. o Directive 839-03 – Culturally and Linguistically Appropriate Services to Consumers who have Limited English Proficiency (LEP), or are Hard of Hearing or Deaf – The purpose of this Directive is to ensure each Facility and Community Mental Health Center has a policy and procedure to provide culturally and linguistically appropriate services to its consumers who are not proficient in the English language, to the extent that they cannot access the services or programs offered by the agency without language assistance.
It is the policy of the Department of Mental Health (DMH) to recognize and respect the cultural diversity of its consumers and to provide culturally and linguistically appropriate services to all of its consumers. Moreover, it is the policy of the Department to provide services to those needing them without regard to national origin or disabilities. Included are individuals who have limited English proficiency, or are hard-of-hearing or deaf. The Department recognizes that in order to provide meaningful access to its behavioral health services to consumers who have limited English proficiency, or are hard-of-hearing or deaf, DMH facilities and community mental health centers must have procedures in place to provide communication services, including interpreter services at no cost to the consumer. Accurate and adequate communication between consumers and providers is a necessary element for providing good quality care, and it is a recognized right of consumers. The treatment staff needs to have the capability to effectively communicate with and relate to the experiences of consumers from diverse cultures, as this is an important component of culturally competent treatment. o Directive 894-09 – Cultural Competence – This directive establishes the policy for the creation and maintenance of culturally and linguistically competent system of care at the South Carolina Department of Mental Health (SCDMH).
The Department recognizes that culture is dynamic and that cultural competence must be an ongoing process, believing that valuing individual and group cultural differences is critical to achieving the organizational goals. SCDMH considers cultural competence a necessary part of good clinical services. Organized under the Division of Community Mental Health Services the Statewide Multi- Cultural Council and Center/Facility Multi-Cultural Committees are charged with the responsibility to advise and guide SCDMH leadership in the creation and maintenance of a linguistically and culturally competent workforce, service divisions, programs, and collaborative endeavors reflective of the diversity of the population served and the community. Administrative Services, Centers and Facilities will refer to the Departmental Directive No. 839-03 Culturally and Linguistically Appropriate Services to Consumers who have Limited English Proficiency (LEP), or are Hard of Hearing or Deaf for compliance procedures.
Statutory Criterion for Mental Health Block Grant (MHBG) The information provided below is a summary of SCDMH’s fulfillment of the five (5) statutory criterion for the MHBG as further detailed in Environmental Factors and Plan, Item 9. Statutory Criterion for MHBG.
Criterion 1. Comprehensive Community-Based Mental Health Service Systems SCDMH has a long-established and existent organized community-based system of care for individuals with mental illness, including those with co-occurring mental and substance use disorders. Services and resources are available within a comprehensive system of care, provided with federal, state, and other public and private resources, in order to enable individuals to function outside of inpatient or residential institutions to the maximum extent of their capabilities.
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Criterion 2. Mental Health System Data Epidemiology SCDMH participates in the Substance Abuse and Mental Health Services Administration’s (SAMHSA) Uniform Reporting System (URS). From said system, SCDMH extracts a statewide estimate of the prevalence of SMI among adults and SED among children (URS Table 1). SCDMH uses this data in conjunction with community-centric feedback to evaluate and substantiate planning and implementation activities for its mental health system of care.
Criterion 3. Children’s Services SCDMH provides for a system of integrated services in order for children to receive care for their multiple needs. Services are coordinated to provide for a comprehensive system of care that includes social services; educational services including services provided under IDEA; juvenile justice services; substance abuse services; and health and mental health services.
Criterion 4. Targeted Services to Rural and Homeless Populations and to Older Adults SCDMH provides outreach to and services for individuals who experience homelessness; ensures community-based services to individuals in rural areas; and, cooperates in community-based services to older adults.
Criterion 5. Management Systems Computerized Online Learning Modules provide training to staff to meet regulatory/accrediting standards while minimizing travel to and from Columbia. Tailored curricula have been developed for staff who provide care to meet the special needs of our patients. Other online resources are made available for staff. Free or low-cost Continuing Education Credit are offered, via Distance Learning. Staff are sent updated offerings monthly. Staff are able to take the continuing education offerings online as time permits, at home, or at work.
DMH’s clinical staff of physicians, nurses, social workers, and psychologists provides diagnostic and therapeutic services upon which its patients and their families depend. The skills of the clinical staff enhance patient care throughout this unified system of care. DMH understands that the single-most important service the Agency provides is compassionate care that respects patients’ dignity and individuality. Clinical staff serve in a variety of inpatient and outpatient care areas throughout our state, affording them the opportunity to use their full range of skills. DMH understands that collaboration is invaluable in providing the best possible care to our patients. As such, the Agency encourages its staff to pursue and participate in research opportunities.
Public Mental Health in South Carolina As referenced herein, SCDMH addresses the needs of people with mental illness by providing a comprehensive structure to the mental health service system in South Carolina. SCDMH meets the expectation that it will not only offer a core array of usual and customary psychiatric services, but that it will also be the leader in innovative and technologically-advanced approaches to the delivery of mental health and other ancillary and support services.
[End]
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Step 2: Identify the unmet service needs and critical gaps within the current system.
Narrative Question: This step should identify the unmet service needs and critical gaps in the state's current M/SUD system of care as well as the data sources used to identify the needs and gaps of the required populations relevant to each block grant within the state's M/SUD system of care. States should also continue to use the prevalence formulas for adults with SMI and children with SED, as well as the prevalence estimates, epidemiological analyses, and profiles to establish mental health treatment, SUD prevention, and SUD treatment goals at the state level.
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Planning Steps – Step 2– Identify the Unmet Service Needs and Critical Gaps within the Current System
Identifying Unmet Service Needs and Critical Gaps In order to identify the unmet service needs and critical gaps within the current system to address the specific populations of children with SED, adults with SMI, and older adults with SMI, among other identified groups, the South Carolina Department of Mental Health (SCDMH) systematically reviews its programs and services throughout the fiscal year. As a result of such reviews, SCDMH is able to determine the areas in which it particularly excels and subsequently share such excellence with its partners and stakeholders. Similarly, SCDMH is also able to determine the areas in which gaps or needs have arisen and subsequently address such shortages with its Senior Leadership and staff. Based on data-driven analyses, performance measurements, and feedback mechanisms, SCDMH is able to articulate its competence as the mental health authority in the State of South Carolina while continually evaluating, assessing, and refining its programs, services, and service delivery systems for its patients.
An External Comprehensive Review In May 2018, SCDMH began a formalized review of its operations under Chapter 2, Title 2 of the 1976 Code (Legislative Oversight of Executive Departments) as the South Carolina House of Representatives exercised its option to conduct an information request under the authority of an oversight review. The specific task of the South Carolina House of Representatives, House Legislative Oversight Committee, Healthcare and Regulatory Subcommittee is to conduct legislative oversight studies and investigations of state agencies at least once every seven years.
“The purpose of legislative oversight is to determine if agency laws and programs are being implemented and carried out in accordance with the intent of the General Assembly and whether or not they should be continued, curtailed or even eliminated. Any House Member may file legislation to implement the Legislative Oversight Committee's recommendations.”
Information regarding SCDMH’s participation in the oversight process can be found at the following link: https://www.scstatehouse.gov/CommitteeInfo/HouseLegislativeOversightCommittee/AgencyPHPFiles/MentalHealth .php
During this formalized review process, SCDMH provided an abbreviated list of agency challenges. Many of the articulated challenges illuminated unmet service needs and critical gaps within the current system. • Increasing Access to Veterans Nursing Home Beds – Based on a formula promulgated by the Department of Veterans Affairs, there exists in South Carolina the need for additional veterans’ long-term beds. Title 38, Part 59 provides the total number of allowed State Home beds, which, when netted with the number of current State Home beds (530), indicates a need for an additional 559 veterans nursing home beds. • Reducing the Time for Forensics Admissions – By law, criminal defendants found incompetent to stand trial due to a mental illness must go through a commitment process to a SCDMH hospital. Because of a significant increase in commitment orders, the length of time that defendants must wait for admission substantially increased. As a result, in June, 2016, SCDMH made reducing the wait time for forensic admissions its first priority and developed a multi-faceted Action Plan. • Increasing Hospital Capacity without Increasing Hospital Beds – If SCDMH is able to increase the availability of intensive community mental health services and increase the availability of supported community housing, it will lead to shorter hospital lengths of stay. In effect, expanding community housing and intensive mental health services will result in SCDMH being able to hospitalize more patients with its current number of beds. The challenge is to fund increased community housing and additional mental health services delivered at a patient’s residence. SCDMH has requested recurring appropriations to support these services.
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• Addressing Crisis Stabilization – It is critical the SCDMH be able to partner with local hospitals and other community officials to increase residential crisis stabilization programs. Such programs help divert individuals in a psychiatric crisis who can be safely cared for outside of a hospital from emergency departments. Charleston has opened a 10-bed Crisis Stabilization Center and discussions are ongoing with other communities. • Addressing Workforce Recruitment and Retention - Like many healthcare providers, SCDMH is faced with enormous challenges in recruiting and retaining all of the healthcare professionals it needs, including competing with other public and private healthcare providers for a limited supply of psychiatrists, nurses, and counselors. SCDMH is pursuing a number of new measures to reach prospective employees, including dedicating recruiting staff to attend job fairs, expanding its presence on social media, and placing job announcements in professional publications. SCDMH’s Human Resources office is also streamlining the hiring process with the goal of significantly shortening the time between receiving job applications and being able to offer positions.
This list of significant challenges that SCDMH will encounter in the future is not complete. However, the items listed above are ongoing and, consequently, require ongoing consideration.
SCDMH also provided an abbreviated list of emerging issues agency representatives anticipate having an impact on agency operations in the upcoming five (5) years. Many of the articulated issues also illuminated unmet service needs and critical gaps within the current system. • Changes continue to occur throughout healthcare regarding third party payors and proposed models of reimbursement. Whether this will increase the demand on the Department or possibly increase services by private sector is uncertain. • Population growth, especially along coast, is increasing demand for services in those areas. • Cost of housing and appropriate services affects the ability of people to remain in their home communities and will continue to bring challenges.
The Healthcare and Regulatory Subcommittee produced a study report in March 2020 with recommendations concerning SCDMH. The study report can be found at the following link: https://www.scstatehouse.gov/CommitteeInfo/HouseLegislativeOversightCommittee/AgencyWebpages/MentalHealt h/Full_Comm_Report_DMH_2020.pdf
The challenges and emerging issues cited above are still relevant.
FY2022 Budget Requests SCDMH’s FY2022 budget requests to the Governor of the State of South Carolina and the General Assembly of South Carolina, which were submitted in September 2020 and were requests for additional state appropriations, validate the strength of its performance measurement/system oversight capacity by consistently identifying and consequently formulating systemic needs into requests for appropriated funding. The budget requests reflect SCDMH’s acknowledgement of the unmet service needs and critical gaps in the current system and the possibility that other unmet service needs and gaps could develop. SCDMH’s FY2022 budget requests are listed below.
FY2022 Budget Requests The South Carolina Mental Health Commission and the leadership of the SCDMH are well aware of the adverse impacts which the current pandemic is having not only on SCDMH, but on the State of South Carolina’s current and projected revenues.
While the most recognizable mission of SCDMH is to support the recovery of persons with a mental illness, State law authorizes, but does not require, SCDMH to operate psychiatric hospitals and community mental health centers. In contrast, SCDMH has several other important missions which are not only authorized, but mandated:
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➢ Forensic Services: SCDMH is required to provide Court-ordered evaluations and psychiatric hospitalization to the increasing number of defendants referred by the State’s criminal justice system; ➢ Sexually Violent Predator Treatment Program: SCDMH is required to operate the State’s Sexually Violent Predator Treatment Program; and ➢ State Veterans Nursing Homes: SCDMH is the State agency designated by law in South Carolina to operate State Veterans Nursing Homes.
Each of SCDMH’s FY2022 budget requests relate to one of its 3 statutorily required missions. Given the adverse financial impact resulting from the pandemic, SCDMH limited its requests to those amounts needed to fully fund its mandatory services.
However, in furtherance of its responsibility to keep the State’s elected leadership informed of the agency’s financial situation, SCDMH additionally prepared a companion document addressing its projected financial needs to sustain, at current levels, its civil psychiatric hospital services and its community mental health services, and to meet the increasing anticipated demand for public mental health services due to both the emotional and economic impacts of the pandemic. Its contents are summarized below.
Sustainability of Services • SCDMH has become reliant on utilizing one-time funds to fund recurring operations in both its Inpatient and Administrative Divisions, as costs have escalated without corresponding increases in appropriations or revenue. • The needed funding would allow SCDMH to be on a sustainable footing by replacing the one-time funding that is projected to be utilized in its FY2021 budget to meet recurring operating needs. o Inpatient Services: Recurring funds are needed to support critical clinical positions across the inpatient services system. Positions include registered nurses, LPNs, behavioral health assistants, certified nursing assistants, social workers, therapeutic assistants, counselors, psychiatrists, food specialists and nutritionists. o Care Coordination: This program is valued by both SCDMH and SCDHHS, however the current rates of $15 and $20 are not adequate to sustain the program at existing expenditure levels. o Human Resources: The SCDMH Office of Human Resources developed a recruitment and retention program focusing efforts on recruiting hard-to-fill positions, which is called TARP (Talent Acquisition & Retention Program). This program uses both traditional and non-traditional recruitment strategies for some of our hard-to-fill positions such as nurses (RNs, NPs, LPNs) and CNAs; Licensed Mental Health Professionals; Social Workers and Public Safety Officers; Psychologists and Psychiatrists; and Trades Specialists. o Physical Plant Services: As SCDMH continues to address its deferred maintenance needs (many buildings are nearing the 20+ year age, thus requiring new HVAC systems and roofs), the need for skilled project managers is necessary. o Information Technology: Information technology costs are increasing as SCDMH continues to expand its Telepsychiatry capacity to provide services and deploy clinicians in schools and community settings. Included in these costs are Microsoft licenses, internet bandwidth, computers, and software to support virtual service delivery. o Public Safety: Funds requested are to support critical law enforcement positions as well as increased operating costs due to the South Carolina Criminal Justice Academy training requirements shifted to law enforcement agencies. o Central Office: Funds requested are to support the hiring of a Chief Diversity and Inclusion Officer. This senior leader working with the State Director and Senior Leadership Team will help define the SCDMH’s vision and strategies to promote a culture of inclusion across all clinical and administrative divisions and programs. • The requested amount was $12,580,003.
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Sustainability of Workforce • As a healthcare provider, SCDMH is unique among State agencies: SCDMH employees directly deliver medically necessary services to patients in hospitals and through community mental health centers, both in clinics and while out-stationed in schools and other community settings, and SCDMH employees deliver medical and nursing care to residents in its nursing care facilities. • The diversity of the needed workforce in terms of education, skills and qualifications, includes many licensed health care professionals – physicians (both psychiatrists and primary care physicians), mid-level licensed practitioners, such as Advanced Nurse Practitioners (APRNs) and Physician Assistants (PAs), Registered Nurses, and Licensed Practical Nurses, Licensed Social Workers, Licensed Professional Counselors, Licensed Marriage and Family Therapists, as well as Certified Nursing Assistants – all of which are in high demand in both the private and public sector. • The agency is consequently challenged to recruit and retain the staff it needs to continue to provide its existing services, and is hampered in increasing services because of workforce shortages, even when the South Carolina General Assembly increases funding for additional service delivery. • Average turnover rate across SCDMH Divisions for FY2020 was 24% for the Division of Inpatient Services, 16% for the Division of Community Mental Health Services, and 16% for the Division of Administrative Services. • The average age of SCDMH’s nursing staff is 52 years old. Nursing salaries now offered by community hospitals for beginning nurses are so much higher than those which SCDMH can offer for an RNI beginning nurse as to render SCDMH unable to compete, and force SCDMH to rely on temporary nurse staffing agencies and overtime in order to have adequate nurse coverage in its hospitals and nursing homes. Improving recruitment and retention of Registered Nurses, Licensed Practical Nurses and Advanced Practice Nurses is critical to service delivery in inpatient and outpatient settings. • SCDMH Public Safety employs certified Law Enforcement Officers as well as general Security Officers to provide support, security primarily for SCDMH hospitals and inpatient facilities, and transportation for those patients who must be in secure custody when traveling to outside medical appointments or to court. The turnover rate in FY2020 for SCDMH Public Safety was 20%. SCDMH competes with local, State, and federal law enforcement agencies throughout the State to recruit and retain officers. • SCDMH cannot adequately sustain its current workforce without increasing compensation and has developed a plan to gradually increase pay for various categories of employees. The requested funds would support Phase I of a multi-year approach to address recruitment and retention challenges with for many hard-to-fill positions. • The requested amount was $21,666,720.
Out-of-Home Placement • State recurring funds are needed to fund additional short-term therapeutic residential services for adolescents with a mental illness who are at high risk for institutionalization. Examples would be children and adolescents with a mental illness who have come into contact with the juvenile justice system and/or hospital emergency departments. • At one time, available service options under the State’s Medicaid Plan included Intensive Family Services, such as Multi-Systemic Therapy (MST), Therapeutic Foster Care (TFC), and Temporary De-escalation Care (TDC – Respite care), and prior to 2008, therapeutic group homes. • Changes in the Medicaid plan impacting these services were in most cases to “unbundle” the multiple clinical interventions which made up a particular intensive “wrap” service and require that each intervention be separately documented and billed. Such a change increased the amount of administrative time clinical staff had to spend documenting, and resulted in substantially lowering the overall level of reimbursement to private community providers, as well as SCDMH community mental health centers, of these intensive wrap services, often below the cost to provide the previous level of services to the adolescent patient and their family. Also, as a result of a ruling by the Centers for Medicare and Medicaid Services (CMS), since 2008 Medicaid no longer pays for care in therapeutic group homes. • With the changes, the availability of intensive wrap services and respite services to children and adolescents by quality private providers has largely disappeared. Even when intensive community “wrap” services are
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appropriate for a particular youth, institutional care, such as in a Psychiatric Residential Treatment Facility (PRTF) or hospital is now frequently the only available option for high risk juveniles. • Unfortunately, access to PRTFs for adolescents in State care or custody has become increasingly limited, especially for juvenile justice-involved youth. In August 2016, SC DHHS announced its intention to “carve- in” PRTF services to its contracts with the five (5) Medicaid Managed Care Organizations (MCOs). The carve-in was effective July 1, 2017. The inclusion of PRTF services in Medicaid managed care did not improve the availability of PRTF services for high risk juveniles in State care and custody, and in fact appears to have generally resulted in lowering the lengths of stay for those juveniles who were admitted to a PRTF. Without sufficient quality community “wrap” services providers available, juveniles discharged from a PRTF remain at significant risk for coming into contact with emergency services and/or law enforcement. • Therapeutic Group Homes are a type of residential placement periodically utilized for juveniles unable to receive their mental health treatment services while residing at home. They are a less intensive alternative to PRTF level of care or may serve as a “step-down” following a juvenile’s hospitalization or treatment within a PRTF. • As noted, Medicaid has not paid for therapeutic group home services since 2008. Consequently, SCDMH and SCDJJ have increasingly been using their limited funds to cost-share the full cost of therapeutic group home placements and PRTFs for DJJ-involved juveniles with a serious mental illness, even when such juveniles are Medicaid eligible. The two agencies expended approximately $900,000 in FY2019 on therapeutic group home placements for DJJ-involved juveniles with a serious mental illness. With the recent – July 1, 2019 – carve-in to Medicaid managed care of Under-21 psychiatric hospital services, SCDMH expects to see shorter hospital lengths of stay for high-risk juveniles, and a corresponding greater need to utilize therapeutic group home services in FY2020. • The funds identified as needed would enable the agency to serve an estimated 40 to 50 youth annually cost- sharing with DJJ for juveniles in a PRTF placement or in a therapeutic group home, based current average lengths of stay. • The requested amount was $750,000.
Suicide Prevention • With federal grant funding SCDMH received over 7 years ago, SCDMH has been able to bring increased focus on reducing suicide deaths in South Carolina. • Using a public health approach, SCDMH in partnership with the South Carolina chapter of the American Foundation for Suicide Prevention, the South Carolina Department of Education and other State agencies, members of the General Assembly, and many other public and private organizations, reactivated the State’s Suicide Prevention Coalition, which developed a State Suicide Prevention Plan. • SCDMH’s Office of Suicide Prevention (OSP) and its many partners now offer multiple free suicide prevention trainings appropriate to various community audiences – teachers, students, church groups, civic organizations – as well as raising public awareness through traditional media and social media about the importance of suicide prevention, and the role that every person can play in reducing suicide deaths. • Additional funding will ensure the sustainability of existing suicide prevention efforts for children and adults across the life span that are currently grant funded. • Additional funding would also support best-practices in community-based suicide prevention and evidence- based practices in the clinical setting. • The requested amount was $500,000.
Appointed Counsel in Civil Commitment Proceedings • By way of background, during the Recession of 2000 - 2001 State agencies were required to cut their budgets. The Judicial Department made the decision to discontinue paying appointed counsel and private physician Designated Examiners who provided representation/examinations in civil commitment proceedings. The Chief Justice notified all the Probate Judges by letter to stop sending the Judicial Department the invoices of appointed attorneys and private examiners. The Probate Judges were concerned and contacted SCDMH.
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• In 2001, SCDMH and the Judicial Department reached an agreement to preserve some payment for appointed counsel in civil commitment hearings. Under the terms of the agreement, the Judicial Department dropped the reimbursement rate for attorneys from $75 to $50 per hearing, and completely eliminated reimbursement for private Designated Examiners (DEs). In return, SCDMH agreed to fund the payment of the appointed counsel by the Judicial Department, essentially to preserve the working of the judicial commitment process, especially the hybrid process of Special Probate Judges holding commitment hearings in psychiatric hospitals. • The major reason SCDMH was willing to step in and replace a major part of the funding cut by the Judicial Department was the process created by SCDMH and Court Administration in the 1980s, based on a recommendation from the Legislative Audit Council, enabling the holding of civil commitment hearings in psychiatric hospitals. Without this measure, hospitals, including SCDMH hospitals, would have to transport patients and staff around the State to the various County Probate Courts for such hearings, which would both increase costs and create safety issues. • The amount of SCDMH funding annually sent to Court Administration for the payment of attorneys in civil commitment proceedings has been approximately $375,000. • The needed funds would enable the Department to not only continue paying appointed counsel at the rate which has been in effect since 2001, but increase the rate to $75 per hearing, which SCDMH and the Probate Judges Association believe is long overdue. • The requested amount was $400,000.
Emergency Department Telepsychiatry • In a collaboration of historic significance, SCDMH partnered with The Duke Endowment in December 2007 to create an innovative solution to the overcrowding of psychiatric patients in local hospital emergency departments. The SCDMH Emergency Department Telepsychiatry Program is a cutting-edge statewide delivery service model that provides remote access for emergency departments in South Carolina to psychiatrists whenever a psychiatric comprehensive evaluation is required. • Since 2012, longitudinal results demonstrate: o Higher follow-up and retention of patients seen with telepsychiatry o Shorter lengths of stay o Few inpatient admissions o Total charges in the emergency department that were significantly lower for patients seen with Telepsychiatry o The Program has experienced significant growth since FY2017, providing approximately 5,350 assessments in FY2017 to approximately 8,100 assessments in FY2020, a change of 51.40%. In FY2019, SCDMH experienced a record-breaking 8,916 assessments. • In order to meet increased demand for services and maintain reasonable wait times, SCDMH has successfully recruited additional physicians to the Program – the additional physicians have been funded with time-limited allocations from the South Carolina Telehealth Alliance (SCTA). Simultaneous with the increase in expenses associated with physician salaries, SCDMH has experienced a shortfall in revenue associated with a change in payer mix – an increased number of self-pay patients. The impact is a protracted collections cycle for the Program, resulting in reduced revenue in any single fiscal year. This identified needed funds would balance the shortfall created by the change in payer mix in order to sustain current and future levels of services. • The requested amount was $250,000.
Community Supportive Housing • SCDMH has a long history of making efforts to foster more supportive community housing for its patients, including permanent independent housing. Appropriate housing is often the single biggest factor in determining whether a patient with serious psychiatric impairments is able to remain successful in their recovery in the community. • The needed funds would be used for rental assistance, security and utility deposits, utilities, and furnishings to move 50 patients into community placements. Priority will be given to patients transitioning from
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inpatient settings and community residential care facilities into more independent living arrangements, such as apartments and single-family homes. Funds will be allocated to community mental health centers located in geographic areas with the highest client need and in locations with available housing stock. • The requested amount was $500,000.
School Mental Health • SCDMH school mental health services improve access to needed mental health services for children and their families. • The additional funding would enable SCDMH to increase by at least 20 the number of school mental health therapists based on the average State support needed to sustain a position being $30,000 per school-based therapist. • The requested amount was $600,000.
Young Adult Intervention Services • SCDMH understands that young adults with mental health concerns often go undiagnosed for years before an event triggers diagnosis and service delivery. Through the expansion of young adult initiatives across our state, SCDMH would like to increase outreach and improve access to treatment and support to the young adult population in South Carolina. These initiatives address a longstanding need across the country to ensure access and retention concerns among this population. • The global pandemic has increased stressors – isolation, fear, loss and death, economic uncertainty – that have the capacity to accelerate the diagnosis of serious mental illness in young adults and to increase the numbers of young adults experiencing such illnesses. • Additional funding would support two (2) programs for individuals who have experienced the early onset of a psychotic disorder, such as Schizophrenia. • The first symptoms of psychotic disorders typically manifest in individuals between the ages of 16 and 25. Young adults are a challenging population to engage and stay in treatment. Young adult intervention programs are aimed at guiding young adults experiencing psychosis (and their families) toward mental, physical, and functional health. • The programs improve treatment engagement and adherence and substantially reduce the likelihood that patients’ psychotic disorders will lead to long-term disability. • Despite the clear benefits of these program for patients and for reducing long-term care costs, neither public nor private insurance currently reimburse many of the services. • The requested amount was $600,000.
Clinicians in Law Enforcement • The identified additional funding would allow SCDMH to hire five (5) masters’ level clinicians that will be embedded in local law enforcement agencies. These clinicians will partner with law enforcement to respond to the needs of the community. • Predicated on the Child Development-Community Policing model, these clinicians will provide immediate prevention and early intervention supports to children and adults experiencing trauma. • This collaborative model provides enhanced supports for those in need and establishes opportunities to improve linkages to trauma-informed care and access to resources that support recovery and wellness. • The requested amount was $325,000.
SC Hopes Mental Health Support Line • The additional needed funds would allow SCDMH to sustain the SC Hopes statewide toll-free support line that was developed to respond to the mental health and behavioral health needs of SC citizens impacted by COVID19. • SCDMH staff trained in Crisis Counseling Programs provide coverage for the support line and link callers with the resources needed. Callers needing mental health services are transferred to Community Mental Health Centers while callers needing substance use services are transferred to DAODAS County Commissions.
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• Callers experiencing a mental health crisis are transferred to SCDMH Mobile Crisis. • A team of mental health professionals and substance use counselors has been created to specifically serve healthcare providers who have been impacted by COVID19. • The requested amount was $500,000.
Capital Requests • SCDMH’s Capital Requests totaled $95,118,997. • Certification of State Match (Additional VA Nursing Homes) • Coastal-Empire HVAC, Sprinkler System, Fire Alarm & Roof • Crafts-Farrow Campus Electrical Distribution System • Harris Hospital Renovations (Anti-ligature) • Gaffney Building Purchase & Renovations • Crafts-Farrow Grease Trap Interceptor • Campbell Nursing Home Refrigerator & Freezer Replacement • Waccamaw Center HVAC, Sprinkler System, Fire Alarm & Roof • Crafts-Farrow Fisher Auditorium & Library Demolition • Bryan Chilled Water Loop Branch Line Replacement • Crafts-Farrow Water Booster Pump Generator • Morris Village Sidewalks and Drainage • Bryan Energy Center Drainage • Roddey Phased Water Piping Replacement • Pee Dee MHC Boiler and Chiller Replacement • Aiken-Barnwell HVAC Replacement • Anderson-Oconee-Pickens MHC Construction • Catawba MHC Construction • Campbell Veterans Nursing Home Renovations • Roddey Nursing Home Floor Replacement • Morris Village Nursing Station Renovations • Morris Village Infirmary
Decision-Support through Data Management By means of consistent evaluation of data resources, and interpretation of the data related thereto, SCDMH is well- positioned to articulate its strengths, weaknesses, opportunities, and threats, and is well-positioned to measure its performance as it encounters and addresses unmet service needs and gaps. The key to SCDMH’s successful evaluation was its data systems (listed below).
CIS – The Client Information System (CIS) is SCDMH’s outpatient fee-for-service billing system. It is utilized in the community mental health centers, Care Coordination, and Telepsychiatry. EMR – The outpatient EMR is an internally developed electronic medical record used in conjunction with CIS. SCDMH is evaluating replacement of this EMR. AvatarPM – AvatarPM is a vendor supported inpatient billing system used in SCDMH inpatient facilities. EHR - The inpatient EHR is a vendor supported electronic health record used in conjunction with AvatarPM. SCEIS – South Carolina Enterprise Information System: The South Carolina Enterprise Information System consolidated more than 70 state agencies onto a single, statewide enterprise system, built on SAP software, for finance, materials management and human resources/payroll.
The specific attention that has been placed by SCDMH Senior Leadership on data and its meaning, and the importance of usefulness that has been emphasized for the underlying electronic databases, document management systems, business intelligence systems, and associated programs has provided SCDMH with a means to effectively navigate current and future situations.
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Tracking and Trending Identified Areas of Emphasis SCDMH Senior Leadership is developing a new dashboard of high-level performance indicators that it will review and refine on a periodic basis. The indicators will be quick reference global measures to evaluate actual performance against the strategic plan and to provide ready evaluation of the status of agency operations. While measurement of an activity does not indicate identification of an unmet service need, it could alert Senior Leadership to a potential or impending gap. The dashboard performance measures will include Inpatient Services Dashboard Indicators and Community Mental Health Services Dashboard Indicators.
Current Strategic Direction (The Impact of the COVID-19 Pandemic) By means of consistent evaluation of data resources, and interpretation of the data related thereto, SCDMH is well- positioned to articulate its strengths, weaknesses, opportunities, and threats, and is well-positioned to measure its performance as it encounters and addresses unmet service needs and gaps. The results of such emphasis have equipped SCDMH to measure the impact of COVID-19 on the provision of services.
Data updated on March 11, 2021 (see Table 1) for SCDMH Community Mental Health Services, and based on the calendar year, indicated that from 2019 to 2020, and 2020 to 2021, respectively: ➢ The number of patients seen increased by 7.72% and decreased by 7.46%. ➢ The number of services provided increased by 3.26% and decreased by 13.15%. ➢ The number of bill hours increased by 4.36% and decreased by 22.81%.
Table 1. Number of Patients Seen in Corresponding Weeks
Table 2. Percentage of Patients Not Seen During COVID-19
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Table 3. Number of Open Cases
As measured from May 4, 2020 to March 11, 2021, the percentage of patients not seen (see Table 2) by SCDMH’s Community Mental Health Centers has decreased significantly – from 14.08% to 0.03%.
As measured from May 4, 2020 to March 11, 2021, the number of open cases (see Table 3) in SCDMH’s Community Mental Health Centers has rebounded, but experienced a significant downturn until September 2020.
Similarly, the effects of mitigation on SCDMH Division of Inpatient Services resulted in a 25% decrease in census, which includes its long-term care services which alone experienced a 19% decrease.
Since March 2021, SCDMH Community Mental Health Center data indicates that the number of services has plateaued. The trend line for the 14-month period from March 2020 to May 2021 is flat.
Similarly, the SCDMH Division of Inpatient Services is experiencing a rebound in average daily census as measured from July 2020 to April 2021.
Given the significant impact of the COVID-19 pandemic on patients seen, services provided, bill hours, and average daily census, along with double-digit turnover rates, the number of staff vacancies, and the need to increase compensation to address recruitment and retention challenges, SCDMH has taken a conservative approach to evaluating the expected levels of service projected in this MHBG Uniform Application. Consequently, the FY2022- 2023 MHBG Uniform Application closely aligns with the FY2020-2021 MHBG Uniform Application including alignment with Performance Indicators. It is due to the circumstances listed in this paragraph that SCDMH has deliberately set many of the First-Year Target measurements equal to the Baseline measurements.
Conclusion A proactive healthcare continuum is constantly monitoring, controlling and reacting to the forces acting upon it. It creates key performance indicators and key results areas that measure activity and identify progress. It adjusts to unanticipated results and defines the measure of success in a changing environment. These are the fundamentals on which SCDMH has built its strategic direction. Its continuous systemic analysis provides a blueprint from which SCDMH can continue to positively impact the mental health service delivery system for the benefit of the citizens of the State of South Carolina, and especially to support the recovery of people with mental illnesses.
[End]
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Table 1 Priority Areas and Annual Performance Indicators
Priority #: 1
Priority Area: Accountability Report Baseline Performance Measures
Priority Type: MHS
Population(s): SMI, SED, Other
Goal of the priority area:
The goal of the priority area is to maximize the effective use of the resources of the Department in order to achieve the outcomes reflected in the Accountability Report Baseline Performance Measures (Measure) as each Measure represents a key area of focus for the Department and correlates closely with the Department’s Strategic Planning initiatives.
Strategies to attain the goal:
Given the comprehensiveness of the measurement tools, changes in results from one year to the next generally are a reasonable determinant of the effectiveness of the mental health continuum - understanding that South Carolina has an integrated system of care over which SCDMH has significant influence and control since it is the primary service provider for inpatient and community services.
Annual Performance Indicators to measure goal success
Indicator #: 1
Indicator: Percentage of under 18 year-old population in SC served by DMH will be within 0.1% of previous year's percentage.
Baseline Measurement: Percent of Under 18 Year Old Population Served - Baseline = 2.13%
First-year target/outcome measurement: 2.13%
Second-year target/outcome measurement: 2.13%
Data Source:
Calculated using current FY patient count and US Census estimate of previous year (most recent) - Central Office Internet Technology (IT)
Description of Data:
Value Type = Percent - equal to or greater than; Calculation Method = Under 18 population of SC served by DMH / total population of SC under 18
Data issues/caveats that affect outcome measures:
Strategy Description - Services will be available to people in need.; Notes - As population of SC increases, it is expected that more people will receive services but the percentage of population should be consistent.
Indicator #: 2
Indicator: Percentage of adult population in SC served by DMH will be within 0.1% of previous year's percentage.
Baseline Measurement: Percent of Adult Population Served - Baseline = 1.43%
First-year target/outcome measurement: 1.43%
Second-year target/outcome measurement: 1.43%
Data Source:
Calculated using current FY patient count and US Census estimate of previous year (most recent) - Central Office IT
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Data issues/caveats that affect outcome measures:
Strategy Description - Services will be available to people in need.; Notes - Serves as an indicator that people needing services can receive them.
Indicator #: 3
Indicator: Number of inpatient "bed days" used will be equal to or greater than running average of previous five fiscal years.
Baseline Measurement: Number of Inpatient Bed Days - Baseline = 540,805
First-year target/outcome measurement: 540,805
Second-year target/outcome measurement: 540,805
Data Source:
Calculated using reporting software - Central Office IT
Description of Data:
Value Type = Count - equal to or greater than; Calculation Method = Number of new patients admitted to inpatient forensic setting
Data issues/caveats that affect outcome measures:
Strategy Description - Services will be available to people in need.; Notes - Increase indicates SCDMH working to meet the need of local agencies.
Indicator #: 4
Indicator: Patients requiring CMHC appointments will be seen in a timely manner according to protocol (priority, urgent, or routine). Target is average of previous five years.
Baseline Measurement: Percent of Appointments Meeting Timeliness Expectations - Baseline = 95%
First-year target/outcome measurement: 95.0%
Second-year target/outcome measurement: 92.8%
Data Source:
Calculated using reporting software - Community Mental Health Services Reporting (CMHS)
Description of Data:
Value Type = Percent - equal to or greater than; Calculation Method = Percent of patients seen in a timely manner / total number of patients
Data issues/caveats that affect outcome measures:
Strategy Description - Appointments will be prioritized by need and with goal of reducing hospital admissions.; Notes - Failure to provide community services when needed may result in unnecessary hospitalizations.
Indicator #: 5
Indicator: Upon discharge from an inpatient psychiatric facility, patients will have scheduled appointments at CMHCs at a rate equal to or less than the previous five-year average. Data measured is the average number of days between discharge and scheduled appointment.
Baseline Measurement: Median Number of Days from Discharge to Appointment at Community Mental Health Center - Baseline = 4.6
First-year target/outcome measurement: 4.6
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Data Source:
Calculated using reporting software - Community Mental Health Services
Description of Data:
Value Type = Count (whole number) - equal to or less than; Calculation Method = Average number of days between inpatient discharge and first scheduled CMHC appointment for previous five years.
Data issues/caveats that affect outcome measures:
Strategy Description - Appointments will be prioritized by need and with goal of reducing hospital admissions.; Notes - Timely transition from hospital to community treatment is indicator of compliance with treatment and medication, decreasing readmissions.
Indicator #: 6
Indicator: Percentage of patients requiring readmission within thirty days of discharge will be equal to or less than previous five-year average.
Baseline Measurement: Percentage of Patients Requiring Readmission within 30 Days of Discharge - Baseline = 1.20%
First-year target/outcome measurement: 1.20%
Second-year target/outcome measurement: 2.29%
Data Source:
Calculated using reporting software - Central Office IT
Description of Data:
Value Type = Percent - equal to or less than; Calculation Method = Number of patients requiring readmission within thirty days of discharge / total number of patients discharged
Data issues/caveats that affect outcome measures:
Strategy Description - Reduce the number of patients requiring readmission following discharge from SCDMH hospitals.; Notes - Increase of rapid readmissions may indicate a break in the continuity of care between hospitals and CMHCs.
Indicator #: 7
Indicator: The number of hospitals utilizing SCDMH Telepsychiatry services will remain constant or increase.
Baseline Measurement: Number of Participating Hospitals - ED Telepsychiatry Consultation Program - Baseline = 23
First-year target/outcome measurement: 23
Second-year target/outcome measurement: 23
Data Source:
Internal Records - Telepsychiatry Department
Description of Data:
Value Type = Count - equal to or increase; Calculation Method = Total number of community mental health centers participating in Telepsychiatry services on June 30, 2021
Data issues/caveats that affect outcome measures:
Strategy Description - Hospital Emergency Departments and CMHCs in rural or otherwise underserved areas will have access to SCDMH physicians regardless of location.; Notes - Increased ability to provide services in emergency departments reduces hospitalizations and wait times in EDs and improves compliance with out-patient treatment.
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Indicator: The number of Community Mental Health Centers utilizing Telepsychiatry services will remain constant or increase.
Baseline Measurement: Number of CMHCs Providing Services via Telepsychiatry - Baseline = 16
First-year target/outcome measurement: 16
Second-year target/outcome measurement: 16
Data Source:
Internal Records - Telepsychiatry Department
Description of Data:
Value Type = Count - equal to or increase; Calculation Method = Total number of hospitals participating with Telepsychiatry Program on June 30, 2021.
Data issues/caveats that affect outcome measures:
Strategy Description - Hospital Emergency Departments and CMHCs in rural or otherwise underserved areas will have access to SCDMH physicians regardless of location.; Notes - On July 1, 2019, Greenville and Piedmont CMHCs combined to form the Greater Greenville CMHC. Purpose of measure is to demonstrate efficient use of physician time in serving rural communities.
Indicator #: 9
Indicator: Percentage of SCDMH patients having competitive employment will be equal to or greater than average of previous five years.
Baseline Measurement: Percent of SCDMH Patients having Competitive Employment - Baseline = 14.00%
First-year target/outcome measurement: 14.00%
Second-year target/outcome measurement: 13.60%
Data Source:
Calculated using reporting software. - Community Mental Health Services
Description of Data:
Value Type = Percent - equal to or greater than; Calculation Method = Number participating in SCDMH employment programs, gaining meaningful employment/ Total Number of SCDMH patients
Data issues/caveats that affect outcome measures:
Strategy Description - Patients will be able to achieve and maintain productive, meaningful employment.; Notes - People competitively employed generally have better self-esteem and have more social activity.
Indicator #: 10
Indicator: Percentage of patients participating in SCDMH employment programs, gaining meaningful employment, will meet or exceed average of previous five years. (National benchmark = 40%).
Baseline Measurement: Percent of Patients Gaining Meaningful Employment - Baseline = 52.00%
First-year target/outcome measurement: 52.00%
Second-year target/outcome measurement: 57.60%
Data Source:
Calculated using reporting software - Community Mental Health Services
Description of Data:
Value Type = Percent - equal to or greater than; Calculation Method = Number of SCDMH patients having competitive employment / Total Number of SCDMH patients Printed: 7/19/20217/21/2021 2:103:2812:38 PM PM - -South South Carolina Carolina - OMB No. 0930-0168 Approved: 04/19/2019 Expires: 04/30/2022 PagePage 54 4 of of 222 11 Data issues/caveats that affect outcome measures:
Strategy Description - Patients will be able to achieve and maintain productive, meaningful employment.; Notes - Represents benefit of SCDMH vocational training and placement as compared to general population of SCDMH patients.
Indicator #: 11
Indicator: Life expectancy at Roddy Pavilion (skilled nursing facility) will be equal to or greater than average of previous five years. (National average = 1.2 years.)
Baseline Measurement: Life Expectancy as Compared Internally and to National Average - Baseline = 6.6
First-year target/outcome measurement: 6.6
Second-year target/outcome measurement: 6.9
Data Source:
Calculated using reporting software (actual calculation is length of stay) - Central Office IT
Description of Data:
Value Type = Ratio - equal to or greater than; Calculation Method = Average lifespan per patient in years
Data issues/caveats that affect outcome measures:
Strategy Description - Residents of SCDMH nursing facilities will enjoy high standards of medical care.; Notes - A determination of whether expected standards of care are achieved.
Indicator #: 12
Indicator: Life expectancy at Stone Pavilion (skilled nursing facility for veterans) will be equal to or greater than average of previous five years. (National average = 1.2 years.)
Baseline Measurement: Life Expectancy as Compared Internally and to National Average - Baseline = 2.3
First-year target/outcome measurement: 2.3
Second-year target/outcome measurement: 2.4
Data Source:
Calculated using reporting software (actual calculation is length of stay) - Central Office IT
Description of Data:
Value Type = Ratio - equal to or greater than; Calculation Method = Average lifespan per patient in years
Data issues/caveats that affect outcome measures:
Strategy Description - Residents of SCDMH nursing facilities will enjoy high standards of medical care.; Notes - A determination of whether expected standards of care are achieved.
Indicator #: 13
Indicator: Use of restraints in SCDMH Bryan Hospital Civil inpatient facility will be equal to or below the average of the previous five years' data. National average = 0.46 hours per 1,000 hours of inpatient service (CY2018).
Baseline Measurement: Inpatient Restraint Rate as Compared Internally and to National Average - Baseline = 0.06
First-year target/outcome measurement: 0.06
Second-year target/outcome measurement: 0.146
Data Source:
Calculated using reporting software - Department of Inpatient Services, Quality Management
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Value Type = Ratio - equal to or less than; Calculation Method = Average number of hours in restraints per patient per 1000 hours.
Data issues/caveats that affect outcome measures:
Strategy Description - Standard of care in inpatient facilities will result in reduced need for patient restraint. ; Notes - Low incidence of seclusion or restraint indicates less intrusive treatments are employed effectively.
Indicator #: 14
Indicator: Use of restraints in Patrick Harris Hospital inpatient facility will be equal to or below the average of the previous five years' data. National average = 0.46 hours per 1,000 hours of inpatient service (CY2018).
Baseline Measurement: Inpatient Restraint Rate as Compared Internally and to National Average - Baseline = 0.01
First-year target/outcome measurement: 0.01
Second-year target/outcome measurement: 0.46
Data Source:
Calculated using reporting software - Department of Inpatient Services, Quality Management
Description of Data:
Value Type = Ratio - equal to or less than; Calculation Method = Average number of hours in seclusion rooms per patient per 1000 hours.
Data issues/caveats that affect outcome measures:
Strategy Description - Standard of care in inpatient facilities will result in reduced need for patient restraint. ; Notes - Not applicable.
Indicator #: 15
Indicator: Use of seclusion rooms in SCDMH Bryan Hospital Civil inpatient facility will be equal to or below the average of the previous five years' data. National average = 0.36 hours per 1,000 hours of inpatient service (CY2018).
Baseline Measurement: Inpatient Seclusion Rate as Compared Internally and to National Average - Baseline = 0.28
First-year target/outcome measurement: 0.28
Second-year target/outcome measurement: 0.214
Data Source:
Calculated using reporting software - Department of Inpatient Services, Quality Management
Description of Data:
Value Type = Ratio - equal to or less than; Calculation Method = Average number of hours in restraints per patient per 1000 hours.
Data issues/caveats that affect outcome measures:
Strategy Description - Standard of care in inpatient facilities will result in reduced need for patient restraint. ; Notes - Low incidence of seclusion or restraint indicates less intrusive treatments are employed effectively.
Indicator #: 16
Indicator: Use of seclusion rooms in Patrick Harris Hospital inpatient facility will be equal to or below the average of the previous five years' data. National average = 0.36 hours per 1,000 hours of inpatient service (CY2018).
Baseline Measurement: Inpatient Seclusion Rate as Compared Internally and to National Average - Baseline = 0.01
First-year target/outcome measurement: 0.01
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Data Source:
Calculated using reporting software - Department of Inpatient Services, Quality Management
Description of Data:
Value Type = Ratio - equal to or less than; Calculation Method = Average number of hours in restraints per patient per 1000 hours.
Data issues/caveats that affect outcome measures:
Strategy Description - Standard of care in inpatient facilities will result in reduced need for patient restraint. ; Notes - Not applicable.
Indicator #: 17
Indicator: Percentage of adults expressing satisfaction with SCDMH services will meet or exceed national averages (US average 88%).
Baseline Measurement: Percent of Adults Expressing Satisfaction with SCDMH Services - Baseline = 97%
First-year target/outcome measurement: 97%
Second-year target/outcome measurement: 95%
Data Source:
Calculated using reporting software - Central Office IT
Description of Data:
Value Type = Percent - equal to or greater than; Calculation Method = number of adults expressing satisfaction with SCDMH services / total number surveyed
Data issues/caveats that affect outcome measures:
Strategy Description - SCDMH staff throughout all settings will be highly trained and able to provide highest standards of care.; Notes - Indicates SCDMH is providing services which improve patients' lives.
Indicator #: 18
Indicator: Percentage of youths in School Mental Health Services receiving SCDMH services will remain consistently high (no national average available for youth satisfaction rates).
Baseline Measurement: Percent of Youth in School Mental Health Services Receiving SCDMH Services - Baseline = 97%
First-year target/outcome measurement: 97%
Second-year target/outcome measurement: 95%
Data Source:
Calculated using reporting software - Central Office IT
Description of Data:
Value Type = Percent - equal to or greater than; Calculation Method = number of youths in School Mental Health Services receiving SCDMH services / number of youths in School Mental Health Services
Data issues/caveats that affect outcome measures:
Strategy Description - SCDMH staff throughout all settings will be highly trained and able to provide highest standards of care.; Notes - Indicates SCDMH is providing services which improve patients' lives.
Indicator #: 19
Indicator: All Community Mental Health Centers will meet Centers for Medicare and Medicaid Studies' rules for emergency preparedness when surveyed for compliance (at least once every three Printed: 7/19/20217/21/2021 2:103:2812:38 PM PM - -South South Carolina Carolina - OMB No. 0930-0168 Approved: 04/19/2019 Expires: 04/30/2022 PagePage 57 7 of of 222 11 years).
Baseline Measurement: CMHCs will Meet the New Regulatory Requirements for Emergency Preparedness as Per 42- CFR-485.920 - Baseline = 100%
First-year target/outcome measurement: 100%
Second-year target/outcome measurement: 100%
Data Source:
Internal Records - Community Mental Health Services
Description of Data:
Value Type = Percent - Maintain; Calculation Method = number of community mental health center meeting compliance / number of community mental health centers surveyed
Data issues/caveats that affect outcome measures:
Strategy Description - SCDMH will trained and prepared for emergencies affecting itself and surrounding communities.; Notes - Any deficiency could potentially result in loss of Medicaid reimbursement for that CMHC.
Indicator #: 20
Indicator: SCDMH will have trained personnel prepared to staff the State Emergency Operation's Center (SEOC) throughout all drills and "real world" emergency situations. (Minimum = 4 staff).
Baseline Measurement: SCDMH will have Staff Available to Assist State and County Emergency Operations Centers - Baseline = 75%
First-year target/outcome measurement: 75%
Second-year target/outcome measurement: 100%
Data Source:
County Records - Administration
Description of Data:
Value Type = Percent - equal to or greater than; Calculation Method = Each staff member represents 25%
Data issues/caveats that affect outcome measures:
Strategy Description - SCDMH will trained and prepared for emergencies affecting itself and surrounding communities.; Notes - Indicates compliance with responsibilities outlined in SC Emergency Operations Plan.
Indicator #: 21
Indicator: Number of people awaiting beds will be equal to or less than average of previous five years' data.
Baseline Measurement: Number of Individuals Waiting in ER - Baseline = 1,993
First-year target/outcome measurement: 1,993
Second-year target/outcome measurement: 2,126
Data Source:
Calculated using reporting software - Central Office IT
Description of Data:
Value Type = Count - equal to or less than; Calculation Method = Total count of people awaiting beds. Data is based upon a "Monday morning snapshot" of hospital emergency departments.
Data issues/caveats that affect outcome measures:
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Indicator #: 22
Indicator: The number of patients awaiting beds, at time of Monday snapshot (8:30AM), not discharged by 5:00PM, will be equal to or less than average of previous five years' data.
Baseline Measurement: Number of Individuals Still in ED at 5:00PM - Baseline = 1,442
First-year target/outcome measurement: 1,442
Second-year target/outcome measurement: 1,623
Data Source:
Calculated using reporting software - Central Office IT
Description of Data:
Value Type = Count - equal to or less than; Calculation Method = Number indicates patients in ED at 8:30 AM still in ED at 5:00PM.
Data issues/caveats that affect outcome measures:
Strategy Description - Reduce number of patients in hospital emergency rooms needing inpatient beds for mental health or substance abuse treatment.; Notes - Lower numbers indicate intervention efforts by Department are effective.
Indicator #: 23
Indicator: The percentage of schools in South Carolina with Mental Health Services will increase.
Baseline Measurement: Percent of South Carolina Schools with Access to a School Mental Health Program Counselor - Baseline = 64%
First-year target/outcome measurement: 64.0%
Second-year target/outcome measurement: 66.9%
Data Source:
Internal Records - Community Mental Health Services
Description of Data:
Value Type = Percent - equal to or greater than; Calculation Method = schools in South Carolina with Mental Health Services / 1292 schools
Data issues/caveats that affect outcome measures:
Strategy Description - School Mental Health Clinicians will be embedded throughout South Carolina schools to manage compliance with appointments and better serve partnering schools.; Notes - Higher number indicates more school-aged children have easier access to mental health services.
Indicator #: 24
Indicator: SCYSPI will partner with an increasing number of schools in SC.
Baseline Measurement: Number of Schools Partnered with SCYSPI - Baseline = 45
First-year target/outcome measurement: 45
Second-year target/outcome measurement: 50
Data Source:
Internal Records - South Carolina Youth Suicide Prevention Initiative
Description of Data:
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Data issues/caveats that affect outcome measures:
Strategy Description - The South Carolina Youth Suicide Prevention Initiative (SCYSPI) will collaborate with a variety of healthcare providers and support agencies to reduce the risk of suicide in teens and young adults.; Notes - Higher number indicates increased opportunity to engage school administration and students.
Indicator #: 25
Indicator: SCYSPI will be in partnerships with a CMHC, Federally Qualified Health Center, a hospital ED, and an inpatient hospital.
Baseline Measurement: Partnerships as a Percent of the Total By Organizational Type - Baseline = 75%
First-year target/outcome measurement: 75%
Second-year target/outcome measurement: 100%
Data Source:
Internal Records - South Carolina Youth Suicide Prevention Initiative
Description of Data:
Value Type = Percent Complete - Complete; Calculation Method = Each partnership will be 25% of achieving goal.
Data issues/caveats that affect outcome measures:
Strategy Description - The South Carolina Youth Suicide Prevention Initiative (SCYSPI) will collaborate with a variety of healthcare providers and support agencies to reduce the risk of suicide in teens and young adults.; Notes - Indicates progress toward goal of reducing youth suicides in SC.
Priority #: 2
Priority Area: First Episode Psychosis Program
Priority Type: MHS
Population(s): ESMI
Goal of the priority area:
The goal of the priority area is to maximize the effective use of the resources of the Department in order to achieve the outcomes reflected below as these First Episode Psychosis Program(s) are a key area of focus for the Department and correlate closely with the Department’s Strategic Planning initiatives.
Strategies to attain the goal:
The Department has specifically cited Motivational Interviewing (MI) and Cognitive Behavioral Therapy (CBT) as the treatment modalities it will deploy utilizing a portion of the Ten Percent Set Aside. These treatment modalities have been identified as appropriate and effective for persons experiencing First Episode Psychosis (FEP). It has also been found that maximum effectiveness is attainable when the two modalities are deployed together. MI serves as the engagement modality and CBT serves as the therapy modality.
SCDMH will also deploy NAVIGATE as its CSC (Coordinated Specialty Care) program utilizing a portion of the Ten Percent Set Aside.
Annual Performance Indicators to measure goal success
Indicator #: 1
Indicator: First Episode Psychosis Program(s)
Baseline Measurement: Total Number of Patients Served - Baseline = 288
First-year target/outcome measurement: 288
Second-year target/outcome measurement: 323
Data Source: Printed: 7/19/20217/21/2021 2:103:2812:38 PM PM - -South South Carolina Carolina - OMB No. 0930-0168 Approved: 04/19/2019 Expires: 04/30/2022 PagePage 60 10 of of 222 11 Calculated using reporting software. - Community Mental Health Services
Description of Data:
Value Type = Count - Total; Calculation Method = Total number of patients served.
Data issues/caveats that affect outcome measures:
Strategy Description - FEP Program(s) will receive referrals as appropriate and maintain program requirements for CSC programs.; Notes - Not applicable
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Footnotes:
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Table 2 State Agency Planned Expenditures States must project how the SMHA will use available funds to provide authorized services for the planning period for state fiscal years 2022/2023. Include public mental health services provided by mental health providers or funded by the state mental health agency by source of funding.
Planning Period Start Date: 7/1/2021 Planning Period End Date: 6/30/2023
Activity Source of Funds (See instructions for using Row 1.)
A. Substance B. Mental C. Medicaid D. Other E. State Funds F. Local G. Other H. COVID-19 I. COVID-19 J. ARP Funds Abuse Block Health Block (Federal, Federal Funds Funds Relief Funds Relief Funds (MHBG)b Grant Grant State, and (e.g., ACF (excluding (MHBG)a (SABG)a Local) (TANF), CDC, local CMS Medicaid) (Medicare) SAMHSA, etc.)
1. Substance Abuse Prevention and Treatment
a. Pregnant Women and Women with Dependent Children
b. All Other
2. Primary Prevention
a. Substance Abuse Primary Prevention
b. Mental Health Primary Preventionc $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00
3. Evidence-Based Practices for Early Serious Mental Illness including First Episode Psychosis (10 percent $2,164,250.00 $0.00 $0.00 $0.00 $0.00 $0.00 $1,243,624.00 $1,074,040.00 of total award MHBG)d
4. Tuberculosis Services
5. Early Intervention Services for HIV
6. State Hospital $0.00 $0.00
7. Other 24-Hour Care $0.00 $0.00 $0.00
8. Ambulatory/Community Non-24 Hour Care $1,150,000.00 $9,039,330.00
9. Administration (excluding program/provider level)e $122,000.00 $9,420,804.00 $90,000.00 MHBG and SABG must be reported separately
10. Crisis Services (5 percent set-aside)f $1,082,126.00 $0.00 $0.00 $0.00 $0.00 $0.00 $621,812.00 $537,020.00
11. Total $0.00 $3,368,376.00 $0.00 $0.00 $0.00 $0.00 $0.00 $12,436,240.00 $0.00 $10,740,390.00
a The 24-month expenditure period for the COVID-19 Relief supplemental funding is March 15, 2021 - March 14, 2023, which is different from the expenditure period for the "standard" SABG and MHBG. Per the instructions, the standard SABG expenditures are for the state planned expenditure period of July 1, 2021 – June 30, 2023, for most states.
b The expenditure period for The American Rescue Plan Act of 2021 (ARP) supplemental funding is September 1, 2021 - September 30, 2025, which is different from expenditure period for the "standard" MHBG. Per the instructions, the standard MHBG expenditures captured in Columns A-G are for the state planned expenditure period of July 1, 2021 - June 30, 2022, for most states
c While a state may use state or other funding for these services, the MHBG funds must be directed toward adults with SMI or children with SED.
d Column 3B should include Early Serious Mental Illness programs funded through MHBG set aside.
e Per statute, administrative expenditures cannot exceed 5% of the fiscal year award.
f Row 10 should include Crisis Services programs funded through different funding sources, including the MHBG set aside. States may expend more than 5 percent of their MHBG allocation.
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Footnotes: 1 – ESTIMATES ONLY: The information presented above represents a 24-month period (July 1, 2021 – June 30, 2023). Note that SCDMH only budgets for a 12-month period based on the prevailing Appropriations Act for the applicable fiscal year.
2 – Note that as in previous Uniform Applications, estimates are based on Allocations and Revenues from SCDMH’s Financial Reports. Allocations and Revenues approximate Total Expenditures and are more easily cross-referenced with SCDMH’s program areas in its Financial Reports. This table includes any consideration for Supplemental Funding.
3 – Note that Allocations, Revenues, Expenditures, and Supplemental Funding – as represented in SCDMH’s Financial Reports – are based on forecasts for the applicable fiscal year with the expectation that as changes occur to the operations of SCDMH said changes may be reflected in changes to forecasts; therefore, amounts provided at the beginning of a fiscal year may not be the actual result presented at the end of the fiscal year. Consequently, this 24-month budget is subject to variations, especially based on the date of reporting.
4 – Related to the total amount reported for the Mental Health Block Grant (MHBG), due to having three (3) MHBGs active during any given state fiscal year for SCDMH - July 1 through June 30 - it is possible that the amount associated with MHBG expenditures may vary from the actual amount of a single year award.
5 – As per SAMHSA’s instruction, SCDMH used the “FY2021 Mental Health Block Grant Final Allotments” file for purposes of completing the FY2022-2023 MHBG planned expenditures (Table 2) and related planned expenditures.
6 – Please note that "Activity" by “Source of Funds” is not a classification structure in the SCDMH accounting system. Consequently, the assignment of expenditures to any particular "Activity" by “Source of Funds” may be subject to interpretation, which could result in the Printed: 7/21/2021 12:38 PM - South Carolina - OMB No. 0930-0168 Approved: 04/19/2019 Expires: 04/30/2022 PagePage 62 of1 of222 2 inadvertent misclassification of one or more expenditure amounts.
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Table 6 Non-Direct Services/System Development
MHBG Planning Period Start Date: 07/01/2021 MHBG Planning Period End Date: 06/30/2023
Activity FFY 2022 FFY 20221 FFY 20222 FFY 2023 FFY 20231 FFY 20232 Block Grant COVID Funds ARP Funds Block Grant COVID Funds ARP Funds
1. Information Systems $0.00 $9,120,804.00 $0.00 $0.00 $0.00 $0.00
2. Infrastructure Support $60,000.00 $0.00 $45,000.00 $60,000.00 $0.00 $45,000.00
3. Partnerships, community outreach, and $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 needs assessment
4. Planning Council Activities (MHBG required, $1,000.00 $0.00 $0.00 $1,000.00 $0.00 $0.00 SABG optional)
5. Quality Assurance and Improvement $0.00 $0.00 $0.00 $0.00 $0.00 $0.00
6. Research and Evaluation $0.00 $0.00 $0.00 $0.00 $0.00 $0.00
7. Training and Education $0.00 $300,000.00 $0.00 $0.00 $0.00 $0.00
8. Total $61,000.00 $9,420,804.00 $45,000.00 $61,000.00 $0.00 $45,000.00
1 The 24-month expenditure period for the COVID-19 Relief supplemental funding is March 15,2021 - March 14, 2023, which is different from the expenditure period for the "standard" SABG and MHBG. Per the instructions, the standard MHBG expenditures are for the state planned expenditure period of July 1, 2021 - June 30, 2023, for most states. 2 The expenditure period for The American Rescue Plan Act of 2021 (ARP) supplemental funding is September 1, 2021 - September 30, 2025, which is different from the expenditure period for the "standard" MHBG. Per the instructions, the standard MHBG expenditures are for the state planned expenditure period of July 1, 2021 - June 30, 2023, for most states.
OMB No. 0930-0168 Approved: 04/19/2019 Expires: 04/30/2022
Footnotes: ESTIMATES ONLY: The information presented above represents a 24-month period (July 1, 2021 – June 30, 2023). Note that SCDMH only budgets for a 12-month period based on the prevailing Appropriations Act for the applicable fiscal year.
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1. The Health Care System, Parity and Integration - Question 1 and 2 are Required
Narrative Question Persons with mental illness and persons with substance use disorders are likely to die earlier than those who do not have these conditions.22 Early mortality is associated with broader health disparities and health equity issues such as socioeconomic status but "[h]ealth system factors" such as access to care also play an important role in morbidity and mortality among these populations. Persons with mental illness and substance use disorders may benefit from strategies to control weight, encourage exercise, and properly treat such chronic health conditions as diabetes and cardiovascular disease.23 It has been acknowledged that there is a high rate of co-occurring M/SUD, with appropriate treatment required for both conditions.24
Currently, 50 states have organizationally consolidated their mental and substance use disorder authorities in one fashion or another with additional organizational changes under consideration. More broadly, SAMHSA and its federal partners understand that such factors as education, housing, and nutrition strongly affect the overall health and well-being of persons with mental illness and substance use disorders.25 SMHAs and SSAs may wish to develop and support partnerships and programs to help address social determinants of health and advance overall health equity.26 For instance, some organizations have established medical-legal partnerships to assist persons with mental and substance use disorders in meeting their housing, employment, and education needs.27 Health care professionals and persons who access M/SUD treatment services recognize the need for improved coordination of care and integration of physical and M/SUD with other health care in primary, specialty, emergency and rehabilitative care settings in the community. For instance, the National Alliance for Mental Illness has published materials for members to assist them in coordinating pediatric mental health and primary care.28
SAMHSA and its partners support integrated care for persons with mental illness and substance use disorders.29 The state should illustrate movement towards integrated systems of care for individuals and families with co-occurring mental and substance use disorders. The plan should describe attention to management, funding, payment strategies that foster co-occurring capability for services to individuals and families with co-occurring mental and substance use disorders. Strategies supported by SAMHSA to foster integration of physical and M/SUD include: developing models for inclusion of M/SUD treatment in primary care; supporting innovative payment and financing strategies and delivery system reforms such as ACOs, health homes, pay for performance, etc.; promoting workforce recruitment, retention and training efforts; improving understanding of financial sustainability and billing requirements; encouraging collaboration between M/SUD providers, prevention of teen pregnancy, youth violence, Medicaid programs, and primary care providers such as Federally Qualified Health Centers; and sharing with consumers information about the full range of health and wellness programs. Health information technology, including EHRs and telehealth are examples of important strategies to promote integrated care.30 Use of EHRs - in full compliance with applicable legal requirements - may allow providers to share information, coordinate care, and improve billing practices. Telehealth is another important tool that may allow M/SUD prevention, treatment, and recovery to be conveniently provided in a variety of settings, helping to expand access, improve efficiency, save time, and reduce costs. Development and use of models for coordinated, integrated care such as those found in health homes31 and ACOs32 may be important strategies used by SMHAs and SSAs to foster integrated care. Training and assisting M/SUD providers to redesign or implement new provider billing practices, build capacity for third-party contract negotiations, collaborate with health clinics and other organizations and provider networks, and coordinate benefits among multiple funding sources may be important ways to foster integrated care. SAMHSA encourages SMHAs and SSAs to communicate frequently with stakeholders, including policymakers at the state/jurisdictional and local levels, and State Mental Health Planning Council members and consumers, about efforts to foster health care coverage, access and integrate care to ensure beneficial outcomes. SMHAs and SSAs also may work with state Medicaid agencies, state insurance commissioners, and professional organizations to encourage development of innovative demonstration projects, alternative payment methodologies, and waivers/state plan amendments that test approaches to providing integrated care for persons with M/SUD and other vulnerable populations.33 Ensuring both Medicaid and private insurers provide required preventive benefits also may be an area for collaboration.34 One key population of concern is persons who are dually eligible for Medicare and Medicaid.35 Roughly, 30 percent of persons who are dually eligible have been diagnosed with a mental illness, more than three times the rate among those who are not dually eligible.36 SMHAs and SSAs also should collaborate with state Medicaid agencies and state insurance commissioners to develop policies to assist those individuals who experience health insurance coverage eligibility changes due to shifts in income and employment.37 Moreover, even with expanded health coverage available through the Marketplace and Medicaid and efforts to ensure parity in health care coverage, persons with M/SUD conditions still may experience challenges in some areas in obtaining care for a particular condition or in finding a provider.38 SMHAs and SSAs should remain cognizant that health disparities may affect access, health care coverage and integrated care of M/SUD conditions and work with Printed: 7/19/20217/21/2021 2:093:2812:38 PM PM - -South South Carolina Carolina - OMB No. 0930-0168 Approved: 04/19/2019 Expires: 04/30/2022 PagePage 65 of1 of222 5 partners to mitigate regional and local variations in services that detrimentally affect access to care and integration. SMHAs and SSAs should work with partners to ensure recruitment of diverse, well-trained staff and promote workforce development and ability to function in an integrated care environment.39 Psychiatrists, psychologists, social workers, addiction counselors, preventionists, therapists, technicians, peer support specialists, and others will need to understand integrated care models, concepts, and practices.
Parity is vital to ensuring persons with mental health conditions and substance use disorders receive continuous, coordinated, care. Increasing public awareness about MHPAEA could increase access to M/SUD services, provide financial benefits to individuals and families, and lead to reduced confusion and discrimination associated with mental illness and substance use disorders. Block grant recipients should continue to monitor federal parity regulations and guidance and collaborate with state Medicaid authorities, insurance regulators, insurers, employers, providers, consumers and policymakers to ensure effective parity implementation and comprehensive, consistent communication with stakeholders. The SSAs, SMHAs and their partners may wish to pursue strategies to provide information, education, and technical assistance on parity-related issues. Medicaid programs will be a key partner for recipients of MHBG and SABG funds and providers supported by these funds. The SSAs and SMHAs should collaborate with their states' Medicaid authority in ensuring parity within Medicaid programs. SAMHSA encourages states to take proactive steps to improve consumer knowledge about parity. As one plan of action, states can develop communication plans to provide and address key issues. Another key part of integration will be defining performance and outcome measures. The Department of Health and Human Services (HHS) and partners have developed the National Quality Strategy, which includes information and resources to help promote health, good outcomes, and patient engagement. SAMHSA's National Behavioral Health Quality Framework includes core measures that may be used by providers and payers.40 SAMHSA recognizes that certain jurisdictions receiving block grant funds - including U.S. Territories, tribal entities and those jurisdictions that have signed a Compact of Free Association with the United States and are uniquely impacted by certain Medicaid provisions or are ineligible to participate in certain programs.41 However, these jurisdictions should collaborate with federal agencies and their governmental and non- governmental partners to expand access and coverage. Furthermore, the jurisdiction should ensure integration of prevention, treatment, and recovery support for persons with, or at risk of, mental and substance use disorders.
22 BG Druss et al. Understanding excess mortality in persons with mental illness: 17-year follow up of a nationally representative US survey. Med Care. 2011 Jun; 49(6):599- 604; Bradley Mathers, Mortality among people who inject drugs: a systematic review and meta-analysis, Bulletin of the World Health Organization, 2013; 91:102-123 http://www.who.int/bulletin/volumes/91/2/12-108282.pdf; MD Hert et al., Physical illness in patients with severe mental disorders. I. Prevalence, impact of medications and disparities in health care, World Psychiatry. Feb 2011; 10(1): 52-77
23 Research Review of Health Promotion Programs for People with SMI, 2012, http://www.integration.samhsa.gov/health-wellness/wellnesswhitepaper; About SAMHSA's Wellness Efforts, https://www.samhsa.gov/wellness-initiative; JW Newcomer and CH Hennekens, Severe Mental Illness and Risk of Cardiovascular Disease, JAMA; 2007; 298: 1794-1796; Million Hearts, https://www.samhsa.gov/million-hearts-initiative; Schizophrenia as a health disparity, http://www.nimh.nih.gov/about/director/2013/schizophrenia-as-a-health-disparity.shtml
24 Comorbidity: Addiction and other mental illnesses, http://www.drugabuse.gov/publications/comorbidity-addiction-other-mental-illnesses/why-do-drug-use- disorders-often-co-occur-other-mental-illnesses Hartz et al., Comorbidity of Severe Psychotic Disorders With Measures of Substance Use, JAMA Psychiatry. 2014; 71 (3):248-254. doi:10.1001/jamapsychiatry.2013.3726; https://www.samhsa.gov/find-help/disorders
25 Social Determinants of Health, Healthy People 2020, http://www.healthypeople.gov/2020/topicsobjectives2020/overview.aspx?topicid=39; https://www.cdc.gov/nchhstp/socialdeterminants/index.html
26 https://www.samhsa.gov/behavioral-health-equity/quality-practice-workforce-development
27 http://medical-legalpartnership.org/mlp-response/how-civil-legal-aid-helps-health-care-address-sdoh/
28 Integrating Mental Health and Pediatric Primary Care, A Family Guide, 2011. https://www.integration.samhsa.gov/integrated-care-models/FG- Integrating,_12.22.pdf; Integration of Mental Health, Addictions and Primary Care, Policy Brief, 2011, https://www.ahrq.gov/downloads/pub/evidence/pdf/mhsapc/mhsapc.pdf; Abrams, Michael T. (2012, August 30). Coordination of care for persons with substance use disorders under the Affordable Care Act: Opportunities and Challenges. Baltimore, MD: The Hilltop Institute, UMBC. http://www.hilltopinstitute.org/publications/CoordinationOfCareForPersonsWithSUDSUnderTheACA-August2012.pdf; Bringing Behavioral Health into the Care Continuum: Opportunities to Improve Quality, Costs and Outcomes, American Hospital Association, Jan. 2012, http://www.aha.org/research/reports/tw/12jan-tw- behavhealth.pdf; American Psychiatric Association, http://www.psych.org/practice/professional-interests/integrated-care; Improving the Quality of Health Care for Mental and Substance-Use Conditions: Quality Chasm Series ( 2006), Institute of Medicine, National Affordable Care Academy of Sciences, http://books.nap.edu/openbook.php?record_id=11470&page=210; State Substance Abuse Agency and Substance Abuse Program Efforts Towards Healthcare Integration: An Environmental Scan, National Association of State Alcohol/Drug Abuse Directors, 2011, http://nasadad.org/nasadad-reports
29 Health Care Integration, http://samhsa.gov/health-reform/health-care-integration; SAMHSA-HRSA Center for Integrated Health Solutions, (http://www.integration.samhsa.gov/)
30 Health Information Technology (HIT), http://www.integration.samhsa.gov/operations-administration/hit; Characteristics of State Mental Health Agency Data Systems, Telebehavioral Health and Technical Assistance Series, https://www.integration.samhsa.gov/operations-administration/telebehavioral-health; State Medicaid Best Practice, Telemental and Behavioral Health, August 2013, American Telemedicine Association, http://www.americantelemed.org/home; National Telehealth Policy Resource Center, https://www.cchpca.org/topic/overview/;
31 Health Homes, http://www.integration.samhsa.gov/integrated-care-models/health-homes Printed: 7/19/20217/21/2021 2:093:2812:38 PM PM - -South South Carolina Carolina - OMB No. 0930-0168 Approved: 04/19/2019 Expires: 04/30/2022 PagePage 66 of2 of222 5 32 New financing models, https://www.integration.samhsa.gov/financing
33 Waivers, http://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Waivers/Waivers.html; Coverage and Service Design Opportunities for Individuals with Mental Illness and Substance Use Disorders, CMS Informational Bulletin, Dec. 2012, http://medicaid.gov/Federal-Policy-Guidance/Downloads/CIB-12- 03-12.pdf
34 What are my preventive care benefits? https://www.healthcare.gov/what-are-my-preventive-care-benefits/; Interim Final Rules for Group Health Plans and Health Insurance Issuers Relating to Coverage of Preventive Services Under the Patient Protection and Affordable Care Act, 75 FR 41726 (July 19, 2010); Group Health Plans and Health Insurance Issuers Relating to Coverage of Preventive Services Under the Patient Protection and Affordable Care Act, 76 FR 46621 (Aug. 3, 2011); http://www.hhs.gov/healthcare/facts/factsheets/2010/07/preventive-services-list.html
35 Medicare-Medicaid Enrollee State Profiles, http://www.cms.gov/Medicare-Medicaid-Coordination/Medicare-and-Medicaid-Coordination/Medicare-Medicaid- Coordination-Office/StateProfiles.html; About the Compact of Free Association, http://uscompact.org/about/cofa.php
36 Dual-Eligible Beneficiaries of Medicare and Medicaid: Characteristics, Health Care Spending, and Evolving Policies, CBO, June 2013, http://www.cbo.gov/publication/44308
37 BD Sommers et al. Medicaid and Marketplace Eligibility Changes Will Occur Often in All States; Policy Options can Ease Impact. Health Affairs. 2014; 33(4): 700-707
38 TF Bishop. Acceptance of Insurance by Psychiatrists and the Implications for Access to Mental Health Care, JAMA Psychiatry. 2014;71(2):176-181; JR Cummings et al, Race/Ethnicity and Geographic Access to Medicaid Substance Use Disorder Treatment Facilities in the United States, JAMA Psychiatry. 2014; 71(2):190-196; JR Cummings et al. Geography and the Medicaid Mental Health Care Infrastructure: Implications for Health Reform. JAMA Psychiatry. 2013; 70(10):1084-1090; JW Boyd et al. The Crisis in Mental Health Care: A Preliminary Study of Access to Psychiatric Care in Boston. Annals of Emergency Medicine. 2011; 58(2): 218
39 Hoge, M.A., Stuart, G.W., Morris, J., Flaherty, M.T., Paris, M. & Goplerud E. Mental health and addiction workforce development: Federal leadership is needed to address the growing crisis. Health Affairs, 2013; 32 (11): 2005-2012; SAMHSA Report to Congress on the Nation's Substance Abuse and Mental Health Workforce Issues, January 2013, https://www.cibhs.org/sites/main/files/file-attachments/samhsa_bhwork_0.pdf; Creating jobs by addressing primary care workforce needs, https://obamawhitehouse.archives.gov/the-press-office/2012/04/11/fact-sheet-creating-health-care-jobs-addressing-primary-care-workforce-n
40 About the National Quality Strategy, http://www.ahrq.gov/workingforquality/about.htm;
41 Letter to Governors on Information for Territories Regarding the Affordable Care Act, December 2012, http://www.cms.gov/cciio/resources/letters/index.html; Affordable Care Act, Indian Health Service, http://www.ihs.gov/ACA/
Please respond to the following items in order to provide a description of the healthcare system and integration activities: 1. Describe how the state integrates mental health and primary health care, including services for individuals with co-occurring mental and substance use disorders, in primary care settings or arrangements to provide primary and specialty care services in community -based mental and substance use disorders settings. SCDMH provides strategic leadership throughout its delivery systems of care for the expansion of the agency's partnership with public and private primary healthcare providers and mental health and substance abuse stakeholders. Under SCDMH's leadership a number of alignment care initiatives were implemented and expanded to support the identification of need and the provision of primary care services for its patients with both public and private primary care stakeholders.
SCDMH continues to strengthen its existing bi-directional service alignment partnerships with both public and private primary healthcare providers. Designated community mental health centers (CMHC) have maintained longstanding alignment care arrangements to include: facilitated referrals, co-location and bi-directional partnerships with Federally Qualified Health Centers (FQHC), public and private primary healthcare providers, and mental health and substance abuse stakeholders.
Two CMHCs have mental health services embedded in FQHCs utilizing mental health professionals to deliver services – Beckman Center for Mental Health Services is located in 6 of 11 of its FQHC partner’s locations. Three CMHCs have primary care clinicians embedded in the CMHC – Charleston-Dorchester Community Mental Health Center partners with four rural health clinics through the Highway to Hope initiative. One CMHC has a primary care clinician onsite three days per week and in satellite clinics one day per week, while another CMHC coordinates with an FQHC to provide homeless outreach.
Highway 2 Hope Mobile Response Program – In 2020, DMH received a federal grant of $6,403,686 to provide support to South Carolinians in rural areas who are experiencing mental health and substance use crises or have unmet treatment needs. The primary focus of the initiative is a Mobile Response Program serving nine counties beginning in 2021, called the Highway to Hope Mobile Response Program (H2H). H2H will serve both adults and children in some of the most rural areas of South Carolina, utilizing nine RVs operated by DMH staff from the three DMH mental health centers. H2H is based on a long-running, highly successful model for rural patients operated by DMH’s Charleston-Dorchester MHC since 2010. The program will offer both mental health treatment and some basic primary care services directly to those in need who may not have transportation to services otherwise. Based on the patient’s assessment, the professional care staff will also make referrals to other community resources. The RVs will be equipped with telehealth equipment, and the services available will be delivered both in-person and virtually.
SCDMH partners with publicly-funded provider entities and payors for the development of local collaborative and outcomes- based models of primary/behavioral health alignment service delivery, to include Medicaid Managed Care Organizations, primary care network providers and care management staff – Spartanburg Area Mental Health Center partners with a Managed Care Organization for care coordination. In addition, SCDMH has undertaken the implementation of transitional care management Printed: 7/19/20217/21/2021 2:093:2812:38 PM PM - -South South Carolina Carolina - OMB No. 0930-0168 Approved: 04/19/2019 Expires: 04/30/2022 PagePage 67 of3 of222 5 partnerships between the Medicaid MCOs, acute care inpatient facilities, community mental health centers and SCDMH's inpatient facilities in accordance with patient privacy/confidentiality requirements. 2. Describe how the state provides services and supports towards integrated systems of care for individuals and families with co- occurring mental and substance use disorders, including management, funding, and payment strategies that foster co-occurring capability. The agency participates in ongoing multi-agency stakeholder policy platforms, which includes medical service providers, behavioral health entities and payors, in its efforts to support further expansion of service alignment capacity for systems of care for individuals with co-occurring mental and substance use disorders.
To further these efforts, key stakeholder partnerships are being sustained, to include the SC Rural Health Association, Federally Qualified Health Centers, Medicaid Managed Care Organizations, South Carolina Health Information Exchange Office, and SC Department of Health and Human Services-Medicaid Agency.
The South Carolina Behavioral Health Coalition in which SCDMH is a partner “is an unprecedented alliance of public and private agencies, organizations and healthcare providers collectively committed to improving the mental health and well-being of everyone in our state. This multi-sector coalition is an important outgrowth of the valuable work of the SC Institute of Medicine and Public Health’s Behavioral Health Task Force, the SC House Opioid Study Committee, and the Governor’s Opioid Crisis Task Force that each provided a set of recommended actions to improve the care and outcomes of South Carolinians suffering with mental illness and/or substance use disorders. A coalition charter has been established that defines five specific strategic priority areas: - Crisis stabilization and management of patients with acute behavioral health disorders - Alignment of behavioral health and primary care services and resources - Substance use disorder prevention and treatment - Children and youth ages 0 through 25 access to services - Behavioral health and the justice system involved population…”
The agency has successfully continued its efforts to promote localized alignment care models and strengthen its workforce capacity to address co-occurring chronic medical and behavioral health conditions of its target population. Partnerships with Medicaid Managed Care Organizations in support of population health management models across the 16 CMHCs are being evaluated and recommended as a means to explore potential mechanisms for outcomes-based alignment care models. In fact, SCDMH is exploring with one Medicaid MCO a possible model to enhance the savings available when certain benchmarks are achieved with high-management patients.
Lastly, SCDMH maintains active participation in the expansion of the South Carolina Health Information Exchange (SCHIEx) partnership. This partnership provides enhanced capacity for health information exchange to ensure continuity of care for patients with co-occurring disorders. The strategic plan includes statewide rollout of the SCHIEx/DIRECT Messaging initiative among 16 CMHCs, the SCDMH Office of Clinical Care Coordination and local SCHIEx participating providers (e.g. hospitals, federally qualified health centers, rural health clinics, primary care partners and alcohol and other substance use disorder providers.) 3. a) Is there a plan for monitoring whether individuals and families have access to M/SUD services offered Yes No through Qualified Health Plans?
b) and Medicaid? Yes No
4. Who is responsible for monitoring access to M/SUD services provided by the QHP? The South Carolina Department of Mental Health is not responsible for monitoring access to M/SUD services by the QHP. 5. Is the SSA/SMHA involved in any coordinated care initiatives in the state? Yes No
6. Do the M/SUD providers screen and refer for:
a) Prevention and wellness education Yes No
b) Health risks such as
ii) heart disease Yes No
iii) hypertension Yes No
iv) high cholesterol Yes No
v) diabetes Yes No
c) Recovery supports Yes No
7. Is the SSA/SMHA involved in the development of alternative payment methodologies, including risk-based Yes No contractual relationships that advance coordination of care?
8. Is the SSA and SMHA involved in the implementation and enforcement of parity protections for mental and Yes No Printed: 7/19/20217/21/2021 2:093:2812:38 PM PM - -South South Carolina Carolina - OMB No. 0930-0168 Approved: 04/19/2019 Expires: 04/30/2022 PagePage 68 of4 of222 5 substance use disorder services?
9. What are the issues or problems that your state is facing related to the implementation and enforcement of parity provisions? The South Carolina Department of Mental Health defers comment to those state agencies directly involved in the implementation and enforcement of parity protections for mental and substance use disorder services. 10. Does the state have any activities related to this section that you would like to highlight? In order to improve the physical and mental health of patients, SCDMH supports various integrated care services throughout the state. Feedback from clinics that have offered these services has shown that there are specific barriers to providing integrated care services despite recognition that these services are valued. While SCDMH maintains central oversight of all state Community Mental Health Centers (CMHC), CMHCs are deploying various integrated care strategies that increasingly require SCDMH Central Office supports without a coordinated strategy for the infrastructure required for their broader development.
SCDMH has established a workgroup to guide the development of integrated care initiatives. The workgroup has three (3) aims: - To establish a set of priorities/goals for integrated care services; - To define a shared set of outcomes that SCDMH can use to measure progress towards these goals; and - To coordinate the development of infrastructure to support broader adoption of integrated care services based on these shared goals and defined outcomes.
The scope of the workgroup includes immediate issues related to care provision as well as guiding strategies for ongoing program development. A core group of participants both internal as well as external to SCDMH informs on best practices and real- world clinical care, and pulls in key stakeholders/experts as needed for particular projects. The workgroup is currently evaluating integrated care services using a multi-phase approach: Phase 1 Foundational Assessment; Phase 2 SCDMH Infrastructure Development; Phase 3 Site Implementation; and Phase 4 Sustainability.
As SCDMH continues to deploy various integrated care strategies in order to meet demand for the services, even while coordinating a strategy for the broader development of a supporting infrastructure, additional staff are required. SCDMH is requesting to use American Rescue Plan Act funds allocated by SAMHSA to secure 1.0 FTE of additional Nurse Practitioner time to provide primary care services. Please indicate areas of technical assistance needed related to this section Not Applicable OMB No. 0930-0168 Approved: 04/19/2019 Expires: 04/30/2022
Footnotes:
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2. Health Disparities - Requested
Narrative Question In accordance with the HHS Action Plan to Reduce Racial and Ethnic Health Disparities42, Healthy People, 202043, National Stakeholder Strategy for Achieving Health Equity44, and other HHS and federal policy recommendations, SAMHSA expects block grant dollars to support equity in access, services provided, and M/SUD outcomes among individuals of all cultures, sexual/gender minorities, orientation and ethnicities. Accordingly, grantees should collect and use data to: (1) identify subpopulations (i.e., racial, ethnic, limited English speaking, tribal, sexual/gender minority groups, etc.) vulnerable to health disparities and (2) implement strategies to decrease the disparities in access, service use, and outcomes both within those subpopulations and in comparison to the general population. One strategy for addressing health disparities is use of the recently revised National Standards for Culturally and Linguistically Appropriate Services in Health and Health Care (CLAS)45.
The Action Plan to Reduce Racial and Ethnic Health Disparities, which the HHS Secretary released in April 2011, outlines goals and actions that HHS agencies, including SAMHSA, will take to reduce health disparities among racial and ethnic minorities. Agencies are required to assess the impact of their policies and programs on health disparities.
The HHS Secretary's top priority in the Action Plan is to "assess and heighten the impact of all HHS policies, programs, processes, and resource decisions to reduce health disparities. HHS leadership will assure that program grantees, as applicable, will be required to submit health disparity impact statements as part of their grant applications. Such statements can inform future HHS investments and policy goals, and in some instances, could be used to score grant applications if underlying program authority permits."46
Collecting appropriate data is a critical part of efforts to reduce health disparities and promote equity. In October 2011, HHS issued final standards on the collection of race, ethnicity, primary language, and disability status47. This guidance conforms to the existing Office of Management and Budget (OMB) directive on racial/ethnic categories with the expansion of intra-group, detailed data for the Latino and the Asian-American/Pacific Islander populations48. In addition, SAMHSA and all other HHS agencies have updated their limited English proficiency plans and, accordingly, will expect block grant dollars to support a reduction in disparities related to access, service use, and outcomes that are associated with limited English proficiency. These three departmental initiatives, along with SAMHSA's and HHS's attention to special service needs and disparities within tribal populations, LGBTQ populations, and women and girls, provide the foundation for addressing health disparities in the service delivery system. States provide M/SUD services to these individuals with state block grant dollars. While the block grant generally requires the use of evidence-based and promising practices, it is important to note that many of these practices have not been normed on various diverse racial and ethnic populations. States should strive to implement evidence-based and promising practices in a manner that meets the needs of the populations they serve.
In the block grant application, states define the populations they intend to serve. Within these populations of focus are subpopulations that may have disparate access to, use of, or outcomes from provided services. These disparities may be the result of differences in insurance coverage, language, beliefs, norms, values, and/or socioeconomic factors specific to that subpopulation. For instance, lack of Spanish primary care services may contribute to a heightened risk for metabolic disorders among Latino adults with SMI; and American Indian/Alaska Native youth may have an increased incidence of underage binge drinking due to coping patterns related to historical trauma within the American Indian/Alaska Native community. While these factors might not be pervasive among the general population served by the block grant, they may be predominant among subpopulations or groups vulnerable to disparities.
To address and ultimately reduce disparities, it is important for states to have a detailed understanding of who is and is not being served within the community, including in what languages, in order to implement appropriate outreach and engagement strategies for diverse populations. The types of services provided, retention in services, and outcomes are critical measures of quality and outcomes of care for diverse groups. For states to address the potentially disparate impact of their block grant funded efforts, they will address access, use, and outcomes for subpopulations.
42 http://www.minorityhealth.hhs.gov/npa/files/Plans/HHS/HHS_Plan_complete.pdf
43 http://www.healthypeople.gov/2020/default.aspx
44 https://www.minorityhealth.hhs.gov/npa/files/Plans/NSS/NSS_07_Section3.pdf
45 http://www.ThinkCulturalHealth.hhs.gov
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47 https://aspe.hhs.gov/basic-report/hhs-implementation-guidance-data-collection-standards-race-ethnicity-sex-primary-language-and-disability-status
48 https://www.whitehouse.gov/wp-content/uploads/2017/11/Revisions-to-the-Standards-for-the-Classification-of-Federal-Data-on-Race-and-Ethnicity- October30-1997.pdf
Please respond to the following items:
1. Does the state track access or enrollment in services, types of services received and outcomes of these services by: race, ethnicity, gender, sexual orientation, gender identity, and age?
a) Race Yes No
b) Ethnicity Yes No
c) Gender Yes No
d) Sexual orientation Yes No
e) Gender identity Yes No
f) Age Yes No
2. Does the state have a data-driven plan to address and reduce disparities in access, service use and Yes No outcomes for the above sub-population?
3. Does the state have a plan to identify, address and monitor linguistic disparities/language barriers? Yes No
4. Does the state have a workforce-training plan to build the capacity of M/SUD providers to identify Yes No disparities in access, services received, and outcomes and provide support for improved culturally and linguistically competent outreach, engagement, prevention, treatment, and recovery services for diverse populations?
5. If yes, does this plan include the Culturally and Linguistically Appropriate Services(CLAS) Standards? Yes No
6. Does the state have a budget item allocated to identifying and remediating disparities in M/SUD care? Yes No
7. Does the state have any activities related to this section that you would like to highlight? The following are two SCDMH Directives related to the subject matter.
Directive 839-03 – Culturally and Linguistically Appropriate Services to Consumers who have Limited English Proficiency (LEP), or are Hard of Hearing or Deaf.
The purpose of this Directive is to ensure each Facility and Community Mental Health Center has a policy and procedure to provide culturally and linguistically appropriate services to its consumers who are not proficient in the English language, to the extent that they cannot access the services or programs offered by the agency without language assistance.
It is the policy of the Department of Mental Health (DMH) to recognize and respect the cultural diversity of its consumers and to provide culturally and linguistically appropriate services to all of its consumers. Moreover, it is the policy of the Department to provide services to those needing them without regard to national origin or disabilities. Included are individuals who have limited English proficiency, or are hard-of-hearing or deaf. The Department recognizes that in order to provide meaningful access to its behavioral health services to consumers who have limited English proficiency, or are hard-of-hearing or deaf, DMH facilities and community mental health centers must have procedures in place to provide communication services, including interpreter services at no cost to the consumer. Accurate and adequate communication between consumers and providers is a necessary element for providing good quality care, and it is a recognized right of consumers. The treatment staff needs to have the capability to effectively communicate with and relate to the experiences of consumers from diverse cultures, as this is an important component of culturally competent treatment.
Directive 894-09 – Cultural Competence
This directive establishes the policy for the creation and maintenance of culturally and linguistically competent system of care at the South Carolina Department of Mental Health (SCDMH).
The Department recognizes that culture is dynamic and that cultural competence must be an ongoing process, believing that valuing individual and group cultural differences is critical to achieving the organizational goals. SCDMH considers cultural competence a necessary part of good clinical services. Organized under the Division of Community Mental Health Services the Statewide Multi-Cultural Council and Center/Facility Multi-Cultural Committees are charged with the responsibility to advise and guide SCDMH leadership in the creation and maintenance of a linguistically and culturally competent workforce, service divisions, programs, and collaborative endeavors reflective of the diversity of the population served and the community. Administrative
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Footnotes:
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3. Innovation in Purchasing Decisions - Requested
Narrative Question While there are different ways to define value-based purchasing, its purpose is to identify services, payment arrangements, incentives, and players that can be included in directed strategies using purchasing practices that are aimed at improving the value of health care services. In short, health care value is a function of both cost and quality:
Health Care Value = Quality ÷ Cost, (V = Q ÷ C)
SAMHSA anticipates that the movement toward value based purchasing will continue as delivery system reforms continue to shape states systems. The identification and replication of such value-based strategies and structures will be important to the development of M/SUD systems and services.
There is increased interest in having a better understanding of the evidence that supports the delivery of medical and specialty care including M/SUD services. Over the past several years, SAMHSA has collaborated with CMS, HRSA, SMAs, state M/SUD authorities, legislators, and others regarding the evidence of various mental and substance misuse prevention, treatment, and recovery support services. States and other purchasers are requesting information on evidence-based practices or other procedures that result in better health outcomes for individuals and the general population. While the emphasis on evidence-based practices will continue, there is a need to develop and create new interventions and technologies and in turn, to establish the evidence. SAMHSA supports states' use of the block grants for this purpose. The NQF and the IOM recommend that evidence play a critical role in designing health benefits for individuals enrolled in commercial insurance, Medicaid, and Medicare.
To respond to these inquiries and recommendations, SAMHSA has undertaken several activities. SAMHSA's Evidence Based Practices Resource Center assesses the research evaluating an intervention's impact on outcomes and provides information on available resources to facilitate the effective dissemination and implementation of the program. SAMHSA's Evidence-Based Practices Resource Center provides the information & tools needed to incorporate evidence-based practices into communities or clinical settings.
SAMHSA reviewed and analyzed the current evidence for a wide range of interventions for individuals with mental illness and substance use disorders, including youth and adults with chronic addiction disorders, adults with SMI, and children and youth with SED. The evidence builds on the evidence and consensus standards that have been developed in many national reports over the last decade or more. These include reports by the Surgeon General,49 The New Freedom Commission on Mental Health,50 the IOM,51 NQF,and the Interdepartmental Serious Mental Illness Coordinating Committee (ISMICC).52. The activity included a systematic assessment of the current research findings for the effectiveness of the services using a strict set of evidentiary standards. This series of assessments was published in "Psychiatry Online."53 SAMHSA and other federal partners, the HHS' Administration for Children and Families, Office for Civil Rights, and CMS, have used this information to sponsor technical expert panels that provide specific recommendations to the M/SUD field regarding what the evidence indicates works and for whom, to identify specific strategies for embedding these practices in provider organizations, and to recommend additional service research.
In addition to evidence-based practices, there are also many promising practices in various stages of development. Anecdotal evidence and program data indicate effectiveness for these services. As these practices continue to be evaluated, the evidence is collected to establish their efficacy and to advance the knowledge of the field.
SAMHSA's Treatment Improvement Protocol Series (TIPS)54 are best practice guidelines for the SUD treatment. SAMHSA draws on the experience and knowledge of clinical, research, and administrative experts to produce the TIPS, which are distributed to a growing number of facilities and individuals across the country. The audience for the TIPS is expanding beyond public and private SUD treatment facilities as alcohol and other drug disorders are increasingly recognized as a major health problem.
SAMHSA's Evidence-Based Practice Knowledge Informing Transformation (KIT)55 was developed to help move the latest information available on effective M/SUD practices into community-based service delivery. States, communities, administrators, practitioners, consumers of mental health care, and their family members can use KIT to design and implement M/SUD practices that work. KIT covers getting started, building the program, training frontline staff, and evaluating the program. The KITs contain information sheets, introductory videos, practice demonstration videos, and training manuals. Each KIT outlines the essential components of the evidence-based practice and provides suggestions collected from those who have successfully implemented them.
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49 United States Public Health Service Office of the Surgeon General (1999). Mental Health: A Report of the Surgeon General. Rockville, MD: Department of Health and Human Services, U.S. Public Health Service
50 The President's New Freedom Commission on Mental Health (July 2003). Achieving the Promise: Transforming Mental Health Care in America. Rockville, MD: Department of Health and Human Services, Substance Abuse and Mental Health Services Administration.
51 Institute of Medicine Committee on Crossing the Quality Chasm: Adaptation to Mental Health and Addictive Disorders (2006). Improving the Quality of Health Care for Mental and Substance-Use Conditions: Quality Chasm Series. Washington, DC: National Academies Press.
52 National Quality Forum (2007). National Voluntary Consensus Standards for the Treatment of Substance Use Conditions: Evidence-Based Treatment Practices. Washington, DC: National Quality Forum.
53 http://psychiatryonline.org/
54 http://store.samhsa.gov
55 https://store.samhsa.gov/sites/default/files/d7/priv/ebp-kit-how-to-use-the-ebp-kit-10112019_0.pdf
Please respond to the following items:
1. Is information used regarding evidence-based or promising practices in your purchasing or policy Yes No decisions?
2. Which value based purchasing strategies do you use in your state (check all that apply):
a) Leadership support, including investment of human and financial resources.
b) Use of available and credible data to identify better quality and monitored the impact of quality improvement interventions. c) Use of financial and non-financial incentives for providers or consumers. d) Provider involvement in planning value-based purchasing. e) Use of accurate and reliable measures of quality in payment arrangements. f) Quality measures focused on consumer outcomes rather than care processes.
g) Involvement in CMS or commercial insurance value based purchasing programs (health homes, accountable care organization, all payer/global payments, pay for performance (P4P)). h) The state has an evaluation plan to assess the impact of its purchasing decisions. 3. Does the state have any activities related to this section that you would like to highlight? Evidence-based practices provide proven tools to help patients achieve the goal of recovery. As the field moves forward, demand for EBPs by patients and other stakeholders have increased. Evidence-based practices do not exist for every problem nor do they work for every person. However, they do exist for certain conditions and they have been demonstrated by research to be effective. As resources continue to shrink, providing care that is proven effective seems an optimal way to stretch these resources.
In order to understand what services and treatments work best and for whom, and to build public support, it is essential that data on outcomes be measured and the results reported and used to inform decision-making. This activity is achieved through the combined efforts of internal programmatic resources and external program evaluators.
Providing evidence-based practices is essential to any plan striving to improve the quality of mental health treatment. Patients, family members, other stakeholders, and funders want to ensure that mental health practices with a strong evidence base are available. Evidence-based practices offer the greatest hope yet, through new treatments and services that have been proven to be effective through scientific evidence and research. Please indicate areas of technical assistance needed related to this section. Not Applicable OMB No. 0930-0168 Approved: 04/19/2019 Expires: 04/30/2022
Footnotes:
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4. Evidence-Based Practices for Early Interventions to Address Early Serious Mental Illness (ESMI) - 10 percent set aside - Required MHBG
Narrative Question Much of the mental health treatment and recovery service efforts are focused on the later stages of illness, intervening only when things have reached the level of a crisis. While this kind of treatment is critical, it is also costly in terms of increased financial burdens for public mental health systems, lost economic productivity, and the toll taken on individuals and families. There are growing concerns among consumers and family members that the mental health system needs to do more when people first experience these conditions to prevent long-term adverse consequences. Early intervention* is critical to treating mental illness before it can cause tragic results like serious impairment, unemployment, homelessness, poverty, and suicide. The duration of untreated mental illness, defined as the time interval between the onset of a mental disorder and when an individual gets into treatment, has been a predictor of outcomes across different mental illnesses. Evidence indicates that a prolonged duration of untreated mental illness may be viewed as a negative prognostic factor for those who are diagnosed with mental illness. Earlier treatment and interventions not only reduce acute symptoms, but may also improve long-term prognosis.
SAMHSA's working definition of an Early Serious Mental Illness is "An early serious mental illness or ESMI is a condition that affects an individual regardless of their age and that is a diagnosable mental, behavioral, or emotional disorder of sufficient duration to meet diagnostic criteria specified within DSM-5 (APA, 2013). For a significant portion of the time since the onset of the disturbance, the individual has not achieved or is at risk for not achieving the expected level of interpersonal, academic or occupational functioning. This definition is not intended to include conditions that are attributable to the physiologic effects of a substance use disorder, are attributable to an intellectual/developmental disorder or are attributable to another medical condition. The term ESMI is intended for the initial period of onset."
States may implement models that have demonstrated efficacy, including the range of services and principles identified by National Institute of Mental Health (NIMH) via its Recovery After an Initial Schizophrenia Episode (RAISE) initiative. Utilizing these principles, regardless of the amount of investment, and by leveraging funds through inclusion of services reimbursed by Medicaid or private insurance, states should move their system to address the needs of individuals with a first episode of psychosis (FEP). RAISE was a set of NIMH sponsored studies beginning in 2008, focusing on the early identification and provision of evidence-based treatments to persons experiencing FEP. The NIMH RAISE studies, as well as similar early intervention programs tested worldwide, consist of multiple evidence-based treatment components used in tandem as part of a Coordinated Specialty Care (CSC) model, and have been shown to improve symptoms, reduce relapse, and lead to better outcomes.
State shall expend not less than 10 percent of the MHBG amount the State receives for carrying out this section for each fiscal year to support evidence-based programs that address the needs of individuals with early serious mental illness, including psychotic disorders, regardless of the age of the individual at onset. In lieu of expending 10 percent of the amount the State receives under this section for a fiscal year as required a state may elect to expend not less than 20 percent of such amount by the end of such succeeding fiscal year.
* MHBG funds cannot be used for primary prevention activities. States cannot use MHBG funds for prodromal symptoms (specific group of symptoms that may precede the onset and diagnosis of a mental illness) and/or those who are not diagnosed with a SMI.
Please respond to the following items:
1. Does the state have policies for addressing early serious mental illness (ESMI)? Yes No
2. Has the state implemented any evidence-based practices (EBPs) for those with ESMI? Yes No
If yes, please list the EBPs and provide a description of the programs that the state currently funds to implement evidence- based practices for those with ESMI. Initially, States were permitted to address the needs of persons with early psychotic disorders, specifically first episode psychosis, either through enhancing existing program activities or development of new activities. SCDMH’s approach was to enhance existing program activities.
After several discussions with the Substance Abuse and Mental Health Services Administration (SAMHSA), and based on its guidance, the Department specifically cited Motivational Interviewing (MI) and Cognitive Behavioral Therapy (CBT) as the treatment modalities it would deploy utilizing the Set Aside funds. These treatment modalities were identified as appropriate and effective for persons experiencing First Episode Psychosis (FEP). This initial pathway became The Traditional Program.
In subsequent communications, SAMHSA indicated that its preference for the use of the Set-Aside funds was to implement Coordinated Specialty Care programs. Consequently, all future programs funded with Set-Aside funds will reflect Printed: 7/21/2021 9:0612:38 AM PM - -South South Carolina Carolina - OMB No. 0930-0168 Approved: 04/19/2019 Expires: 04/30/2022 PagePage 75 of1 of222 4 SAMHSA’s current preference.
Therefore, SCDMH’s approach with future funds for First Episode Psychosis (FEP) is the development of an additional Coordinated Specialty Care (CSC) Program at a new CMHC site. This program will be referred to as The CSC Program.
The current SCDMH-funded FEP Programs are listed below:
The Traditional Program Charleston/Dorchester Community Mental Health Center Pee Dee Mental Health Center Lexington County Community Mental Health Center
The CSC Program Charleston/Dorchester Community Mental Health Center (NAVIGATE) Spartanburg Area Mental Health Center (NAVIGATE) – Implementation Phase 3. How does the state promote the use of evidence-based practices for individuals with ESMI and provide comprehensive individualized treatment or integrated mental and physical health services? Given the geographic specificity of the deployment of SCDMH’s First Episode Psychosis (FEP) programs, promotion and outreach for the programs are unique to each SCDMH Community Mental Health Center (CMHC) offering an FEP program.
At Charleston-Dorchester Mental Health Center (Traditional Program and CSC Program), the NAVIGATE and New Directions programs promote the use of EBP by using the NAVIGATE model. All of the components of the NAVIGATE EBP have been very successful with the patient meeting their goal and ultimately supporting the mission of SCDMH. There are continuous efforts to inform the intake staff and clinicians in the agency of the program criteria for both programs in order to assist with gaining new referrals.
Lexington County Community Mental Health Center (Traditional Program) offers training opportunities at the center throughout the year for evidence-based practices. Center clinicians are trained in TF-CBT and Motivational Interviewing. Regarding individualized treatment, the Center conducts a comprehensive assessment at the initiation of treatment and uses this information to develop an individualized collaborative treatment plan with each patient. The goal is for the treatment services to be catered to the individual patient and comprehensive in addressing needs.
Pee Dee has developed marketing materials to promote the program. It has a short overview on its website with information about its program (https://www.peedeementalhealth.org/adult-outpatient-services/#aop). This program helps those who are experiencing psychotic symptoms for the first time. People with early psychotic disorders may not understand what is happening to them and can find the unfamiliar symptoms confusing and distressful. The early treatment provided by this evidenced based program can help improve the long-term outcomes for these individuals. 4. Does the state coordinate across public and private sector entities to coordinate treatment and recovery Yes No supports for those with ESMI?
5. Does the state collect data specifically related to ESMI? Yes No
6. Does the state provide trainings to increase capacity of providers to deliver interventions related to ESMI? Yes No
7. Please provide an updated description of the state's chosen EBPs for the 10 percent set-aside for ESMI.
Charleston/Dorchester Community Mental Health Center - Charleston Dorchester Mental Health currently has 16 patients in the NAVIGATE program and 15 in the New Directions program. The NAVIGATE program meets with patients in the Schizophrenia spectrum with first episode psychosis. The New Directions program meets with patients with any psychotic disorder in their first episode. Both programs use the NAVIGATE treatment model with their patients and all team members are trained in this. There are 12 patients who are currently working jobs. Out of the current patients in the program, 25 patients have not been in the hospital since starting the program. There are 18 patients who are receiving the additional services on the team (PRS, CAT services, Care Coordination, PSS). Due to this, many patients are seen by at least one team member on a weekly basis. NAVIGATE has an additional grant, ESPRITO, which researches the NAVIGATE patients. The grant started to have patients actively enrolled in August 2020. There have been 30 patients enrolled in the ESPRITO program since August 2020. Since September 2020, there have been 11 patients that have successfully graduated the program and transitioned to MMO or closure.
Pee Dee Mental Health Center - Pee Dee Mental Health FEP program services 24 patients between the ages 17-30 that have experienced early psychotic disorders such as Schizophrenia, Schizoaffective, Bipolar 1 & 2, and Borderline Personality Disorder. There are two masters-level clinicians in the program and each has 12 FEP patients on their caseload. Both clinicians provide an array of different services such as, but not limited to, rehabilitative psychosocial services, individual and family therapy, and assessments.
There was no caseload increase during the 2020 year at Pee Dee Mental Health FEP, largely due to the COVID pandemic, which resorted in telehealth services being provide rather than face-to-face services. Unfortunately, Pee Dee Mental Health did have a Printed: 7/21/2021 9:0612:38 AM PM - -South South Carolina Carolina - OMB No. 0930-0168 Approved: 04/19/2019 Expires: 04/30/2022 PagePage 76 of2 of222 4 few clients to decompensate during the pandemic, due to loss of employment, death within immediate family, increase in substance/drug abuse, and medication non-compliance. However, Pee Dee FEP program had three success stories during the pandemic outbreak.
There were three clients that desired to work and/or go back to school. One started working at Dollar General part-time and enrolled into Florence Darlington Tech. The second client enrolled in Florence Darlington Tech Welding Program, graduated from the program and was hired at Honda in the welding department. The third client enrolled into school, starting working three jobs and moved out of the mental health housing program and he has graduated from the FEP program.
Lexington County Community Mental Health Center - During FY 2021, LCCMHC has continued with the same treatment team approach and intensive services for patients. The team faced many challenges this year related to COVID-19 pandemic and implemented training for staff on engagement of patients through telehealth services. LCCMHC also continued to provide in person and community-based services to patients throughout the pandemic.
LCCMHC also experienced some turnover in clinical staff this year. The position has been filled with a clinician who has completed the 10-day intensive training in Dialectical Behavioral Therapy (DBT) model. LCCMHC has been extremely fortunate to retain the same psychiatrist who is very supportive of this program and our patients. Despite turnover in clinical staff and the global pandemic, LCCMHC has worked consistently to provide intensive treatment services to clients experiencing their first episode of psychosis.
Spartanburg Area Mental Health Center – Since the funds were allotted, SAMHC has accomplished the following: advertised positions for Program Director, IRT Therapists (2), Family Education Therapist, SEE, Peer Support Specialist and Administrative Support; filled the following positions: Program Director, IRT Therapists, SEE and Peer Support; identified staff for Administrative Support, Prescriber and Nursing roles in FEP program; completed Program Director and IRT training with Navigate consultants; scheduled ongoing consultation calls for IRT with Navigate consultants; begun holding weekly Navigate treatment team meetings; begun holding weekly Navigate supervision with IRT, SEE and Peer Support staff; developed a Navigate Program Manual specific to SAMHC; prepared a SAMHC Navigate referral form; prepare a SAMHC Navigate brochure; compiled a list of possible community resources/referrals; updated Navigate consultants of hire of SEE and scheduling SEE training; provided a Navigate presentation to SAMHC board members; conducted ongoing community outreach/education; enrolled 6 patients in the SAMHC Navigate Program with 2 current pending referrals; and, conducted ongoing communication PRN with Navigate consultants and SAMHC senior management about program concerns, staffing etc.
The program uses the NAVIGATE model to provide comprehensive, evidenced based treatment to individuals that are experiencing First Episode Psychosis (FEP) in the local community mental health center setting. The program utilizes a multi-disciplinary treatment team approach combined with specific treatment interventions to target and treat individuals experiencing FEP. These treatment interventions are intended to reduce hospitalizations, increase quality of life, support family members of patients experiencing FEP and promote community tenure for FEP patients. 8. Please describe the planned activities for FFY 2022 and FFY 2023 for your state's ESMI programs including psychosis? Coronavirus Response and Relief Supplement Appropriations Proposal Implementation of NAVIGATE Program(s) at Community Mental Health Centers - $600,000 Lexington County CMHC initially cited Motivational Interviewing (MI) and Cognitive Behavioral Therapy (CBT) as the treatment modalities it would deploy utilizing a portion of the Ten Percent Set Aside. These treatment modalities have been identified as appropriate and effective for persons experiencing First Episode Psychosis (FEP). It has also been found that maximum effectiveness is attainable when the two modalities are deployed together. MI serves as the engagement modality and CBT serves as the therapy modality. This approach was approved by SAMHSA when the FEP Set-Aside was initially instituted. Lexington County CMHC has been successful with this model. Lexington County CMHC now proposes to implement the NAVIGATE Program as its CSC (Coordinated Specialty Care) program.
American Rescue Plan Act of 2021 Funding Plan Proposal Implementation of NAVIGATE Program(s) at Community Mental Health Centers - $537,020 As described in the MHBG Uniform Application, “States may implement models that have demonstrated efficacy, including the range of services and principles identified by National Institute of Mental Health (NIMH) via its Recovery After an Initial Schizophrenia Episode (RAISE) initiative. Utilizing these principles, regardless of the amount of investment, and by leveraging funds through inclusion of services reimbursed by Medicaid or private insurance, states should move their system to address the needs of individuals with a first episode of psychosis (FEP). RAISE was a set of NIMH sponsored studies beginning in 2008, focusing on the early identification and provision of evidence-based treatments to persons experiencing FEP. The NIMH RAISE studies, as well as similar early intervention programs tested worldwide, consist of multiple evidence-based treatment components used in tandem as part of a Coordinated Specialty Care (CSC) model, and have been shown to improve symptoms, reduce relapse, and lead to better outcomes” SCDMH proposes to implement the NAVIGATE Program – a CSC model – at one, or more, SCDMH Community Mental Health Center(s). Such amount(s) will fund the program(s) each year for four years.
SCDMH anticipates that the next new Community Mental Health Centers to implement the NAVIGATE Program will be Greater Greenville Mental Health Center and Aiken-Barnwell Community Mental Health Center. Printed: 7/21/2021 9:0612:38 AM PM - -South South Carolina Carolina - OMB No. 0930-0168 Approved: 04/19/2019 Expires: 04/30/2022 PagePage 77 of3 of222 4 9. Please explain the state's provision for collecting and reporting data, demonstrating the impact of the 10 percent set-aside for ESMI. SCDMH utilizes its ability to track client-level data via its electronic medical record to provide aggregated outputs (counts) and outcomes (results) in order to demonstrate the effective and efficient use of the Ten Percent Set-Aside for First Episode Psychosis funds. SCDMH is able to identify both the clinicians and the patients involved in the Program, so data specific to the Program can be reported. 10. Please list the diagnostic categories identified for your state's ESMI programs. The CSC Program provides services to patients who have experienced an FEP and have a schizophrenia spectrum disorder and the Traditional Programs serve patients who have experienced an FEP with any mental health diagnosis. Please indicate areas of technical assistance needed related to this section. Not Applicable OMB No. 0930-0168 Approved: 04/19/2019 Expires: 04/30/2022
Footnotes:
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5. Person Centered Planning (PCP) - Required MHBG
Narrative Question States must engage adults with a serious mental illness or children with a serious emotional disturbance and their caregivers where appropriate in making health care decisions, including activities that enhance communication among individuals, families, caregivers, and treatment providers. Person-centered planning is a process through which individuals develop their plan of service. The PCP may include a representative who the person has freely chosen, and/or who is authorized to make personal or health decisions for the person. The PCP team may include family members, legal guardians, friends, caregivers and others that the person or his/her representative wishes to include. The PCP should involve the person receiving services and supports to the maximum extent possible, even if the person has a legal representative. The PCP approach identifies the person’s strengths, goals, preferences, needs and desired outcome. The role of state and agency workers (for example, options counselors, support brokers, social workers, peer support workers, and others) in the PCP process is to enable and assist people to identify and access a unique mix of paid and unpaid services to meet their needs and provide support during planning. The person’s goals and preferences in areas such as recreation, transportation, friendships, therapies, home, employment, education, family relationships, and treatments are part of a written plan that is consistent with the person’s needs and desires.
1. Does your state have policies related to person centered planning? Yes No
2. If no, describe any action steps planned by the state in developing PCP initiatives in the future. SCDMH does not use the term "person-centered planning" but refers to its internal process as an Individualized Plan of Care.
SCDMH Community Mental Health Centers (CMHCs) provide training and education initially, and on-going thereafter, in order to communicate how to embody individualized care that includes families/supports. The CMHCs also teach how clinical documents from the Initial Clinical Assessment (ICA), to Individualized Plan of Care (POC), to 90-Day POC Summaries, to Service Notes, to Physician Medical Orders (PMO), to Nursing Notes all must reflect the patient's unique needs, progress, and other considerations. 3. Describe how the state engages consumers and their caregivers in making health care decisions, and enhance communication. Please see answer to Question 4. 4. Describe the person-centered planning process in your state. Following are components of the "person-centered planning" process for the South Carolina Department of Mental Health. - SCDMH offers psychiatric advanced directive information and assistance. - SCDMH offers at admission the opportunity for the patient to identify family/supports to be involved in treatment. - SCDMH offers at admission the opportunity for the patient to identify any designee(s) to have access to treatment information. - SCDMH employs family-based care for children and adolescents in order to facilitate achievement of goals. - SCDMH utilizes its Continuity of Care Manual to inform "Family Inclusion" in care treatment for adults. - SCDMH uses the ICA, which is strengths-based. It identifies goals, preferences, needs, desired outcomes in numerous dimensions. - SCDMH uses initial individualized POC with patient and family/support input, documented collaboratively, and patient signature. - SCDMH uses POC to identify discharge/transition parameters for each patient. - SCDMH collaboratively documents at any time, but at least each 90 days, an updated POC based on progress and changes. - SCDMH focuses services on the whole person, including social, health, living, education, spirituality, employment, etc. - SCDMH Care Coordinators identify options and resources and link patients to such. - SCDMH Peer Support Specialists use Recovery for Life and WHAM to promote/support balanced lives and skills for patients. - SCDMH utilizes Engagement Specialists for outreach to patients who miss appointments. - SCDMH uses Levels of Care - a tool to communicate to patient and families/support movement toward desired outcomes. - SCDMH uses Collaborative Documentation to ensure patient and families/support contribute to information input into EMR. Please indicate areas of technical assistance needed related to this section. Not Applicable OMB No. 0930-0168 Approved: 04/19/2019 Expires: 04/30/2022
Footnotes:
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6. Program Integrity - Required
Narrative Question SAMHSA has placed a strong emphasis on ensuring that block grant funds are expended in a manner consistent with the statutory and regulatory framework. This requires that SAMHSA and the states have a strong approach to assuring program integrity. Currently, the primary goals of SAMHSA program integrity efforts are to promote the proper expenditure of block grant funds, improve block grant program compliance nationally, and demonstrate the effective use of block grant funds.
While some states have indicated an interest in using block grant funds for individual co-pays deductibles and other types of co-insurance for M/SUD services, SAMHSA reminds states of restrictions on the use of block grant funds outlined in 42 U.S.C. §§ 300x-5 and 300x-31, including cash payments to intended recipients of health services and providing financial assistance to any entity other than a public or nonprofit private entity. Under 42 U.S.C. § 300x-55(g), SAMHSA periodically conducts site visits to MHBG and SABG grantees to evaluate program and fiscal management. States will need to develop specific policies and procedures for assuring compliance with the funding requirements. Since MHBG funds can only be used for authorized services made available to adults with SMI and children with SED and SABG funds can only be used for individuals with or at risk for SUD. SAMHSA guidance on the use of block grant funding for co-pays, deductibles, and premiums can be found at: http://www.samhsa.gov/sites/default/files/grants/guidance-for-block-grant-funds-for-cost-sharing-assistance-for-private-health- insurance.pdf. States are encouraged to review the guidance and request any needed technical assistance to assure the appropriate use of such funds.
The MHBG and SABG resources are to be used to support, not supplant, services that will be covered through the private and public insurance. In addition, SAMHSA will work with CMS and states to identify strategies for sharing data, protocols, and information to assist our program integrity efforts. Data collection, analysis, and reporting will help to ensure that MHBG and SABG funds are allocated to support evidence-based, culturally competent programs, substance use disorder prevention, treatment and recovery programs, and activities for adults with SMI and children with SED.
States traditionally have employed a variety of strategies to procure and pay for M/SUD services funded by the MHBG and SABG. State systems for procurement, contract management, financial reporting, and audit vary significantly. These strategies may include: (1) appropriately directing complaints and appeals requests to ensure that QHPs and Medicaid programs are including essential health benefits (EHBs) as per the state benchmark plan; (2) ensuring that individuals are aware of the covered M/SUD benefits; (3) ensuring that consumers of M/SUD services have full confidence in the confidentiality of their medical information; and (4) monitoring the use of M/SUD benefits in light of utilization review, medical necessity, etc. Consequently, states may have to become more proactive in ensuring that state-funded providers are enrolled in the Medicaid program and have the ability to determine if clients are enrolled or eligible to enroll in Medicaid. Additionally, compliance review and audit protocols may need to be revised to provide for increased tests of client eligibility and enrollment.
Please respond to the following items:
1. Does the state have a specific policy and/or procedure for assuring that the federal program requirements Yes No are conveyed to intermediaries and providers?
2. Does the state provide technical assistance to providers in adopting practices that promote compliance Yes No with program requirements, including quality and safety standards?
3. Does the state have any activities related to this section that you would like to highlight? In the life cycle of a MHBG award, expenditures related thereto may be reviewed by any combination of SCDMH's Division of Administrative Services, Office of Grants Administration, Office of Budgeting, Accounts Payable, Office of Procurement and Internal Audit, among others. It is also subject to the scrutiny of other state government agencies, including the Office of the State Auditor, Office of the Comptroller General, and the Materials Management Office.
SCDMH has established internal controls sufficient to institute preventive controls - designed to discourage errors or fraud – and detective controls - designed to identify an error or fraud after it has occurred. It is also subject to external controls established by the State of South Carolina. It is, therefore, reasonable to assert that SCDMH has instituted measures that provide for appropriate separation of duties, assignment of roles and responsibilities to appropriately qualified staff, establishment of sound business practices, and sustainability to a system that ensures proper authorization and recordation of procedures for financial transactions (Literature reference: AICPA).
Beginning in FY2018, SCDMH implemented an oversight procedure for non-profit organizations - sub-recipients of MHBG funds through a Request for Proposal (RFP) process administered by SCDMH. Attached is the Monitoring Tool used for said procedure. The implementation of this procedure was based on a recommendation from SAMHSA. Printed: 7/19/20217/21/2021 2:103:2812:38 PM PM - -South South Carolina Carolina - OMB No. 0930-0168 Approved: 04/19/2019 Expires: 04/30/2022 PagePage 80 of1 of222 6 Compliance – The South Carolina Mental Health Commission and the South Carolina Department of Mental Health built and implemented a Compliance Program consistent with the procedural and structural guidance provided by the Office of Inspector General (OIG) of the Department of Health and Human Services to advance the prevention of fraud, abuse, and waste and the Federal Sentencing Guidelines. The goal of the Program is to implement a process for the continuous development, implementation, and refinement of internal controls and practices that promote adherence to applicable federal and state laws, identify, address and correct areas of risk, and further relevant policies of the Department, particularly those that support compliance activities. The South Carolina Mental Health Commission and the DMH expect all staff to conform to the standards of conduct as stated in its Code of Ethics and Conduct.
Quality Management Advisory Committee – DMH’s Quality Management Advisory Committee (QMAC) includes compliance and quality assurance. Compliance promotes and monitors DMH’s adherence to state and federal laws and regulations, as well as to requirements of third-party payors for the delivery and billing of quality services. Quality Assurance establishes methods and procedures to ensure that services provided are of the highest quality; and, systematically monitors performance against established standards for practice and implements actions for improvements as needed to ensure that service delivery is appropriate and meets the needs of DMH’s patients.
Internal Audit – DMH’s Office of Internal Audit serves as an independent function to examine and evaluate Agency activities as a service to the South Carolina Mental Health Commission and the DMH state director. Internal Audit’s overall objectives are to: evaluate internal controls and safeguard Agency assets; test for compliance with State, Federal, and Agency requirements; identify opportunities for revenue enhancement, cost savings, and overall operational improvements; coordinate audit effects (when requested) with the South Carolina Office of Inspector General, State Auditor’s Office, Legislative Audit Counsel, and other external auditors; deter and identify theft, fraud, waste and abuse; and, protect the assets of the State of South Carolina. As a result, the Office of Internal Audit provides analyses, recommendations, counsel, and information about activities or processes reviewed, usually in the form of an audit report. Please indicate areas of technical assistance needed related to this section Not Applicable
OMB No. 0930-0168 Approved: 04/19/2019 Expires: 04/30/2022
Footnotes:
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Monitor Name:
Date of Monitoring Activity:
Applicable Monitoring Period:
Sub-recipient Organization Name:
Program Name:
Is the Sub-recipient familiar with CFDA 93.958, Objectives (050): Yes / No
Is the Sub-recipient familiar with CFDA 93.958, Use and Restrictions (070): Yes / No
Is the Sub-recipient familiar with CFDA 93.958, Post Assistance Requirements (110): Yes / No
Is the Sub-recipient familiar with CFDA 93.958, Audits (112): Yes / No
Is the Sub-recipient aware that available funding for this program is subject to the enactment of a final federal budget or an annualized Continuing Resolution (CR)? Offerors/Contractors should be aware that SCDMH cannot guarantee that sufficient funds will be appropriated to fully fund this program? Yes / No
Is the Sub-recipient aware that should SCDMH receive guidance from SAMHSA/CMHS that the services provided as a result of this request for proposal no longer satisfy the requirements of the Community Mental Health Services Block Grant State Behavioral Health Assessment and Plan as Administered by the Center for Mental Health Services, Division of State and Community Systems Development, or its designee, that based on its interpretation of said guidance, SCDMH may discontinue future funding for any awards made as a result of this request for proposal within the applicable terms set forth herein? Yes / No
Indicate the Type of Monitoring Activity (Circle One)
Onsite Review Onsite Visit
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[Programmatic Review]
1. Does all information related to program(s) support the assertion that the program(s) support mental health transformation activities such as: expansion of access to mental health services; advancement of evidence- based practices; promotion of early screening, assessment, referral, and treatment; and/or promotion of consumer and family driven mental health care?
2. Is the program able to provide the dates and types of services provided, including the number of clients served (duplicated and unduplicated)?
3. Is the program able to provide a categorization of adult versus child persons served, the number of units of service provided within said categories, and the county of origin of service recipient?
4. Is the program able to describe evaluation activities including outcomes data collected and methods of collection?
5. Is the program able to quantify the actual outcomes versus proposed outcomes?
6. Does the organization maintain personnel files on its employees who provide services for which MHBG are used (neither visual nor independent verification is required)?
7. Have MHBG funds been used only for purposes supported by MHBG statutes, regulations, etc.?
[Financial Review]
1. Is the program able to provide the amount expended for direct services and the amount expended for indirect services, including the amount expended for administration?
2. Is the program able to provide an itemized income statement for activities associated with the use of MHBG funds, exclusive of any other activities?
3. Choosing one invoice, is the program able to provide supporting documentation for all expenditures for which it requested reimbursement? a. Date of Invoice: b. Date of Service Period: c. Amount of Invoice:
[Other Related Information]
1. Are there any other activities funded by the grant for which a quantitative measure is not feasible?
2. Are there any other relevant statistical measurements implemented by the entity that substantiates its eligibility for MHBG funds?
Sub-Recipient Organization Name: Date of Monitoring Activity:
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[Staff Interview]
1. Describe how the program(s) support mental health transformation activities such as: expansion of access to mental health services; advancement of evidence-based practices; promotion of early screening, assessment, referral, and treatment; and/or promotion of consumer and family driven mental health care.
2. Describe evaluation activities including outcomes data collected and methods of collection.
3. Quantify the actual outcomes versus proposed outcomes.
4. Describe any outreach, marketing, or other activities used to make others aware of the program.
5. Describe any program eligibility requirements.
6. What are the strengths of the program?
7. What are the areas of growth for the program?
8. What training and/or technical assistance does the program need?
[Program Observation]
1. How many individuals participated in the program?
2. Were the objectives of the training clearly defined?
3. Did the presenter have a good understanding of the subject matter?
4. Did the presentation include appropriate teaching strategies (handouts, lecture, group participation, etc.)?
5. Were the distributed materials helpful?
6. Was the content organized and easy to follow?
7. Were the topics relevant to the purpose of the award… to support mental health transformation activities such as: expansion of access to mental health services; advancement of evidence-based practices; promotion of early screening, assessment, referral, and treatment; and/or promotion of consumer and family driven mental health care?
8. Were the training objectives met?
9. Was the time allotted for the training sufficient?
Sub-Recipient Organization Name: Date of Monitoring Activity:
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Sub-Recipient Organization Name: Date of Monitoring Activity:
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7. Tribes - Requested
Narrative Question The federal government has a unique obligation to help improve the health of American Indians and Alaska Natives through the various health and human services programs administered by HHS. Treaties, federal legislation, regulations, executive orders, and Presidential memoranda support and define the relationship of the federal government with federally recognized tribes, which is derived from the political and legal relationship that Indian tribes have with the federal government and is not based upon race. SAMHSA is required by the 2009 Memorandum on Tribal Consultation56 to submit plans on how it will engage in regular and meaningful consultation and collaboration with tribal officials in the development of federal policies that have tribal implications.
Improving the health and well-being of tribal nations is contingent upon understanding their specific needs. Tribal consultation is an essential tool in achieving that understanding. Consultation is an enhanced form of communication, which emphasizes trust, respect, and shared responsibility. It is an open and free exchange of information and opinion among parties, which leads to mutual understanding and comprehension. Consultation is integral to a deliberative process that results in effective collaboration and informed decision-making with the ultimate goal of reaching consensus on issues.
In the context of the block grant funds awarded to tribes, SAMHSA views consultation as a government-to-government interaction and should be distinguished from input provided by individual tribal members or services provided for tribal members whether on or off tribal lands. Therefore, the interaction should be attended by elected officials of the tribe or their designees and by the highest possible state officials. As states administer health and human services programs that are supported with federal funding, it is imperative that they consult with tribes to ensure the programs meet the needs of the tribes in the state. In addition to general stakeholder consultation, states should establish, implement, and document a process for consultation with the federally recognized tribal governments located within or governing tribal lands within their borders to solicit their input during the block grant planning process. Evidence that these actions have been performed by the state should be reflected throughout the state's plan. Additionally, it is important to note that approximately 70 percent of American Indians and Alaska Natives do not live on tribal lands. The SMHAs, SSAs and tribes should collaborate to ensure access and culturally competent care for all American Indians and Alaska Natives in the states.
States shall not require any tribe to waive its sovereign immunity in order to receive funds or for services to be provided for tribal members on tribal lands. If a state does not have any federally recognized tribal governments or tribal lands within its borders, the state should make a declarative statement to that effect.
56 https://www.energy.gov/sites/prod/files/Presidential%20Memorandum%20Tribal%20Consultation%20%282009%29.pdf
Please respond to the following items: 1. How many consultation sessions has the state conducted with federally recognized tribes? As per SAMHSA's view of "consultation" as a government-to-government interaction that is distinguished from input provided by individual tribal members or services provided for tribal members whether on or off tribal lands where such consultation is attended by elected officials of the tribe or their designees and by the highest possible state officials, the South Carolina Department of Mental Health has not conducted consultation sessions with the State of South Carolina's only federally recognized tribe: the Catawba Indian Nation.
2. What specific concerns were raised during the consultation session(s) noted above? Not Applicable 3. Does the state have any activities related to this section that you would like to highlight? The promulgation of regulations regarding State Recognition of Native American Indian entities in the State of South Carolina resides in the purview of the State Commission for Minority Affairs (SC Code of Laws Section 1-31-40(A)(10)). The purpose of the Commission is “to study the causes and effects of the socio-economic deprivation of minorities in the State and to implement programs necessary to address inequities confronting minorities in the State.”
Pursuant to SC Code of Laws Section 1-31-40(A)(10) and SC Code of Regulations 139, which also falls under the purview of the State Commission for Minority Affairs, the State of South Carolina recognizes three categories of Native American Indian entities in South Carolina: Native American Indian Tribes, Native American Indian Groups, and Native American Indian Special Interest Organizations.
As a part of SC Code of Regulations 139, there is established a Native American Indian Advisory Committee whose purpose is “to preserve the true aboriginal culture of the Americas in the State of South Carolina and to advance the Native American Indian Printed: 7/19/20217/21/2021 2:103:2812:38 PM PM - -South South Carolina Carolina - OMB No. 0930-0168 Approved: 04/19/2019 Expires: 04/30/2022 PagePage 86 of1 of222 2 culture.” The Committee advises the State Commission for Minority Affairs by apprising it of matters regarding Native American Indian Affairs, identifying the needs and concerns of the Native American Indian people of South Carolina by bringing such needs and concerns to the attention of the Commission, making recommendations to the Commission to address the needs and concerns of Native American Indian people, and inviting individuals recognized as specialists in Native American Indian Affairs and representatives of the state and federal agencies to present information to members of the Advisory Committee.
The Native American Affairs Division Advisory Committee is comprised of representatives from the following: Catawba Indian Nation, Beaver Creek Indians, Chaloklowa Chickasaw Indian People, Eastern Cherokee, Southern Iroquois and United Tribes of SC, Edisto Natchez Kusso Tribe of South Carolina, Natchez Tribe of South Carolina, Native American Studies Program, Office of the Governor, University of South Carolina-Lancaster Native American Studies Center, Office of the State Archaeologist, Pee Dee Indian Nation of Upper South Carolina, South Carolina Institute of Archaeology and Anthropology, Pee Dee Indian Tribe of Beaver Creek, Pee Dee Indian Tribe, Piedmont American Indian Association (PAIA), Santee Indian Organization, Lower Eastern Cherokee Nation of South Carolina, Sumter Tribe of Cheraw Indians, The Waccamaw Indian People and the Wassamasaw Tribe of Varnertown Indians.
As of 2012, the South Carolina Mental Health State Planning Council secured representation from the State Commission for Minority Affairs by means of a state employee who is not only employed by the State Commission for Minority Affairs, but who also serves as a liaison to the Native American Indian Advisory Committee.
In addition, both Orangeburg Area Mental Health Center and Catawba Community Mental Health Center have established relationships with local tribes. Catawba CMHC partners with members of the ISWA tribe of the Catawba Indian Nation. Please indicate areas of technical assistance needed related to this section. Not Applicable OMB No. 0930-0168 Approved: 04/19/2019 Expires: 04/30/2022
Footnotes:
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9. Statutory Criterion for MHBG - Required for MHBG
Narrative Question Criterion 1: Comprehensive Community-Based Mental Health Service Systems Provides for the establishment and implementation of an organized community-based system of care for individuals with mental illness, including those with co-occurring mental and substance use disorders. Describes available services and resources within a comprehensive system of care, provided with federal, state, and other public and private resources, in order to enable such individual to function outside of inpatient or residential institutions to the maximum extent of their capabilities.
Please respond to the following items
Criterion 1
1. Describe available services and resources in order to enable individuals with mental illness, including those with co-occuring mental and substance use disorders to function outside of inpatient or residential institutions to the maximum extent of their capabilities. Services include assessment, crisis intervention, and individual and group therapy using evidenced based practices including CBT, TFCBT, AFCBT, DBT, EMDR, PCIT. PMA and nursing services are provided to monitor/reduce symptoms. Patients are offered PSS and PRS to assist in job placement, linking to the Vocational Rehabilitation Department, learning job and other skills to maintain stability in the community. Housing programs assist with placement and subsidy of rent to help patients maintain independent living. Mental Health Court programs, clinicians embedded at Department of Juvenile Justice sites, and the local jail provide interventions to engage patients in treatment and reduce recidivism. The EBP, NAVIGATE model, is used with patients in the FEP programs, as well. 2. Does your state coordinate the following services under comprehensive community-based mental health service systems?
a) Physical Health Yes No
b) Mental Health Yes No
c) Rehabilitation services Yes No
d) Employment services Yes No
e) Housing services Yes No
f) Educational Services Yes No
g) Substance misuse prevention and SUD treatment services Yes No
h) Medical and dental services Yes No
i) Support services Yes No
j) Services provided by local school systems under the Individuals with Disabilities Education Act Yes No (IDEA)
k) Services for persons with co-occuring M/SUDs Yes No
Please describe or clarify the services coordinated, as needed (for example, best practices, service needs, concerns, etc.) Best Practice Examples: Telepsychiatry School Mental Health Services Assessment/Mobile Crisis Metropolitan Children's Advocacy Center (MetCAC) Child and Family Services Parent-Child Interaction Therapy Clinical Care Coordination Deaf Services Peer Support Services Housing and Homeless Services Individual Placement and Supported Employment Program (IPS) Trauma Initiative Dialectical Behavior Therapy Printed: 7/19/20217/21/2021 2:093:2812:38 PM PM - -South South Carolina Carolina - OMB No. 0930-0168 Approved: 04/19/2019 Expires: 04/30/2022 PagePage 88 1 of of 222 10 Towards Local Care (TLC) Jail Diversion/Forensic Services The Art of Recovery
3. Describe your state's case management services Care Coordinators provide targeted case management services to qualifying individuals beginning with a comprehensive needs assessment. In the needs assessment, medical, dental, housing, employment, education, behavioral, and other community support needs are identified. Working collaboratively with the client, a Care Coordinator, who is knowledgeable about the local community resources, links the client to those resources. The Care Coordinator continues to monitor the services until goals are met and needs are resolved. Successful transition to community settings and access to needed services are focus points for Clinical Care Coordination services.
4. Describe activities intended to reduce hospitalizations and hospital stays. Office of Transition Programs – In 2019, DMH created the Office of Transition Programs to assist patients who have been hospitalized in DMH facilities for longer-term treatment to move from a hospital setting to the community and toward independent living. The office assists patients with their identified needs so they can access community resources in an effective and efficient way post-discharge. Transition Specialists work with patients to determine their recovery needs, their preference of where they want to live in the community, and to collaborate with stakeholders to ensure continuous communication as it relates to the patient’s discharge plans. Transition Specialists ensure effective communication between inpatient/outpatient staff regarding patients’ discharge needs and coordinate with all stakeholders (patient, family, clinical care coordinators, certified peer support specialists), streamlining the discharge process and improving the chance for successful transition to the community.
Clinical Care Coordination and Community Long-Term Care – In 2013, DMH launched the Office of Clinical Care Coordination with internally transferred staff, with the goal of improving outcomes for patients and reducing healthcare costs. Care Coordinators help patients find and access resources such as primary care, housing, entitlement programs, etc. Provision of Care Coordination services results in decreased re-hospitalizations and emergency room visits, and increased utilization of primary care physicians. Key features of the service include in-home visits and reporting and monitoring of patients’ progress in collaboration with referral sources. A special program under this division is Community Long-Term Care. It provides in-home support to participants eligible for nursing home care who opt to remain in their homes. Services may include home-delivered meals, personal care aides, incontinence supplies, adult day care, ramps, pest control, and other similar services. As of January 2021, 12 case managers provide services statewide, and case managers served 705 participants with an average of 10-15 new cases added monthly.
Community Placement – DMH sponsors or supports a variety of living arrangements for patients transitioning out of psychiatric hospital settings or receiving mental health services from one of its 16 community mental health centers. DMH community residential options include: - Housing & Homeless Services, which has funded the development of more than 1,600 housing units across the state for people with mental illnesses. - The TLC Program, which includes community care residences, Homeshare, supported apartments, rental assistance, and supportive services. - Community Residential Care Facilities (CRCFs), DHEC-licensed facilities that offer room, board and a degree of personal care for 2 or more people.
South Carolina Mobile Crisis – SC Mobile Crisis is a program created by DMH in partnership with SC Health and Human Services to enhance the Agency’s crisis services array by providing statewide capacity for on-site, emergency, psychiatric screening and assessment. Mobile Crisis provides services 24/7/365. The Program’s goals are to provide access and link those experiencing psychiatric crises to appropriate levels of care, reduce hospitalizations, and reduce unnecessary emergency department visits. Mobile Crisis builds partnerships with local law enforcement, hospitals, judges, community providers, and other mental health providers. Mobile Crisis provides an extension of DMH community mental health center services.
Embedded Mental Health Professionals – Embedded Mental Health Professionals (MHPs) support individuals, families, and communities by working with organizations outside of the DMH system to identify people who need referral to community-based resources and connection to mental health care.
SCDMH Emergency Department Telepsychiatry Program - Begun in 2008, the goals of the ED Telepsychiatry Program are to achieve timely mental health comprehensive evaluations and recommendations; initiate quality treatment services; reduce overall hospital length of stay; affect return on investment through hospital savings; and, provide successful post-emergency department transfer to aftercare services in community settings.
Crisis Stabilization – The Tri-County Crisis Stabilization Center (TCSC) opened in 2017. It is a 10-bed, voluntary, adult unit designed to stabilize individuals with increased psychiatric symptoms and divert people from inpatient hospitals, emergency departments, or jails. The Center accepts residents from Charleston, Dorchester, and Berkeley counties 24/7/365 from local emergency departments, law enforcement, outpatient providers, and self-referrals. The TCSC was opened through a funding partnership comprising MUSC, Roper Saint Francis, Charleston Center, the Charleston County Criminal Justice Coordinating Council, the Charleston County Sheriff's Office, and DMH’s Berkeley Mental Health Center and Charleston-Dorchester Mental Health Center. In addition to providing intensive psychiatric and clinical services, the TCSC also offers adjunct services on site including peer Printed: 7/19/20217/21/2021 2:093:2812:38 PM PM - -South South Carolina Carolina - OMB No. 0930-0168 Approved: 04/19/2019 Expires: 04/30/2022 PagePage 89 2 of of 222 10 support, care coordination, and vocational services, as well as referrals for entitlements. In 2019, TCSC also started receiving referrals from Trident Hospital.
The Ray C. Eubanks, Jr. Support Center opened in 2018. This peer drop-in, “living room”-concept hospital diversion program in Spartanburg is staffed and operated by DMH’s Spartanburg Area MHC in space donated by the Spartanburg Regional Healthcare System. The Eubanks Center: provides individuals with mental illnesses an additional support system outside of clinical settings; includes 3 Peer Support Specialists, 2 clinicians, 1 part-time care coordinator; has resulted in the diversion of 55 individuals from emergency rooms or hospitals from its opening to the start of the COVID-19 pandemic; and, is gradually reopening as the pandemic recedes. Services include: housing subsidies; an automated appointment reminder system; Individual Placement and Support; access to Advance Practice Registered Nurses; Intensive Care Teams; and, Intensive Family Support.
Printed: 7/19/20217/21/2021 2:093:2812:38 PM PM - -South South Carolina Carolina - OMB No. 0930-0168 Approved: 04/19/2019 Expires: 04/30/2022 PagePage 90 3 of of 222 10 Narratve Question Criterion 2: Mental Health System Data Epidemiology Contains an estimate of the incidence and prevalence in the state of SMI among adults and SED among children; and have quantitative targets to be achieved in the implementation of the system of care described under Criterion 1.
Criterion 2
In order to complete column B of the table, please use the most recent SAMHSA prevalence estimate or other federal/state data that describes the populations of focus.
Column C requires that the state indicate the expected incidence rate of individuals with SMI/SED who may require services in the state's M/SUD system.
MHBG Estimate of statewide prevalence and incidence rates of individuals with SMI/SED
Target Population (A) Statewide prevalence (B) Statewide incidence (C)
1.Adults with SMI 215,802 Not Indicated
2.Children with SED 74,660 Not Indicated
Describe the process by which your state calculates prevalence and incidence rates and provide an explanation as to how this information is used for planning purposes. If your state does not calculate these rates, but obtains them from another source, please describe. If your state does not use prevalence and incidence rates for planning purposes, indicate how system planning occurs in their absence. SCDMH participates in the Substance Abuse and Mental Health Services Administration's (SAMHSA) Uniform Reporting System (URS). From said system, SCDMH extracts a statewide estimate of the prevalence of SMI among adults and SED among children (URS Table 1).
SCDMH uses this comparative data in conjunction with community-centric feedback to evaluate and substantiate planning and implementation activities for its mental health system of care.
The community-centric feedback is based on dashboard performance measures that SCDMH Senior Management reviews and refines on a periodic basis. The measures are quick reference global indicators to evaluate actual performance against the strategic plan. The dashboard measures rely on a response to demand approach that seeks to refine the efficiency of the service delivery system in order to create capacity to meet demand as it presents itself. Within the Community Mental Health Centers, the dashboard measures are evaluated by CMHC individually and by SCDMH as a system.
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Criterion 3
Provides for a system of integrated services in order for children to receive care for their multiple needs. Does your state integrate the following services into a comprehensive system of care?
a) Social Services Yes No
b) Educational services, including services provided under IDE Yes No
c) Juvenile justice services Yes No
d) Substance misuse preventiion and SUD treatment services Yes No
e) Health and mental health services Yes No
f) Establishes defined geographic area for the provision of services of such system Yes No
Printed: 7/19/20217/21/2021 2:093:2812:38 PM PM - -South South Carolina Carolina - OMB No. 0930-0168 Approved: 04/19/2019 Expires: 04/30/2022 PagePage 92 5 of of 222 10 Narratve Question Criterion 4: Targeted Services to Rural and Homeless Populations and to Older Adults Provides outreach to and services for individuals who experience homelessness; community-based services to individuals in rural areas; and community-based services to older adults.
Criterion 4
a. Describe your state's targeted services to rural population. South Carolina Mobile Crisis – SC Mobile Crisis is a program created by DMH in partnership with SC Health and Human Services to enhance the Agency’s crisis services array by providing statewide capacity for on-site, emergency, psychiatric screening and assessment. Mobile Crisis provides services 24/7/365. The Program’s goals are to provide access and link those experiencing psychiatric crises to appropriate levels of care, reduce hospitalizations, and reduce unnecessary emergency department visits. Mobile Crisis builds partnerships with local law enforcement, hospitals, judges, community providers, and other mental health providers. Mobile Crisis provides an extension of DMH community mental health center services: - During business hours, DMH mental health centers serve patients by appointment, during walk-in hours, and via phone. - Mobile crisis provides mobile response to patients in the community who cannot or are unable to access services. - After hours, weekends, and on holidays, teams of 2 mental health professionals respond in person, remotely, or by phone to those experiencing psychiatric emergencies.
Highway 2 Hope Mobile Response Program – In 2020, DMH received a federal grant of $6,403,686 to provide support to South Carolinians in rural areas who are experiencing mental health and substance use crises or have unmet treatment needs. The primary focus of the initiative is a Mobile Response Program serving nine counties beginning in 2021, called the Highway to Hope Mobile Response Program (H2H). H2H will serve both adults and children in some of the most rural areas of South Carolina, utilizing nine RVs operated by DMH staff from the three DMH mental health centers that serve those areas: - Pee Dee Mental Health Center (Florence, Darlington, and Marion counties) - Tri-County Mental Health Center (Chesterfield, Dillon, and Marlboro counties) - Waccamaw Center for Mental Health (Horry, Georgetown, and Williamsburg counties)
H2H is based on a long-running, highly successful model for rural patients operated by DMH’s Charleston-Dorchester MHC since 2010. The program will offer both mental health treatment and some basic primary care services directly to those in need who may not have transportation to services otherwise. Based on the patient’s assessment, the professional care staff will also make referrals to other community resources. The RVs will be equipped with telehealth equipment, and the services available will be delivered both in-person and virtually.
DMH has seven telepsychiatry programs: Emergency Department Telepsychiatry; Community Telepsychiatry; Inpatient Services Telepsychiatry; EMS Telehealth Pilot Project; Deaf Services Telepsychiatry; School Telehealth; and, Nursing Home Telepsychiatry.
As SCDMH began preparations to address COVID-19, telehealth became a focus for ensuring the safety and well-being of its patients, residents, and staff. While most of SCDMH’s telehealth programs continued to deliver services without significant modifications, SCDMH’s Community Telepsychiatry Program rapidly enhanced its community-based and school mental health services with a new telehealth component to ensure continuity of care for patients: direct-to-patient (DTP). All of SCDMH’s Community Mental Health Centers (CMHC) remained open, but each was complemented with any array of DTP telehealth services; each CMHC equipped the majority of its clinical staff to work from home – more than 850 used a telehealth platform to do so. The majority of centers’ existing patients – adults, as well as children and families – received services using DTP as the primary medium. With the advent of SCDMH’s DTP presence, established a robust supervision and peer consultation regimen to ensure the highest standards of care for patients and their families. Feedback on DTP services has been positive, with patients and their families enjoying the convenience of DTP care. b. Describe your state's targeted services to the homeless population. Statewide Housing Units for People With Mental Illnesses - Over approximately 30 years, DMH has invested Agency funds to develop more than 1,100 housing units. - Proceeds from the sale of the “Bull Street” property are now used to fund new housing developments, in partnership with private non-profit and for-profit organizations.
Community Housing Rental Assistance Program - This program, launched in 2015, uses more than $2 million in state funds annually to provide rental assistance and related housing costs for DMH patients statewide. - Currently, the Program assists 354 units/569 patients and family members at average annual cost of under $6,500/unit.
Housing and Urban Development (HUD) Continuum of Care Permanent Supportive Housing Programs - These programs provide more than $1.1 million annually for rental assistance for formerly homeless patients and their families in 5 counties. - They currently assist 127 units/176 patients and family members through partnerships with three nonprofit agencies.
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Treatment for Adults Experiencing Homelessness in SC - In 2018, DMH received a grant of $1 million per year for five years from the Substance Abuse and Mental Health Services Administration (SAMHSA) to fund a new initiative called - The Project’s target population is individuals experiencing homelessness who also have serious mental illnesses and co- occurring substance use disorders with the goal of increasing access to evidence-based treatment services, peer support, services that support recovery, and connections to permanent housing. - Treatment sites are located at Prisma Health in Columbia and DMH’s Greater Greenville MHC in Greenville, with each providing intensive services using the Assertive Community Treatment model to serve a total of 75 people over the five-year grant period. c. Describe your state's targeted services to the older adult population. Examples of SCDMH’s targeted services to older adults include Pee Dee Mental Health Center’s Silver Years Program and Santee- Wateree Community Mental Health Center’s Elder Services Program.
The Silver Years Program is for older adults with symptoms of early dementia in addition to mental illness.
The Elder Services Program provides for staff who are trained in and sensitive to the needs of our older citizens. A staff psychiatrist oversees all client services. Staff work closely with each person’s personal physician and other community and support agencies to ensure the highest quality of care. Staff work with the "whole person", not just a piece of the puzzle. Some of the services provided include: Problem assessment, to include full psychological and cognitive assessment, psychiatric assessment for treatment planning, medication intervention & management, and medical referral as needed, Individual, family & group counseling, medication monitoring by nurses and case management, to assist the client in accessing both mental health and appropriate health and social services.
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Criterion 5
Describe your state's management systems. The South Carolina Department of Mental Health (SCDMH) has a comprehensive Staff Development and Training Program. It is housed in the Office of Evaluation, Training and Research (ETR).
A catalog of programs is provided below. Programs listed below may be provided on a schedule other than that which may be cited depending upon need – not all programs are provided routinely.
Evaluation, Training and Research (ETR) - Reports through the SCDMH Division of Inpatient Services. - Provides education and training for the entire agency though the traditional class room approach and an on-line learning management system. - Videoconferencing of trainings is also used for centers and facilities outside of Columbia. This saves on the cost of travel and allows the staff member to remain on site and be available before and after the training. This enhances their ability to continue to provide billable services. - All of the training provided is evaluated by class participants and the results are used to improve existing training and/or create new training offerings to meet identified needs. - The majority of the training is done using in house topic experts which makes them budget neutral.
Mentoring/Succession Program - The purpose of this 10 month long program is to develop a cadre of potential leaders within SCDMH to relieve the void of those retiring. It is also designed to provide participants with sage advice from their mentors, focused feedback and networking resources, thereby enhancing collegiality and building greater loyalty to SCDMH. - Each participant referred to as a mentee, attends class in Columbia one day a month. They are assigned a mentor that they meet with regularly and are given opportunities to attend management meetings and other leadership activities at their center or facility.
Supervisory Mini Series - Designed for individuals in SCDMH who were promoted to a supervisory role and new hires who will be in a supervisory role. - This program is offered live and via video conferencing. - It started out as a three-part mini-series but has grown to four parts based on identified needs of class participants and/or their supervisors.
Executive Leadership Development Program - Designed for individuals in the agency who may serve in Executive Leadership roles in the future. The program was implemented in 2008. - Class participants are required to complete a written Management Improvement Project. The purpose of this project is to give the program candidates the opportunity to use this experience to identify an area in SCDMH for targeted improvement and formulate a document about the improvement for all class participants. The project is required to focus on methods to create a new management initiative or improve or add value to one that is already in place in SCDMH.
Certified Nursing Assistant Training Program - Designed for individuals who will work at C. M. Tucker Nursing Care Center. - The Program began in 2011 and is certified by Health & Human Services. - This program is 120 hours long. Sixty hours are spent in the classroom and 60 hours are spent on the nursing units. Health and Human Services only requires 100 hours of instruction in order to take the certification exam. - SCDMH elected to make its program longer and believe that SCDMH residents benefit from this. - Unfortunately, the retention rate is very low as most leave SCDMH for higher paying positions in the local community.
Psychiatric Grand Rounds - Designed for physicians and other clinical staff. - This program is offered monthly live and via video conferencing. - Participants receive continuing education credit that they can use toward re-licensure. - The topics are selected based on the results of the Needs Assessment that is sent out to the clinical staff each year. - Is done in collaboration with the faculty of the Palmetto Health Medical Group at the University of South Carolina Department of Neuropsychiatry and Behavioral Science.
Annual Psychiatric Update Conference Printed: 7/19/20217/21/2021 2:093:2812:38 PM PM - -South South Carolina Carolina - OMB No. 0930-0168 Approved: 04/19/2019 Expires: 04/30/2022 PagePage 95 8 of of 222 10 - Conducted in September of each year. - Offered to Physicians and other Clinical Staff. - This is ETR’s largest training event of the year and is done with minimal cost. - Faculty from USC-SOM and the residents all participate in the program.
Continuing Education Offerings - ETR provides Continuing Medical Education (CME) for physicians. It also provides Continuing Education for Social Workers (SW), Licensed Professional Counselors (LPC) and Marriage & Family Therapist’s (MFT). SCDMH is also an approved provider of Continuing Nursing Education through the South Carolina Nurses Association. - Number of hours awarded depends on the program offering. In order to receive continuing education credit for programs, the programs must meet specific criteria and an application requesting the credit must be completed and approved prior to the event. - These credits can be used by staff to meet the requirements for re-licensure at no cost to them.
On-Line Learning Modules - SCDMH has an On-line Learning Management System which staff use to take training that is required to meet regulatory and accrediting standards. - All of the learning modules are designed and created in house by topic experts. - If the modules were not available staff would be required to attend the training in person. This would greatly reduce the number of billable hours for clinical staff. - In 2018 a Training Task Force was convened to conduct an extensive review of over 100 on-line learning modules. 46 were removed. 19 were combined with other modules. An elective curriculum was developed. This was all done in order to meet current best practices and regulatory and accrediting standards. - The task force continues its work to ensure all on-line learning modules remain current and relevant.
Psychiatric Residency/Fellowship Training Programs - SCDMH has a long standing agreement with Prisma Health (formerly Palmetto Health) for Psychiatric Residents to rotate in its facilities to gain hands-on psychiatric experience. - There are four Residency/Fellowship training programs at the School of Medicine. They are General Psychiatry, Child and Adolescent, Forensics and Geropsychiatry. All use SCDMH as part of their clinical rotation. - SCDMH Clinical psychiatrists provide supervision to the residents while in SCDMH. - This has proven to be an excellent recruiting tool for the agency as psychiatrists are in high demand nationwide. - ETR provides orientation to all residents who rotate in SCDMH facilities or centers.
Distance Learning - SCDMH recognizes that staff may not always be able to attend training offerings due to scheduling conflicts but still require continuing education credits for re-licensure. - Each month ETR researches on-line learning sites that offer high quality, evidenced based best practice training that staff can take at home or work as their time permits. - ETR emails staff the monthly offerings which include no cost or low-cost trainings that provide continuing education credit.
Nursing Orientation & Training - Nursing is a large and integral part of SCDMH. They have very stringent training requirements to meet regulatory and accrediting standards. - ETR provides an extensive and in-depth classroom orientation for all new hires in nursing. - ETR also provides annual competency verification of all nursing staff. This is an accrediting standard to ensure that staff remains qualified to perform the essential elements of their job duties. - Nursing staff must take and pass written tests and also demonstrate ability to perform identified nursing skills in order to be deemed competent to perform their job duties.
Certified Public Manager Program - Employees of SCDMH also participate in the South Carolina Certified Public Manager (CPM) Program. CPM is a "Nationally Accredited management development program for managers and supervisors in South Carolina state government. The program was initially accredited by the National CPM Consortium in 1996 and was reaccredited in 2006, 2011 and 2016. “The South Carolina Certified Public Manager (CPM) Program is a nationally accredited management development program for managers and supervisors in South Carolina state government. The program was initially accredited by the National CPM Consortium in 1996 and was reaccredited in 2016.
Philosophically, the South Carolina CPM Program strives to encourage innovative management practices and high ethical standards. The mission of the CPM Program is to provide quality training for public administrators, to assist agencies in developing future leaders, and to recognize management as a profession in the public sector. The CPM Program promotes on-the- job application of learning and gives participants experience in solving agency problems.”
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Footnotes:
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11. Quality Improvement Plan- Requested
Narrative Question In previous block grant applications, SAMHSA asked states to base their administrative operations and service delivery on principles of Continuous Quality Improvement/Total Quality Management (CQI/TQM). These CQI processes should identify and track critical outcomes and performance measures, based on valid and reliable data, consistent with the NBHQF, which will describe the health and functioning of the mental health and addiction systems. The CQI processes should continuously measure the effectiveness of services and supports and ensure that they continue to reflect this evidence of effectiveness. The state’s CQI process should also track programmatic improvements using stakeholder input, including the general population and individuals in treatment and recovery and their families. In addition, the CQI plan should include a description of the process for responding to emergencies, critical incidents, complaints, and grievances.
Please respond to the following items:
1. Has your state modified its CQI plan from FFY 2020-FFY 2021? Yes No
Please indicate areas of technical assistance needed related to this section. Not Applicable
OMB No. 0930-0168 Approved: 04/19/2019 Expires: 04/30/2022
Footnotes: The last update to the SCDMH Quality Improvement Plan was signed in September 2020.
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12. Trauma - Requested
Narrative Question Trauma 57 is a widespread, harmful, and costly public health problem. It occurs because of violence, abuse, neglect, loss, disaster, war and other emotionally harmful and/or life threatening experiences. Trauma has no boundaries with regard to age, gender, socioeconomic status, race, ethnicity, geography, or sexual orientation. It is an almost universal experience of people with mental and substance use difficulties. The need to address trauma is increasingly viewed as an important component of effective M/SUD service delivery. Additionally, it has become evident that addressing trauma requires a multi-pronged, multi-agency public health approach inclusive of public education and awareness, prevention and early identification, and effective trauma-specific assessment and treatment. To maximize the impact of these efforts, they need to be provided in an organizational or community context that is trauma-informed.
Individuals with experiences of trauma are found in multiple service sectors, not just in M/SUD services. People in the juvenile and criminal justice system have high rates of mental illness and substance use disorders and personal histories of trauma. Children and families in the child welfare system similarly experience high rates of trauma and associated M/SUD problems. Many patients in primary, specialty, emergency and rehabilitative health care similarly have significant trauma histories, which has an impact on their health and their responsiveness to health interventions. Schools are now recognizing that the impact of exposure to trauma and violence among their students makes it difficult to learn and meet academic goals. Communities and neighborhoods experience trauma and violence. For some these are rare events and for others these are daily events that children and families are forced to live with. These children and families remain especially vulnerable to trauma- related problems, often are in resource poor areas, and rarely seek or receive M/SUD care. States should work with these communities to identify interventions that best meet the needs of these residents.
In addition, the public institutions and service systems that are intended to provide services and supports for individuals are often re- traumatizing, making it necessary to rethink doing ?business as usual.? These public institutions and service settings are increasingly adopting a trauma-informed approach. A trauma-informed approach is distinct from trauma-specific assessments and treatments. Rather, trauma- informed refers to creating an organizational culture or climate that realizes the widespread impact of trauma, recognizes the signs and symptoms of trauma in clients and staff, responds by integrating knowledge about trauma into policies and procedures, and seeks to actively resist re-traumatizing clients and staff. This approach is guided by key principles that promote safety, trustworthiness and transparency, peer support, empowerment, collaboration, and sensitivity to cultural and gender issues. A trauma-informed approach may incorporate trauma- specific screening, assessment, treatment, and recovery practices or refer individuals to these appropriate services. It is suggested that states refer to SAMHSA's guidance for implementing the trauma-informed approach discussed in the Concept of Trauma58 paper.
57 Definition of Trauma: Individual trauma results from an event, series of events, or set of circumstances that is experienced by an individual as physically or emotionally harmful or life threatening and that has lasting adverse effects on the individual's functioning and mental, physical, social, emotional, or spiritual well-being. 58 Ibid
Please consider the following items as a guide when preparing the description of the state’s system:
1. Does the state have a plan or policy for M/SUD providers that guide how they will address individuals with Yes No trauma-related issues?
2. Does the state provide information on trauma-specific assessment tools and interventions for M/SUD Yes No providers?
3. Does the state have a plan to build the capacity of M/SUD providers and organizations to implement a Yes No trauma-informed approach to care?
4. Does the state encourage employment of peers with lived experience of trauma in developing trauma- Yes No informed organizations?
5. Does the state have any activities related to this section that you would like to highlight. SCDMH Trauma-Informed Systems - Support development and implementation of policies, procedures, and practices. - All patients offered evidence-based trauma assessments. - Patients experiencing trauma-related symptoms are offered evidence-based treatment options. - Practices in CMHCs and facilities do not create, nor re-create, traumatizing events for patients.
SCDMH Child and Family Services includes Trauma-Focused Cognitive Behavioral Therapy. SCDMH Office of Suicide Prevention Printed: 7/19/20217/21/2021 2:093:2812:38 PM PM - -South South Carolina Carolina - OMB No. 0930-0168 Approved: 04/19/2019 Expires: 04/30/2022 PagePage 99 of1 of222 2 includes cultural competency trainings focused on high-risk populations (e.g., LGBTQI+, individuals living with serious mental illnesses, trauma-informed care, etc.). Embedded Mental Health Professionals are a part of the Mental Health/Law Enforcement Alliance Project that supports victims of trauma.
Residents from the MUSC Residency Training Program receive educational experiences and supervision in Psychiatry through scheduled rotations at the Charleston Dorchester Mental Health Center (CDMHC). CDMHC is involved with a learning collaborative including DMH, the Crime Victim’s Center at MUSC, and the Dee Norton Lowcountry Children’s Center. This initiative revolves around Trauma-Focused Cognitive Behavioral Therapy. Residents train with CDMHC’s First Responder Support Team and Mobile Crisis. Medical students rotate regularly though CDMHC throughout the academic year. DMH has a contract with MUSC to provide forensic evaluation of adult criminal defendants in 10 counties in South Carolina. Please indicate areas of technical assistance needed related to this section. Not Applicable OMB No. 0930-0168 Approved: 04/19/2019 Expires: 04/30/2022
Footnotes:
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13. Criminal and Juvenile Justice - Requested
Narrative Question More than half of all prison and jail inmates meet criteria for having mental health problems, six in ten meet criteria for a substance use problem, and more than one-third meet criteria for having co-occurring mental and substance use problems. Youth in the juvenile justice system often display a variety of high-risk characteristics that include inadequate family support, school failure, negative peer associations, and insufficient use of community-based services. Most adjudicated youth released from secure detention do not have community follow-up or supervision; therefore, risk factors remain unaddressed.59
Successful diversion of adults and youth from incarceration or re-entering the community from detention is often dependent on engaging in appropriate M/SUD treatment. Some states have implemented such efforts as mental health, veteran and drug courts, Crisis Intervention Training (CIT) and re-entry programs to help reduce arrests, imprisonment and recidivism.60 A diversion program places youth in an alternative program, rather than processing them in the juvenile justice system. States should place an emphasis on screening, assessment, and services provided prior to adjudication and/or sentencing to divert persons with M/SUD from correctional settings. States should also examine specific barriers such as a lack of identification needed for enrollment Medicaid and/or the Health Insurance Marketplace; loss of eligibility for Medicaid resulting from incarceration; and care coordination for individuals with chronic health conditions, housing instability, and employment challenges. Secure custody rates decline when community agencies are present to advocate for alternatives to detention.
The MHBG and SABG may be especially valuable in supporting care coordination to promote pre-adjudication or pre-sentencing diversion, providing care during gaps in enrollment after incarceration, and supporting other efforts related to enrollment.
59 Journal of Research in Crime and Delinquency: : Identifying High-Risk Youth: Prevalence and Patterns of Adolescent Drug Victims, Judges, and Juvenile Court Reform Through Restorative Justice.Dryfoos, Joy G. 1990, Rottman, David, and Pamela Casey, McNiel, Dale E., and Ren?e L. Binder. OJJDP Model Programs Guide 60 http://csgjusticecenter.org/mental-health/
Please respond to the following items 1. Does the state (SMHA and SSA) have a plan for coordinating with the criminal and juvenile justice systems Yes No on diversion of individuals with mental and/or substance use disorders from incarceration to community treatment, and for those incarcerated, a plan for re-entry into the community that includes connecting to M/SUD services?
2. Does the state have a plan for working with law enforcement to deploy emerging strategies (e.g. civil Yes No citations, mobile crisis intervention, M/SUD provider ride-along, CIT, linkage with treatment services, etc.) to reduce the number of individuals with mental and/or substance use problems in jails and emergency rooms?
3. Does the state provide cross-trainings for M/SUD providers and criminal/juvenile justice personnel to Yes No increase capacity for working with individuals with M/SUD issues involved in the justice system?
4. Does the state have an inter-agency coordinating committee or advisory board that addresses criminal and Yes No juvenile justice issues and that includes the SMHA, SSA, and other governmental and non-governmental entities to address M/SUD and other essential domains such as employment, education, and finances?
5. Does the state have any activities related to this section that you would like to highlight? Mental Health Courts – Mental Health Courts aim to divert non-violent, adult offenders with serious mental illness from the criminal justice system. These Courts generally function as partnerships comprising an assigned judge (frequently a Probate Court judge), the local DMH mental health center, and the Solicitor’s Office. South Carolina currently has Mental Health Courts in the following counties: Aiken, Berkeley, Charleston, Greenville, Horry, Richland, and York. In 2017, DMH received a grant from The Duke Endowment to increase the number of Mental Health Courts and/or increase the capacity of existing courts, and to evaluate the outcomes of existing Courts. In addition, DMH receives $400,000 in recurring State appropriations from the General Assembly to increase the number of mental health courts and the capacity of exiting courts.
Embedded Mental Health Professionals – Embedded Mental Health Professionals (MHPs) support individuals, families, and communities by working with organizations outside of the DMH system to identify people who need referral to community-based resources and connection to mental health care. DMH has embedded MHPs in: - Law enforcement agencies o 7 Victims of Crime Act-funded MHPs serve child and adult victims of crime throughout Charleston and Dorchester counties. Printed: 7/19/20217/21/2021 2:093:2812:38 PM PM - -South South Carolina Carolina - OMB No. 0930-0168 Approved: 04/19/2019 Expires: 04/30/2022 PagePage 101 of1 of222 2 o 5 MHPs with the Mental Health/Law Enforcement Alliance Project support victims of trauma. - Detention Centers & Jail Liaisons o These MHPs identify detained offenders in need of referrals to mental health care and continuity of care in the community. - 911 Consolidated Dispatch o 1 MHP in Charleston County, who helps take calls that are mental health-related and supports Dispatch in determining the appropriate response. - Local Hospital Emergency Departments o 10 DMH community mental health centers have MHPs embedded in local hospital EDs to support the mental health needs of patients in the ED, including referral to community treatment and determining the need for inpatient admission. - Non-DMH Crisis Intervention Team o In 2021, DMH is embedding an MHP with the Richland County Sheriff’s Office who will respond alongside an ununiformed officer to calls involving mental health situations for de-escalation and crisis response.
First Responders-Training – Crisis Intervention Training (CIT): This 5-day training teaches law enforcement officers how to respond safely and appropriately to people with serious mental illness in crisis. Officers learn to recognize the signs of psychiatric distress, de-escalation techniques, and how to link people with treatment., avoiding officer injuries, consumer deaths, and tragedy for the community, as well as linking people with appropriate treatment. Classes are taught by a CIT Trainer from the National Alliance on Mental Illness-SC, DMH staff, law enforcement peers, and sometimes other community providers (e.g., county substance use disorder treatment providers).
Applied Suicide Intervention Skills Training (ASIST) – DMH Office of Suicide Prevention: LivingWorks ASIST is a two-day, face-to- face workshop that trains participants how to prevent suicide by recognizing signs, providing skilled intervention, and developing a safety plan to keep someone alive. Developed more than 35 years ago, ASIST is a continually updated, evidence- based training. DMH’s Office of Suicide Prevention Training Team provides this training to SC first responders of all types. Please indicate areas of technical assistance needed related to this section. Not Applicable OMB No. 0930-0168 Approved: 04/19/2019 Expires: 04/30/2022
Footnotes:
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15. Crisis Services - Required for MHBG
Narrative Question In the on-going development of efforts to build an robust system of evidence-based care for persons diagnosed with SMI, SED and SUD and their families via a coordinated continuum of treatments, services and supports, growing attention is being paid across the country to how states and local communities identify and effectively respond to, prevent, manage and help individuals, families, and communities recover from M/SUD crises. SAMHSA has recently released a publication, Crisis Services Effectiveness, Cost Effectiveness and Funding Strategies that states may find helpful.61 SAMHSA has taken a leadership role in deepening the understanding of what it means to be in crisis and how to respond to a crisis experienced by people with M/SUD conditions and their families. According to SAMHSA's publication, Practice Guidelines: Core Elements for Responding to Mental Health Crises62,
"Adults, children, and older adults with an SMI or emotional disorder often lead lives characterized by recurrent, significant crises. These crises are not the inevitable consequences of mental disability, but rather represent the combined impact of a host of additional factors, including lack of access to essential services and supports, poverty, unstable housing, coexisting substance use, other health problems, discrimination, and victimization."
A crisis response system will have the capacity to prevent, recognize, respond, de-escalate, and follow-up from crises across a continuum, from crisis planning, to early stages of support and respite, to crisis stabilization and intervention, to post-crisis follow-up and support for the individual and their family. SAMHSA expects that states will build on the emerging and growing body of evidence for effective community- based crisis-prevention and response systems. Given the multi-system involvement of many individuals with M/SUD issues, the crisis system approach provides the infrastructure to improve care coordination and outcomes, manage costs, and better invest resources. The following are an array of services and supports used to address crisis response.
61http://store.samhsa.gov/product/Crisis-Services-Effective-Cost-Effectiveness-and-Funding-Strategies/SMA14-4848 62Practice Guidelines: Core Elements for Responding to Mental Health Crises. HHS Pub. No. SMA-09-4427. Rockville, MD: Center for Mental Health Services, Substance Abuse and Mental Health Services Administration, 2009. http://store.samhsa.gov/product/Core-Elements-for-Responding-to-Mental-Health-Crises/SMA09-4427
Please check those that are used in your state: 1. Crisis Prevention and Early Intervention
a) Wellness Recovery Action Plan (WRAP) Crisis Planning
b) Psychiatric Advance Directives c) Family Engagement d) Safety Planning e) Peer-Operated Warm Lines f) Peer-Run Crisis Respite Programs g) Suicide Prevention
2. Crisis Intervention/Stabilization
a) Assessment/Triage (Living Room Model) b) Open Dialogue c) Crisis Residential/Respite d) Crisis Intervention Team/Law Enforcement e) Mobile Crisis Outreach f) Collaboration with Hospital Emergency Departments and Urgent Care Systems 3. Post Crisis Intervention/Support
a) Peer Support/Peer Bridgers b) Follow-up Outreach and Support
c) Family-to-Family Engagement
d) Connection to care coordination and follow-up clinical care for individuals in crisis e) Follow-up crisis engagement with families and involved community members Printed: 7/19/20217/21/2021 2:103:2812:38 PM PM - -South South Carolina Carolina - OMB No. 0930-0168 Approved: 04/19/2019 Expires: 04/30/2022 PagePage 103 of1 of222 4 f) Recovery community coaches/peer recovery coaches g) Recovery community organization 4. Does the state have any activities related to this section that you would like to highlight? South Carolina Mobile Crisis – SC Mobile Crisis is a program created by DMH in partnership with SC Health and Human Services to enhance the Agency’s crisis services array by providing statewide capacity for on-site, emergency, psychiatric screening and assessment. Mobile Crisis provides services 24/7/365. The Program’s goals are to provide access and link those experiencing psychiatric crises to appropriate levels of care, reduce hospitalizations, and reduce unnecessary emergency department visits. Mobile Crisis builds partnerships with local law enforcement, hospitals, judges, community providers, and other mental health providers. Mobile Crisis provides an extension of DMH community mental health center services: ? During business hours, DMH mental health centers serve patients by appointment, during walk-in hours, and via phone. ? Mobile crisis provides mobile response to patients in the community who cannot or are unable to access services. ? After hours, weekends, and on holidays, teams of 2 mental health professionals respond in person, remotely, or by phone to those experiencing psychiatric emergencies.
Crisis Stabilization – The Tri-County Crisis Stabilization Center (TCSC) opened in 2017. It is a 10-bed, voluntary, adult unit designed to stabilize individuals with increased psychiatric symptoms and divert people from inpatient hospitals, emergency departments, or jails. The Center accepts residents from Charleston, Dorchester, and Berkeley counties 24/7/365 from local emergency departments, law enforcement, outpatient providers, and self-referrals. The TCSC was opened through a funding partnership comprising MUSC, Roper Saint Francis, Charleston Center, the Charleston County Criminal Justice Coordinating Council, the Charleston County Sheriff's Office, and DMH’s Berkeley Mental Health Center and Charleston-Dorchester Mental Health Center. In addition to providing intensive psychiatric and clinical services, the TCSC also offers adjunct services on site including peer support, care coordination, and vocational services, as well as referrals for entitlements. In 2019, TCSC also started receiving referrals from Trident Hospital.
The Ray C. Eubanks, Jr. Support Center opened in 2018. This peer drop-in, “living room”-concept hospital diversion program in Spartanburg is staffed and operated by DMH’s Spartanburg Area MHC in space donated by the Spartanburg Regional Healthcare System. The Eubanks Center: provides individuals with mental illnesses an additional support system outside of clinical settings; includes 3 Peer Support Specialists, 2 clinicians, 1 part-time care coordinator; has resulted in the diversion of 55 individuals from emergency rooms or hospitals from its opening to the start of the COVID-19 pandemic; and, is gradually reopening as the pandemic recedes. Services include: housing subsidies; an automated appointment reminder system; Individual Placement and Support; access to Advance Practice Registered Nurses; Intensive Care Teams; and, Intensive Family Support.
The SCDMH Mobile Crisis Program provides 24/7 crisis response services for the 5.27 million citizens of South Carolina across 46 counties. Mobile Crisis was launched in 1987 in Charleston county, and in 2018 Mobile Crisis expanded statewide at each of the 16 local Community Mental Health Centers thus extending services to the 45 remaining counties. On-call staffing consists of masters-level Mobile Crisis clinicians assigned to respond in pairs, along with local law enforcement, to those in crisis within 60 minutes. In some areas, Mobile Crisis clinicians have the capability of responding via telehealth in coordination with local law enforcement, local probate courts and emergency departments. Limited crisis funding also allows for state-sponsored inpatient care at no cost to unfunded patients for up to 8 days on a limited basis. Local mental health centers provide outpatient care upon discharge and assist patients in a continuum of care as it relates to their stability, in hopes of avoiding future crisis episodes.
The primary goal of the SCDMH Mobile Crisis Program is to respond, assess and assist in the community those in crisis with de- escalation techniques. Mobile Crisis aims to avoid unnecessary jail and emergency room visits by creating safe environments through safety planning, thereby diverting clients from local emergency department admissions or incarceration.
SCDMH clinicians provide immediate on-site mental status examinations, partnering with patients, their families, friends and community partners/stakeholders to provide the least restrictive and most effective plan for keeping clients safe. Clinicians follow up with clients, connecting them to resources of continued care with appropriate local assisting agencies. SCDMH’s diversionary efforts are largely restricted by limited local resources available to those in crisis.
There are several opportunities to improve South Carolina’s mental health services as it relates to developing a comprehensive crisis continuum. Across the state, local resources vary greatly and often cannot fully meet the needs of someone in crisis. In the Charleston area, mobile clinicians have several resources (e.g. access to a crisis stabilization unit) for those requiring a higher level of care to help avoid local ER admissions. The Tri-County Crisis Stabilization Unit, with just 10 beds, provides an excellent resource for patient stabilization. The majority of the state is not as rich in resources and lacks resources such as crisis stabilization units.
In 2020, the statewide SCDMH Call Center fielded more than 62,000 calls while SCDMH mobile clinicians responded to more than 2,500 crisis calls in the communities of South Carolina. This call center focuses on fielding crisis calls while providing knowledge of available resources, deploying mobile crisis teams and diverting those in need to local crisis stabilization services. This call center would benefit from funding that would improve the infrastructure (technology) and staffing needs and in turn support a more streamlined response.
Finally, South Carolina currently only has one Lifeline Center that answers approximately 70% of the in-state calls. Additional
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Footnotes:
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South Carolina Department of Mental Health - Community Mental Health Services Block Grant Application
Set-Aside - Crisis Services
Guidance for the Revision of the FY2020-2021 Mental Health Block Grant Application for the New Crisis Services 5% Set-Aside On February 3, 2021, the Substance Abuse and Mental Health Services Administration (SAMHSA) issued guidance related to the use of Mental Health Block Grant (MHBG) funds for crisis services. The guidance originated from the Consolidated Appropriations Act, 2021, and the Coronavirus Response and Relief Supplement Appropriations Act, 2021 [P.L. 116-260] as outlined below.
Substance Abuse and Mental Health Services Administration (SAMHSA) is directed by Congress through the Consolidated Appropriations Act, 2021 and the Coronavirus Response and Relief Supplement Appropriations Act, 2021 [P.L. 116-260], to set aside 5 percent of the Mental Health Block Grant (MHBG) allocation for each state to support evidence-based crisis systems. Congress specifically provided an increase to federal fiscal year (FY) 2021 MHBG appropriation over the FY 2020 level to help states meet this new requirement without losing funds for existing services. The appropriation bill has the following requirement for the new 5 percent set-aside.
Furthermore, the Committee directs a new five percent set- aside of the total for evidence-based crisis care programs addressing the needs of individuals with serious mental illnesses and children with serious mental and emotional disturbances. The Committee directs SAMHSA to use the set-aside to fund, at the discretion of eligible States and Territories, some or all of a set of core crisis care elements including: centrally deployed 24/7 mobile crisis units, short-term residential crisis stabilization beds, evidence-based protocols for delivering services to individuals with suicide risk, and regional or State- wide crisis call centers coordinating in real time.
SCDMH Update as of July 8, 2021 The Office of Emergency Services is utilizing block grant funds to expand initiatives supporting mental health and law enforcement collaboration in an effort to better serve our patients and the larger community. The first of these block grant funded initiatives is in response to the support embedded clinician positions have received under the BCBS grant funded Mental Health Law Enforcement Alliance Project (MHLEAP). The success of MHLEAP has sparked interest amongst other law enforcement agencies across the state and resulted in cost share positions with DMH. At this time, block grants are allocated to support eight embedded positions. These embedded clinicians are capable of receiving referrals from their embedded agencies to identify children and families who are at risk for high psychological and functional impairment due to trauma. Embedded clinicians work collaboratively with law enforcement to meet the needs of these patients as well as work alongside our Mobile Crisis clinicians for crisis intervention as needed. New initiatives within these embedded positions include the capability for two of the clinicians to collaborate with Detention Centers to see incarcerated individuals and assess their needs, making treatment recommendations and referrals as appropriate. Block grants are also being utilized for two positions in Columbia and Charleston to hire and embed CIT clinicians. These clinicians work with plain clothed, CIT trained officers and ride in unmarked vehicles to respond to and de-escalate psychiatric calls for service. Another block grant supported position is to embed a clinician in 911 Dispatch in Charleston for diversion purposes. This clinician will have the capability to assist Dispatch with triaging 911 psychiatric calls to determine level of appropriate response needed. The final portion of allocated block grant funds are being used to support a new Program Manager Position for our FRST (First Responder Support Team) Program. The FRST Program Manager will be responsible for oversight and growth of FRST which offers behavioral health and crisis services for first responders and their families. FRST offers an array of services including assessment and referral, short term counseling, EMDR, and individual, couples, and family counseling.
Conclusion Utilizing crisis funds to hire additional embedded clinicians with law enforcement agencies and hiring additional mobile crisis clinicians, as applicable, further expands access to care to the communities of South Carolina. [End]
FY2022-2023 Application - 1
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16. Recovery - Required
Narrative Question The implementation of recovery supports and services are imperative for providing comprehensive, quality M/SUD care. The expansion in access to and coverage for health care compels SAMHSA to promote the availability, quality, and financing of vital services and support systems that facilitate recovery for individuals. Recovery encompasses the spectrum of individual needs related to those with mental disorders and/or substance use disorders. Recovery is supported through the key components of: health (access to quality health and M/SUD treatment); home (housing with needed supports), purpose (education, employment, and other pursuits); and community (peer, family, and other social supports). The principles of recovery guide the approach to person-centered care that is inclusive of shared decision-making. The continuum of care for these conditions includes psychiatric and psychosocial interventions to address acute episodes or recurrence of symptoms associated with an individual's mental or substance use disorder. Because mental and substance use disorders are chronic conditions, systems and services are necessary to facilitate the initiation, stabilization, and management of long-term recovery.
SAMHSA has developed the following working definition of recovery from mental and/or substance use disorders:
Recovery is a process of change through which individuals improve their health and wellness, live a self-directed life to the greatest extent possible, and strive to reach their full potential.
In addition, SAMHSA identified 10 guiding principles of recovery:
• Recovery emerges from hope;
• Recovery is person-driven;
• Recovery occurs via many pathways;
• Recovery is holistic;
• Recovery is supported by peers and allies;
• Recovery is supported through relationship and social networks;
• Recovery is culturally-based and influenced;
• Recovery is supported by addressing trauma;
• Recovery involves individuals, families, community strengths, and responsibility;
• Recovery is based on respect.
Please see SAMHSA's Working Definition of Recovery from Mental Disorders and Substance Use Disorders.
States are strongly encouraged to consider ways to incorporate recovery support services, including peer-delivered services, into their continuum of care. Technical assistance and training on a variety of such services are available through the SAMHSA supported Technical Assistance and Training Centers in each region. SAMHSA strongly encourages states to take proactive steps to implement recovery support services. To accomplish this goal and support the wide-scale adoption of recovery supports in the areas of health, home, purpose, and community, SAMHSA has launched Bringing Recovery Supports to Scale Technical Assistance Center Strategy (BRSS TACS). BRSS TACS assists states and others to promote adoption of recovery-oriented supports, services, and systems for people in recovery from substance use and/or mental disorders.
Because recovery is based on the involvement of consumers/peers/people in recovery, their family members and caregivers, SMHAs and SSAs can engage these individuals, families, and caregivers in developing recovery-oriented systems and services. States should also support existing and create resources for new consumer, family, and youth networks; recovery community organizations and peer-run organizations; and advocacy organizations to ensure a recovery orientation and expand support networks and recovery services. States are strongly encouraged to engage individuals and families in developing, implementing and monitoring the state M/SUD treatment system.
Please respond to the following:
1. Does the state support recovery through any of the following:
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b) Required peer accreditation or certification? Yes No
c) Block grant funding of recovery support services. Yes No
d) Involvement of persons in recovery/peers/family members in planning, implementation, or Yes No evaluation of the impact of the state's M/SUD system?
2. Does the state measure the impact of your consumer and recovery community outreach activity? Yes No
3. Provide a description of recovery and recovery support services for adults with SMI and children with SED in your state. It is the mission of SCDMH to support Recovery Initiatives through the development of empowered patient leadership for persons served through the agency. SCDMH empowers patients by hiring them to be: planners; policy makers; program evaluators; service providers. SCDMH also supports recovery through training and education on recovery principles and recovery-oriented practice and systems, including the role of peers in care; required peer accreditation or certification; block grant funding of recovery support services; involvement of persons in recovery/peers/family members in planning, implementation, or evaluation of the impact of the mental health system; and measurement of the impact of consumer and recovery community outreach activities.
Patient Advisory Boards – Patient Advisory Boards (PABs) exist to provide mechanisms for positive collaboration and communication, and to empower patients at all Departmental levels. PABs provide unique and independent opportunities for input and involvement in the areas of planning, policy-making, program evaluation, and service provision. Most states have a statewide or regional PAB, but DMH is among just a few state systems that have mandated the establishment of PABs at every center and hospital. 4. Provide a description of recovery and recovery support services for individuals with substance use disorders in your state. Recovery is the process by which an individual overcomes the challenges of a mental illness to lead a life of meaning and purpose.
The South Carolina Department of Alcohol and Other Drug Abuse Services is the lead agency for recovery and recovery support services for individuals with substance use disorders in the state. 5. Does the state have any activities that it would like to highlight? The Art of Recovery – The Art of Recovery showcases the talents of those receiving services from DMH and the role that art can play in the recovery process, and gives individuals living with mental illnesses the opportunity to exhibit and sell their works of art.
Pieces are submitted from across South Carolina by participants who use a variety of artistic media, not only as a means of empowerment, but also as a tool to educate the public about, and dispel the stigma associated with, mental illness.
DMH staff volunteers mat, frame, hang, transport, and display pieces in venues throughout the state. Works rotate on a frequent basis.
Pieces from The Art of Recovery have traveled across South Carolina, featured in public galleries, community centers, and conferences across the state The program has been an official exhibitor at the Internationally known Piccolo Spoleto Festival since 2013.
A widely acclaimed program, The Art of Recovery received the 2006 Elizabeth O’Neill Verner Governor’s Award for the Arts, the highest Arts honor in South Carolina It has received grant funding from Blue Cross Blue Shield of South Carolina and serves as a model for other mental health groups in the U.S. Please indicate areas of technical assistance needed related to this section.
Not Applicable OMB No. 0930-0168 Approved: 04/19/2019 Expires: 04/30/2022
Footnotes:
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17. Community Living and the Implementation of Olmstead - Requested
Narrative Question The integration mandate in Title II of the Americans with Disabilities Act (ADA) and the Supreme Court's decision in Olmstead v. L.C., 527 U.S. 581 (1999), provide legal requirements that are consistent with SAMHSA's mission to reduce the impact of M/SUD on America's communities. Being an active member of a community is an important part of recovery for persons with M/SUD conditions. Title II of the ADA and the regulations promulgated for its enforcement require that states provide services in the most integrated setting appropriate to the individual and prohibit needless institutionalization and segregation in work, living, and other settings. In response to the 10th anniversary of the Supreme Court's Olmstead decision, the Coordinating Council on Community Living was created at HHS. SAMHSA has been a key member of the council and has funded a number of technical assistance opportunities to promote integrated services for people with M/SUD needs, including a policy academy to share effective practices with states.
Community living has been a priority across the federal government with recent changes to section 811 and other housing programs operated by the Department of Housing and Urban Development (HUD). HUD and HHS collaborate to support housing opportunities for persons with disabilities, including persons with behavioral illnesses. The Department of Justice (DOJ) and the HHS Office for Civil Rights (OCR) cooperate on enforcement and compliance measures. DOJ and OCR have expressed concern about some aspects of state mental health systems including use of traditional institutions and other settings that have institutional characteristics to serve persons whose needs could be better met in community settings. More recently, there has been litigation regarding certain evidenced-based supported employment services such as sheltered workshops. States should ensure block grant funds are allocated to support prevention, treatment, and recovery services in community settings whenever feasible and remain committed, as SAMHSA is, to ensuring services are implemented in accordance with Olmstead and Title II of the ADA.
It is requested that the state submit their Olmstead Plan as a part of this application, or address the following when describing community living and implementation of Olmstead: Please respond to the following items 1. Does the state's Olmstead plan include :
Housing services provided. Yes No
Home and community based services. Yes No
Peer support services. Yes No
Employment services. Yes No
2. Does the state have a plan to transition individuals from hospital to community settings? Yes No
Please indicate areas of technical assistance needed related to this section. SCDMH finalized its Continuity of Care Plan (SCDMH’s Olmstead Plan) in March of 2020. SCDMH reviews its Continuity of Care Plan (Olmstead Plan) annually and conducted its first update of the final plan in March of 2021. Disability Rights South Carolina (formerly known as Protection and Advocacy for People with Disabilities of South Carolina) reviewed and contributed to the 2020 finalized plan and the 2021 update. OMB No. 0930-0168 Approved: 04/19/2019 Expires: 04/30/2022
Footnotes:
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18. Children and Adolescents M/SUD Services - Required MHBG, Requested SABG
Narrative Question MHBG funds are intended to support programs and activities for children and adolescents with SED, and SABG funds are available for prevention, treatment, and recovery services for youth and young adults with substance use disorders. Each year, an estimated 20 percent of children in the U.S. have a diagnosable mental health condition and one in 10 suffers from a serious emotional disturbance that contributes to substantial impairment in their functioning at home, at school, or in the community.63. Most mental disorders have their roots in childhood, with about 50 percent of affected adults manifesting such disorders by age 14, and 75 percent by age 24.64. For youth between the ages of 10 and 24, suicide is the third leading cause of death and for children between 12 and 17, the second leading cause of death.65.
It is also important to note that 11 percent of high school students have a diagnosable substance use disorder involving nicotine, alcohol, or illicit drugs, and nine out of 10 adults who meet clinical criteria for a substance use disorder started smoking, drinking, or using illicit drugs before the age of 18. Of people who started using before the age of 18, one in four will develop an addiction compared to one in twenty-five who started using substances after age 21.66. Mental and substance use disorders in children and adolescents are complex, typically involving multiple challenges. These children and youth are frequently involved in more than one specialized system, including mental health, substance abuse, primary health, education, childcare, child welfare, or juvenile justice. This multi-system involvement often results in fragmented and inadequate care, leaving families overwhelmed and children's needs unmet. For youth and young adults who are transitioning into adult responsibilities, negotiating between the child- and adult-serving systems becomes even harder. To address the need for additional coordination, SAMHSA is encouraging states to designate a point person for children to assist schools in assuring identified children are connected with available mental health and/or substance abuse screening, treatment and recovery support services.
Since 1993, SAMHSA has funded the Children's Mental Health Initiative (CMHI) to build the system of care approach in states and communities around the country. This has been an ongoing program with 173 grants awarded to states and communities, and every state has received at least one CMHI grant. Since then SAMHSA has awarded planning and implementation grants to states for adolescent and transition age youth SUD treatment and infrastructure development. This work has included a focus on financing, workforce development and implementing evidence- based treatments.
For the past 25 years, the system of care approach has been the major framework for improving delivery systems, services, and outcomes for children, youth, and young adults with mental and/or SUD and co-occurring M/SUD and their families. This approach is comprised of a spectrum of effective, community-based services and supports that are organized into a coordinated network. This approach helps build meaningful partnerships across systems and addresses cultural and linguistic needs while improving the child, youth and young adult functioning in home, school, and community. The system of care approach provides individualized services, is family driven; youth guided and culturally competent; and builds on the strengths of the child, youth or young adult and their family to promote recovery and resilience. Services are delivered in the least restrictive environment possible, use evidence-based practices, and create effective cross-system collaboration including integrated management of service delivery and costs.67.
According to data from the 2015 Report to Congress68 on systems of care, services: 1. reach many children and youth typically underserved by the mental health system; 2. improve emotional and behavioral outcomes for children and youth; 3. enhance family outcomes, such as decreased caregiver stress; 4. decrease suicidal ideation and gestures; 5. expand the availability of effective supports and services; and 6. save money by reducing costs in high cost services such as residential settings, inpatient hospitals, and juvenile justice settings.
SAMHSA expects that states will build on the well-documented, effective system of care approach to serving children and youth with serious M/SUD needs. Given the multi- system involvement of these children and youth, the system of care approach provides the infrastructure to improve care coordination and outcomes, manage costs, and better invest resources. The array of services and supports in the system of care approach includes:
• non-residential services (e.g., wraparound service planning, intensive case management, outpatient therapy, intensive home-based services, SUD intensive outpatient services, continuing care, and mobile crisis response);
• supportive services, (e.g., peer youth support, family peer support, respite services, mental health consultation, and supported education and employment); and
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63Centers for Disease Control and Prevention, (2013). Mental Health Surveillance among Children ? United States, 2005-2011. MMWR 62(2). 64Kessler, R.C., Berglund, P., Demler, O., Jin, R., Merikangas, K.R., & Walters, E.E. (2005). Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry, 62(6), 593-602. 65Centers for Disease Control and Prevention. (2010). National Center for Injury Prevention and Control. Web-based Injury Statistics Query and Reporting System (WISQARS) [online]. (2010). Available from www.cdc.gov/injury/wisqars/index.html. 66The National Center on Addiction and Substance Abuse at Columbia University. (June, 2011). Adolescent Substance Abuse: America's #1 Public Health Problem. 67Department of Mental Health Services. (2011) The Comprehensive Community Mental Health Services for Children and Their Families Program: Evaluation Findings. Annual Report to Congress. Available from https://store.samhsa.gov/product/Comprehensive-Community-Mental-Health-Services-for-Children-and-Their-Families-Program- Evaluation-Findings-Executive-Summary/PEP12-CMHI0608SUM 68 http://www.samhsa.gov/sites/default/files/programs_campaigns/nitt-ta/2015-report-to-congress.pdf
Please respond to the following items: 1. Does the state utilize a system of care approach to support:
a) The recovery and resilience of children and youth with SED? Yes No
b) The recovery and resilience of children and youth with SUD? Yes No
2. Does the state have an established collaboration plan to work with other child- and youth-serving agencies in the state to address M/SUD needs:
a) Child welfare? Yes No
b) Juvenile justice? Yes No
c) Education? Yes No
3. Does the state monitor its progress and effectiveness, around:
a) Service utilization? Yes No
b) Costs? Yes No
c) Outcomes for children and youth services? Yes No
4. Does the state provide training in evidence-based:
a) Substance misuse prevention, SUD treatment and recovery services for children/adolescents, and Yes No their families?
b) Mental health treatment and recovery services for children/adolescents and their families? Yes No
5. Does the state have plans for transitioning children and youth receiving services:
a) to the adult M/SUD system? Yes No
b) for youth in foster care? Yes No
6. Describe how the state provide integrated services through the system of care (social services, educational services, child welfare services, juvenile justice services, law enforcement services, substance use disorders, etc.)
South Carolina used two federal grants, a System of Care Infrastructure Initiative awarded to the Mental Health Agency and an Adolescent Substance Abuse Treatment Coordination Grant to the Substance Abuse Agency, to combined efforts and implement the No Wrong Door Initiative. The most notable sustained outcome was the founding of the Joint Council on Children and Adolescents. Established in 2007 the Joint Council strives to transform service delivery based on the values and principles of a system of care. This body is comprised of child serving agency and organizational directors with the purpose of combining efforts to move the state towards a coordinated system of care which would reduce duplication and utilize the parent/youth voice to inform and improve services and supports.
Most recently noted is a partnership with our child welfare agency, utilizing a coordinated approach to human child trafficking. The agencies and organizations agreed to use a universal screening and a coordinated approach to identification, referrals and training, which is being developed for all providers and school personnel in the state.
SCDMH continues to be a leader in our school based mental health initiative with the goal, in partnership with the state department of education and our independent local school districts, to increase access to mental health services for all children and adolescents across the state.
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SCDMH is also partnering to provide a consultation network across the state to child care and early education centers in collaboration with South Carolina Infant Mental Health Association, Child Welfare, First Steps and Head Start Centers across the state. 7. Does the state have any activities related to this section that you would like to highlight? SCDMH is the recipient of a Healthy Transition Grant, Roads of Independence, currently in year three and in an area of the state that at one point was leading the nation in crime. A robust group of community partners make up the advisory team which includes housing, employment/ local colleges, Child Welfare, Juvenile Justice, the Fatherhood Initiative, etc., with an average of 50 partners willing to assume a role on the advisory council to improve the plight of young adults in a tri-county area of the state. SCDMH has identified additional Block grant opportunities to expand this initiative to another critical part of the state. The HT grant uses a System of Care approach which supports young adults directing services and supports provided to reach their highly individualized identified goals. Please indicate areas of technical assistance needed related to this section. Not Applicable OMB No. 0930-0168 Approved: 04/19/2019 Expires: 04/30/2022
Footnotes:
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19. Suicide Prevention - Required for MHBG
Narrative Question Suicide is a major public health concern, it is the 10th leading cause of death overall, with over 40,000 people dying by suicide each year in the United States. The causes of suicide are complex and determined by multiple combinations of factors, such as mental illness, substance abuse, painful losses, exposure to violence, and social isolation. Mental illness and substance abuse are possible factors in 90 percent of the deaths from suicide, and alcohol use is a factor in approximately one-third of all suicides. Therefore, SAMHSA urges M/SUD agencies to lead in ways that are suitable to this growing area of concern. SAMHSA is committed to supporting states and territories in providing services to individuals with SMI/SED who are at risk for suicide using MHBG funds to address these risk factors and prevent suicide. SAMHSA encourages the M/SUD agencies play a leadership role on suicide prevention efforts, including shaping, implementing, monitoring, care, and recovery support services among individuals with SMI/SED.
Please respond to the following items:
1. Have you updated your state's suicide prevention plan in the last 2 years? Yes No
2. Describe activities intended to reduce incidents of suicide in your state. See attached two reports: SCYSPI Final Report and South Carolina Zero Suicide Initiative.
• In addition to these activities, SCDMH has the Lifeline Capacity Building Grant (SCDMH is in the second year of the 2-year grant). Prior to this grant, South Carolina’s one Lifeline call center only had capacity to answer 5% of one area code (864, which covered 11 counties). On December 2, 2020, it opened to all area codes in the state and now has an average statewide answer rate of 67%. SCDMH received the 988 Planning Grant (Jan-Sept 2021) and are now working on how the state will implement the comprehensive 988 Continuum of Crisis Response. From May 2020 to May 2021, there were 36, 978 calls to the Lifeline from South Carolina phone numbers. • SCDMH worked with our state legislators to draft S. 231 Student Identification Card Suicide Prevention Act. (see attached) In my research on recent records, this is only the second bill specific to suicide prevention enacted in SC, the first being the Jason Flatt Act. Though H. 3257 is not necessarily suicide prevention focused, we were thrilled to see it adopted as well last October. • SCDMH cochairs the SC Suicide Prevention Coalition, along with Sen. Katrina Shealy and Vanessa Riley from the SC Chapter of the American Foundation for Suicide Prevention. This coalition is comprised of a diverse statewide group of stakeholders and has seen interest in this work dramatically increase since 2019, with attendance 3x (approx.. 80 individuals total) that of meetings in the prior years. • Partnered with AFSP National and the SC Chapter to launch a statewide interactive screener program – Hope.ConnectsYou.org. It accessible to the public on the SCDMH, DAODAS and the SCDMH Office of Suicide Prevention websites. This implementation is the first of its kind in the U.S. in that all residents of South Carolina over the age of 18 are eligible to participate, and so it is especially exciting. Those completing a screen will receive a response from a SCDMH or DAODAS staff member who can offer guidance, support, and resources to help connect them with mental health and addiction services. (see attached) • SCDMH also partnered with the Crisis Text Line for a state specific code, HOPE4SC. Having a state specific code allows us to track data in SC, as well as being able to further the message that Hope Lives in SC. From May 2020 to May 2021, there were 17.8k conversations from South Carolina phone numbers. • SCDMH launched universal planning within our divisions. The approach is intended to be proactive, recognizing that we as humans are all vulnerable to having darkness overwhelm our ability to cope on any given day. We want those in distress to know how to care for themselves and reach out before the distress begins. 94% of our patients have an active safety plan and these are reviewed throughout points of treatment. We also utilize Columbia-Suicide Severity Rating Scale (C-SSRS) for universal screening at each point of contact. 3. Have you incorporated any strategies supportive of Zero Suicide? Yes No
4. Do you have any initiatives focused on improving care transitions for suicidal patients being discharged Yes No from inpatient units or emergency departments?
5. Have you begun any targeted or statewide initiatives since the FFY 2020-FFY 2021 plan was submitted? Yes No
If so, please describe the population targeted. • SCDMH increased the number of trained providers in evidenced based therapies (DBT, CAMS, CBT-SP, ABFT for suicide care, Suicide 2 Hope, and Suicide Bereavement Clinician Training) with in the last year from approx. 120 providers to 1000. • Faith Community Outreach – this was done in recognition of the foundation of faith in community engagement in our state, as well as recognizing SC has a higher rate of suicide among faith leaders themselves. - Suicide Prevention in Ministry Settings – pilot program for 120 faith leaders in our state (see attached SC pilot marketing flyer) - From the pilot, we had interest to launch the first SC Faith Coalition Against Suicide (SCFCAS). They are working now to develop a mission statement, goals and a Fall launch event Printed: 7/19/20217/21/2021 2:093:2812:38 PM PM - -South South Carolina Carolina - OMB No. 0930-0168 Approved: 04/19/2019 Expires: 04/30/2022 PagePage 113 1 of of 222 91 - SCDMH has also developed a Church Outreach Committee to address how we as an agency can increase our outreach to faith communities • Work with military populations - From 2016 to 2018 in South Carolina, suicide accounted for 81.9% of violent deaths among current or former military service members. In 2019, 150 of those who had served in the military (South Carolina residents only, any location) died by suicide. - We have a Military Suicide Prevention Panel that includes representation from VA, SCNG, Fort Jackson, 82nd Regional Support Command, OSP/SCDMH, AFSP SC, and Shaw AFB. - SCDMH provided testimony this year to the SC Joint Committee to Study Certain Issues Affecting Veterans’ Intervention Services - SCDMH participated in the SC Team for the VA/SAMHSA Governor’s Challenge to Prevent Suicide Among Service Members, Veterans, and their Families (SMVF). SCDMH staff served as team lead as well. (see attached priority areas) - SCDMH participated as team members on the Pickens Co. team for SMVF Crisis Intercept Map for Suicide Prevention. (see attached fact sheet about the project) • SC State Agencies - We have been collaborating with our sister agencies (SCPPP, SCDVA, SCDCA, SCDHEC, SCDSS, SCHHS, SCDOC, SCDE, DAODAS, SCCJA and SCFA) to launch training initiatives, provide postvention support when they have experienced losses, and increase access to resources for their staff. SCPPP, SCDVA and SCDCA have all trained their entire workforce. SCDHEC has just finalized a policy for annual suicide prevention training for their entire workforce. SCDMH has provided 10, 000 SCDE educators with access to suicide prevention training. • Children serving agencies: - SCDMH has provided 10, 000 SCDE educators with access to suicide prevention training. - SCDMH provided training to the SCDCA staff, as well as their Guardian ad Litem volunteers statewide. - SCDMH provided the SafeSide Youth Services training to 150 SCDSS Foster Group Home workers. We then provided the same training to 100 foster parents through the SC Foster Parent Assoc. SC is the first state to use this training with foster parents. (see attached child welfare snippet) • Primary Care Practices and Healthcare organizations - SCDMH, in partnership with the American Foundation for Suicide Prevention, provided the SafeSide Training for Primary Care to several different settings since Spring 2020. Lexington Medical Center was the first to have 4 practices to complete the training and be recognized by these partners. They then went onto to make the commitment to train all of their ambulatory practices, being the first large hospital system to take this training in partnership with AFSP. SCDMH remains a strong partner. Other settings included 2 residency programs in our state, pediatric practices and internal medicine practices. (see attached flyer) • SCDMH partnered with the Texas Suicide Prevention Collaborative to train 75 individuals in the AS+K About Suicide to Save a Life training as trainers. This training included training for general populations and the following focus areas: (see attached flyer) - Disaster - Marginalized populations (encompassing disabilities, race/ethnicity, LBGTQ youth) - Older Adult - Rural - Military/Veteran Disaster - Spanish version – the first suicide prevention training in our state that will be in Spanish.
The above were both statewide and populations targets. Please indicate areas of technical assistance needed related to this section. Not Applicable OMB No. 0930-0168 Approved: 04/19/2019 Expires: 04/30/2022
Footnotes:
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W hileI breathe, I hope
South Carolina Strategy for Suicide Prevention 2018-2025
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Data, strategies, resources, and language contained in this document were aggregated from materials produced by numerous accredited suicide prevention authorities, including but not limited to: The Substance Abuse and Mental Health Services Administration (SAMHSA) The Centers for Disease Control and Prevention (CDC) The Suicide Prevention Resource Center (SPRC) The American Association of Suicidology (AAS) The American Foundation for Suicide Prevention (AFSP) Other Garrett Lee Smith Memorial Grant Program (GLS) suicide prevention plans
Content accumulated and composed by Dr. Alexandra Karydi Program Director of the S.C. Youth Suicide Prevention Initiative, a GLS-funded program of the S.C. Department of Mental Health
Layout designed by Rob Cottingham, Suicide Prevention Coordinator
Photos donated by numerous photographers, whose names are listed at the end of this document.
Graphic charts courtesy of the Centers for Disease Control and Prevention’s Web-based Injury Statistics Query and Reporting System; Centers for Disease Control and Prevention’s Vital Signs publication
Special thanks go to Helen Pridgen, Director of the American Foundation for Suicide Prevention-SC Chapter; John Magill, Director of the South Carolina Department of Mental Health; Tinotenda Martin, SCYSPI Administrator; Taylor Davis, Ed. S, NBCC, LPC-A – SCYSPI Suicide Prevention Program Coordinator; Brandon Parker, SCYSPI Marketing Coordinator; and the entire S.C. Suicide Prevention Coalition.
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This document is dedicated to the people of South Carolina. Every image contained within was either a free-use photo or donated, and selected to represent each county of our beautiful state.
Brookgreen Gardens Georgetown County
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W hile I breathe, I hope Table of Contents Letter from S.C. Suicide Prevention Coalition Chair S.C. Department of Mental Health Director John Magill...... Page 5 Members of S.C. Suicide Prevention Coalition...... Pages 6-7 Executive Summary...... Pages 8-9 Considering the Language ...... Pages 10-14 Looking at the Data ...... Pages 15-22 Understanding Suicide...... Pages 23-27 - Socioeconomic Model...... Page 24 - Risk Factors...... Page 25 - Warning Signs...... Page 26 - Protective Factors...... Page 27 Activating Protective Factors in S.C.: Goals, Strategies and Recommendations What South Carolinians can do to help on individual, interpersonal, community, and societal levels ...... Pages 28-45 Call to Action...... Page 46 Resources...... Pages 47-51
Photo credits ...... Pages 52-53 References ...... Page 54 Abbeville Court Square Abbeville County
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A letter from the S.C. Suicide Prevention Coalition Chair ohn . agill J Director of theH S.C. Department of MMental Health Dear Citizens of South Carolina, uring the last two years, leaders from stigma, advocate for change in policies and across the state have come together practices, and raise awareness about suicide Dto develop a better understanding of — a preventable death. suicide and its impact on South Carolinians. This is a living document, preliminary This group, known as the South Carolina in nature, that will continue to be updated Suicide Prevention Coalition, has been with resources, research, and strategies, invested in creating hope and decreasing on an annual basis. suicide rates. These individuals have been We want citizens, professionals and working diligently to present information and organizations to share this mission and guidance about suicide in the Palmetto State. effort in promoting health and improving Suicide is currently the second-leading safety in South Carolina. cause of death for South Carolinians aged 10 It has been an honor and a privilege to 35, and it affects every county within our to serve as Chair of the South Carolina state’s borders. Suicide Prevention Coalition, a group of The Coalition’s goal is to develop broad- determined and compassionate individuals based support for suicide prevention, reduce whose efforts I know will save lives. Sincerely,
John. H. Magill State Director South Carolina Department of Mental Health
Printed: 7/19/20217/21/2021 2:093:2812:38 PM PM - -South South Carolina Carolina - OMB No. 0930-0168 Approved: 04/19/2019 Expires: 04/30/2022 PagePage 119 7 of of 222 91 Members 6 of theSouth Carolina Suicide Prevention Coalition “Committed to reducing suicide rates in our state by 20% by 2025.” John H. Magill Dr. Kevin Gray South Carolina Department of Mental Health Medical University of South Carolina State Director and South Carolina Suicide Prevention Coalition Chair Associate Professor of Psychiatry and Behavioral Services and Director of Child and Adolescent Psychiatry Helen Pridgen American Foundation for Suicide Prevention Col. Ronald Taylor SC Chapter Director South Carolina National Guard Chief of Staff Dr. Alexandra Karydi South Carolina Department of Mental Health SFC Christopher Allen Program Director of the S.C. Youth Suicide Prevention Initiative South Carolina National Guard Suicide Prevention Program Manager Dr. Meera Narasimhan University of South Carolina School of Medicine Molly Spearman Associate Provost for Health Sciences South Carolina Department of Education in the Department of Neuropsychiatry and Behavioral Sciences State Superintendent of Education Rep. Shannon Erickson Dr. Sabrina Moore South Carolina State House District 124 South Carolina Department of Education Director of the Office of Student Intervention Services Sen. Katrina Shealy South Carolina State Senate District 23 Dr. Jim Hayes National Alliance on Mental Illness - South Carolina Thornton Kirby Board President South Carolina Hospital Association President and CEO Michael Cunningham AnMed Health Judge Amy McCulloch Vice President of Advancement Richland County Probate Court Justice
Aiken Horse Track Aiken County
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Myrtle Beach Horry County
Printed: 7/19/20217/21/2021 2:093:2812:38 PM PM - -South South Carolina Carolina - OMB No. 0930-0168 Approved: 04/19/2019 Expires: 04/30/2022 PagePage 121 9 of of 222 91 8 here are people in this state who possess hearts with immeasurable compassion; heroes who take it upon themselves to ease the minds T and shoulder the burdens of their fellow South Carolinians. The men, women, and children of our state need these champions, now. Shall we count you among them? Join the fight againstin the suicide Palmetto State. Suicide is a public health issue in South The details of this plan address what we Carolina, but research indicates these deaths can do on individual, interpersonal, commu- are preventable so long as members within nity and societal levels to ensure that those a wide range of communities embrace their among us struggling with suicidal thoughts roles in a unified effort. We can fight suicide feel safe to discuss their worries and illness- by creating suicide care pathways throughout es openly, are encouraged to seek the help our communities, state agencies, and orga- they need, have access to quality mental and nizations serving youth and adults that are physical health care, and are protected by evidence-based, data-driven, and collabora- their friends, families and peers as they val- tive in nature. iantly pursue recovery. Hartwell Dam Anderson County
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Denmark Depot Bamberg County
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Considering the language hen discussing subjects associated with that subject to terms and crafted language pertain- of public concern, it is maintain continuity, accuracy, and ing to the subject for a reason, and Wimperative we use the objectivity. when we fully adopt those definitions language and terminology con- Suicidologists and others who have and practices, we increase our chanc- structed by the professionals who devoted their time to understanding es of effectively fighting suicide in conduct and publish the research and fighting suicide have created the Palmetto State. Buffalo Mill Union County
Florence Veterans Park Florence County
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Hilton Head Island Beaufort County
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Affected by suicide: All those who may feel the im- pact of suicidal behaviors, including those bereaved by suicide, as well as community members and others Bereaved by suicide: Family members, friends, and others affected by the suicide of a loved one (also referred to as “survivors of suicide loss”) Means: The instrument or object used to carry out a Methods: Actions or techniques that result in an self-destructive act, such as chemicals, medications, individual inflicting self-directed injurious behavior, or illicit drugs such as overdose, suffocation, etc.
Cypress Gardens Berkeley County
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Low Falls Landing Calhoun County
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Looking at the data o understand how and Reporting System. Other data state collects more specific and far-reaching suicide is specific to the Palmetto State is diverse information to help de- Tin South Carolina, it is gathered and made available by velop unique strategies for pre- necessary to observe quantitative the S.C. Department of Health and venting suicide among especially data on the issue. Environmental Control’s vulnerable groups. Data concerning suicide is Violent Death Reporting System. The information available paints collected by the Centers for Dis- While both systems provide an a portrait of a state in desperate ease Control and Prevention and in-depth look into the pervasive- need of a refocused suicide published online through their ness of suicide across many prevention plan. Web-based Injury Statistics Query demographics, it is crucial that our
Lake Marion Clarendon County
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On average, There are nearly twice as Suicides Homicides 1 South Carolinian many suicides each year 2015 742 448 dies by suicide in South Carolina every 11 hours. as there are homicides. 2016 815 426
Suicide Death Rates Suicide cost South Carolina more Deaths by Suicide Rate per 100,000 State Rank than $748 million South Carolina 815 15.65 23 of combined lifetime medical and work loss Nationally 44,965 13.42 in 2010, an average of $1.18 million All tables, facts, and figures presented on this page is based on CDC data and research per suicide death
The Peachoid Cherokee County
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Drowning ing), claiming 19.3% Drug Non-Drug of suicides. Drug poi- Poisoning sonings accounterd Poisoning for 9% of suicides. The remaining 7.1% 2.7% 1.6% of suicides involved Cut/Pierce Other non-drug poisoning, 1.5% 0.5% drowning, cutting/ 64.4% 9.2% Fire piercing, falling, fire Fall 0.6% 0.2% and others. n studying suicide, understanding how it is holders with mutual interests. happening is just as important as learning For example, knowing that firearms Iwhy it is happening. account for nearly two-thirds of suicide By analyzing data regarding lethal means, deaths might persuade firearms dealers we gain insight in devising more thorough to disseminate suicide prevention materials strategies that help limit access to those with their products. means. This information also helps craft Some states encourage or require gun dealers awareness, leading to the recruitent of stake- to emphasize gun safety at the point of sale.
Downtown Chester Chester County
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20
15
10
Death rate per 100,000 Death rate 5
0 15-19 20-24 25-29 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84 85-89 85 & up
early everyone has a preconception one age group more than other is unfound- about who is mostly likely to die by ed. Every age group is at risk of suicide, so Nsuicide. plans to reduce suicide across an entire state However, as this graph illustrates, any must include strategies that address individu- notion that suicide overwhelmingly affects als of all ages.
Little Pee Dee State Park Dillon County
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Males 24.5
Females 7.6
0 2 4 6 8 10 12 14 16 18 20 22 24 26 Death rate per 100,000 hen observing the information presented In general, males are more likely to own or have in this graph, it might be easy to devel- access to firearms. Wop simple assumptions about suicide as Only 47.5% of females used firearms (though it relates to gender in South Carolina. research indicates female use of firearms in suicide While males are nearly 3 times more likely to is increasing), while 26.5% used drug poisoning die by suicide than females, females attempt sui- and 19% used suffocation. cide at 3.5 times the rate of males. The difference in method, however, is not an in- Part of this discrepancy is attributed to method- dication that females are “less serious” than males ology: Males use more lethal means. According to about taking their own lives. Every attempt is a the 2016 CDC data, 70% of males who died by true effort to that individual, regardless of method. suicide used firearms and 19.3% used suffocation.
Bettis Academy & Junior College Edgefield County
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0 White Black
Darlington Raceway Darlington County
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Winthrop University York County
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39%
Contributing factors Relationship problem Crisis in the past 2 weeks Problematic or upcoming substance abuse 2 weeks
Job/financial problem Physical health problem
Criminal legal Loss of housing problem
Poisoning Female Other Female Other 10% 31% 8% 16% 8% Poisoning 10% Firearm 41% Firearm Male Male 55% 69% 84% Suffocation 27% Suffocation 27%
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Understanding suicide tatistics present information To properly design suicide impact of risk factors and reduce in an impactful, objective prevention efforts and protocols, the likelihood of suicide attempts Sformat that makes the scope we have to understand risk factors and deaths. of suicide deaths digestable for the and how they contribute to an Finally, we must familiarize public at large. individual’s suicide experiences. ourselves with the warning signs What statistics cannot do, Once we have a grasp of risk of suicide. Knowing what to look however, is answer the questions factors, we can begin instituting for is critical to identifying at-risk of why people attempt suicide protective factors — things we individuals and connecting them and how can we might go about can do and resources we can offer to the support and mental health preventing suicides. that help alleviate or curb the care they need.
Ernest F. Hollings ACE Basin National Wildlife Refuge Hampton County
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Societal Community Relationship Individual
Risk Factors
Availability of lethal Few available sources High-conflict or violent Mental illness means of suicide of supportive relationships relationships Substance abuse Unsafe media portrayals Barriers to health care (lack of Family history of suicide Previous suicide attempt access to providers, of suicide Impulsivity/aggression medications; prejudices)
ne of the best tools for they live on a larger scale, be it a to other people, such as romantic helping us understand risk country, a region, or a state. interests, friends, peers, and family Oand protective factors is Community refers more to the members, and how those connec- the social ecological model, that individual’s geographical position tions affect their mental health. categorizes the various factors that on a smaller scale, such as a town or Individual means the factors impact our lives. district. A person’s location greatly that are almost entirely contained In terms of the model, Societal affects the availability of resources within thatBrookgreen person, such asGardens an refers to how the individual is af- and means of accessing health care. existing mentalGeorgetown illness, a substance County fected by the perceptions and stig- Relationship refers to the health abuse problem, or pain from past or mas held by the culture of where of the individual’s connections currently ongoing trauma.
Camden Revolutionary War Site Kershaw County
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Sergeant Jasper Park Jasper County
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Common Protective Factors include: • Attitudes, values & norms • Impulse control • Support for victims of that enforce strong belief • Resiliency bullying, harassment, in the value of life • Strong sense of self-worth abuse, and physical • Problem-solving or self-esteem or sexual assault & coping skills • Reasons for living • Opportunities to • Access to proper mental • Having a pet participate in and & physical health care • Financial assistance contribute to school or • Strong connections to • Restricted access community activities friends, family, to lethal means • Ability to regulate & supportive • General optimism emotions & tolerate significant others • Employment frustrations • Hope for the future opportunities • Sobriety
Allendale County Courthouse Allendale County
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Clemson Memorial Stadium Pickens County
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Palmetto Trail Bridge Fairfield County Activating protective factors Goals, strategies and recommendations hough educating residents recommendations in this plan best-practice standards developed of our state will improve address different areas of focus through extensive research, not Ttheir perspectives about in suicide prevention, interven- simple opinions and conjecture. suicide, having objectives and tion, and longterm care, as well If we work together, embracing methods for fulfilling them is as how South Carolinians can the language and philosophies the only way to create effective, help on individual, relationship, within this plan, these items will longterm suicide care pathways. communal, and societal levels. be of little difficulty to imple- The goals, strategies, and Each of these items is based on ment and accomplish.
Francis Marion Musgrove Mill Memorial Statue Historical Site Marion County Laurens County
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Increase social norms Improved access Increase coping & that support recovery to quality physical problem-solving skills and help-seeking & mental health care
Increase connectedness Increase safe media Increase support to individuals, family, portrayals of suicide to suvivors community & social & adoption of safe of suicide loss institutions by creating messaging practices safe & supportive school Increase collection & community environments Increase prevention & analysis of data & early intervention regarding risk for mental health & protective factors Reduce access problems, suicidal to help guide to lethal means ideation & behaviors, prevention efforts & substance abuse Dorn’s Flour and Grist Mill Marlboro County McCormick County Courthouse Marlboro County
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Increase Coping and Problem-Solving Skills
STRATEGY: Make universal evidence-based health education and social/emotional health programs approachable and available. EXAMPLES: • Seeking mental and behavioral health services, i.e. Dialectical Behavioral Therapy • Positive behavioral interventions and supports in schools, i.e. The Good Behavior Game, School-based mental health care services • Life skills • Financial planning & budgeting skills THINGS YOU CAN DO FOR YOURSELF: • Find a therapist or support group • Make a safety plan • Build a support network (and use it) • Call the National Suicide Prevention i.e. your social network, coworkers, Lifeline or more resources and help: friends, family, or spiritual connections 1-800-273-8255 (TALK).
Claflin University Orangeburg County
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Increase connectedness to individuals, family, community & social institutions by creating safe & supportive school & community environments Things you can do STRATEGY: Promotion of child abuse for others anytime: prevention services to reduce risk factors that correlate to suicide • Ask someone you are STRATEGY: Utilize the existing peer support worried about if they’re infrastructure to embed suicide thinking about suicide prevention strategies in • Keep them safe. supporting individuals in recovery Reduce access to lethal means for Increase Coping and Problem-Solving Skills those at risk • Be there with STRATEGY: Implement and promote evidence-based them. Listen to parenting programs. what they need EXAMPLES: • Help them connect • Guiding Good Choices with ongoing • Strengthening Families support. You can start with the National Suicide Increase Support to Survivors of Suicide Loss Prevention STRATEGY: Increase outreach to survivors of suicide Lifeline: loss through key partnerships to promote 1-800-273-8255 awareness of and access • Follow up to see to suicide-specific grief supports. how they’re doing STRATEGY: Provide support and resources to health and behavioral healthcare providers for when a client under their care dies by suicide.
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Increase Availability and Access to Quality Physical and Mental Health Care
STRATEGY: Promote the adoption of the ‘ZeroSuicide’ Things communities framework by health and behavioral health can do to help: care providers statewide. Components of ZeroSuicide: • Identify and support people 1. Engage leadership in a commitment at risk of suicide to reduce suicide deaths • Teach problem-solving and coping skills to help people 2. Develop a confident, competent, and caring manage challenges with workforce (quality training CMEs and CEUs relationships, jobs, health, for healthcare professionals) or other concerns 3. Identify every person at risk for suicide using • Promote safe and supportive quality assessments (increase use of environments the Columbia-Suicide Severity Rating Scale) • Offer activities that bring 4. Suicide Care Management Plan people together so they feel (policies and procedures) connected and not alone • Connect people at risk to 5. Use evidence-based treatment to treat suicidal effective and coordinated thoughts and behaviors directly mental and physical healthcare. EXAMPLES: • Expand options for temporary • Use of the Stanley Brown Safety Plan assistance for those struggling • Counseling on Access to Lethal Means to make ends meet • Collaborative Assessment and Management • Prevent future risk of suicide of Suicidality among those who have lost a friend or loved one to suicide. • Dialectical Behavioral Therapy • Improve awareness • Cognitive Behavioral Therapy for Suicide of emergency resources like Prevention) the National Suicide Prevention 6. Support patients through every transition in care Lifeline (1-800-273-8255) and (sources of continued care after psychiatric the Crisis Text Line (741741) hospitalization, warm handoffs and caring contacts and follow up procedures during care transitions) 7. Apply data-driven quality improvement
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Increase Availability and Access to Quality Physical and Mental Health Care STRATEGY: Expand and strengthen South Carolina’s existing crisis services and follow-up after a crisis OBJECTIVES: 1. Promote existing services to increase awareness and utilization 2. Increase use of areas offering Mobile Crisis (CCRI), receiving centers and other stepped interventions and services STRATEGY: Increase access to physical and behavioral healthcare services OBJECTIVES: 1. Increase telehealth availability, particularly in rural communities 2. Increase access to psychotropic medication
Williams-Brice Stadium Richland County
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Increase social norms that support recovery and help-seeking
STRATEGY: Increase awareness of suicide as a preventable public health problem utilizing research- informed communication that is designed to prevent suicide by changing knowledge, attitudes and behaviors. OBJECTIVES: 1. Annually distribute data and resource flyers to professionals and individuals in SC which includes suicide data, prevention resources and crisis line numbers 2. Continue to increase SC capacity for evidence-based gatekeeper trainings (such as ASIST, Mental Health First Aid, Question, Persuade, Refer [QPR], etc.) 3. Develop, implement and evaluate communication initiatives that reach the whole or segments of the population to increase help seeking and promote Dixie Belle Peach Orchard recovery (e.g., Man Therapy, social media, etc.) Saluda County
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Limit access to lethal means irearms are the most lethal and most common method of suicide, accounting for 64.4% of F all suicide deaths in the Palmetto State. More people who die by suicide use a gun than all other methods combined. Suicide attempts with a firearm are almost always fatal. Those who use other methods are less likely to die; nine out of ten people who survive a suicide attempt do not go on to die by suicide, later. Every U.S. study that has examined the relationship has found that access to firearms is a risk factor for suicides. Firearm owners are not more suicidal than non-firearm owners; rather, their suicide attempts are more likely to be fatal. Many suicide attempts are made with little planning during a short-term crisis period. If highly lethal means are less avail- able and temporarily postpone their attempt, the odds are increased that they will survive. Studies in a variety of countries have indicated that when access to highly lethal and leading suicide methods is reduced, the overall suicide rate drops. At a state and local level, we can work to ensure that every suicidal person and their loved ones hear the message that keeping firearms out of reach Newberry Opera House during a suicidal crisis can save lives. Newberry County
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Limit access to lethal means Four practical steps: 1. Change policies by adding “Lethal means counseling” protocols to providers’ and gatekeepers’ existing suicide prevention protocols. 2. Train providers and gatekeepers how to conduct lethal means counseling. 3. Change information systems to cue providers to educate families. 4. Expand options in the community for temporary storage or disposal of firearms for families requesting these services. 1. Change policy Encourage statewide and tions to target: state hospital counseling policies to local professional groups association, social workers’ existing suicide prevention and institutions to add a association, school psychol- policies. “lethal means counseling” ogist association, truancy If a group doesn’t have policy to their current officer association, etc. basic suicide prevention suicide prevention protocols Examples of local agen- policies, try to work with to ensure that all suicidal cies to target: mental health them (or ask The S.C. Suicide or at-risk patients and their agencies, emergency depart- Prevention Coalition) to work families are counseled about ments, schools, employee with them to adopt basic reducing access to guns at assistance groups, etc. suicide prevention policies, home. In most cases, your goal as well as lethal means Examples of state associa- will be to add lethal means counseling policies.
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Limit access to lethal means 2. Train providers personnel, and primary a mental Train providers who care providers. health provider. come into contact with The training covers Think about other people at risk for sui- three general areas (the types of providers with cide and their families public health approach whom they may come on how to talk about to suicide prevention, into contact, such as reducing access to fire- firearm safety basics, police, counselors arms at home. and clinical skills in providing services Most currently do speaking with families to domestic abusers, not. A good training about reducing access defense attorneys, model is the CALM to firearms and lethal substance abuse coun- Training (Counseling medications at home). selors, school truancy on Access to Lethal Suicidal people — officers, primary care Means), which trains particularly those who providers, etc. See other mental health providers, use a firearm — often examples of means emergency department don’t seek out care by reduction programs.
3. Change Information add a flag to indicate whether existing protocols for Systems the patient is considered at responding to suicidal risk. One way to ensure that risk for suicide. Standard paper forms at-risk patients and their Checking off the patient as (for example, intake forms families receive lethal means “at risk” would trigger the for new psychiatric patients, counseling is to build software to remind the pro- suicide assessment forms reminders into an agency’s vider to talk with the patient used by school psycholo- information system. and his/her family about gists, etc.) could also For example, a health care firearms and lethal medica- include check-off boxes institution with electronic tions at home, in addition to cueing the provider to ask patient charting software can following the agency’s about firearms at home.
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Limit access to lethal means 4. Expand options not able to help families. Work with local police Work with them to explore and other public safety some feasible options. groups to expand options If you come up with good for families who want to options (such as getting a permanently or temporarily local shooting range to of- remove their guns. fer storage lockers), please Many police departments contact your local suicide currently have no policy or prevention organizations protocols in place to dispose and let us know so that we of or store firearms and are can spread the word. STRATEGY: Provide training STRATEGY: Partner with STRATEGY: Promote and to providers (pharmacists, firearm retailers and gun distribute tools/strategies counselors, and physicians) owners to incorporate sui- to reduce access to lethal who interact with individuals cide awareness and preven- means such as gun locks, who may be at risk for sui- tion as a basic tenet of fire- safes, and medication lock cide on counseling on access arm safety and responsible boxes/bags, etc. Promote ex- to lethal means. firearm ownership. isting resources such as drug takeback events, prescrip- School for the Deaf and Blind tion drug drop-offs, and Use Walker Hall Only As Directed campaign. Spartanburg County
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Increase Connectedness to Individuals, Family, Community & Social Institutions by Creating Safe & Supportive School & Community Environments
STRATEGY: Support primary prevention and early identification of Adverse Childhood Experiences using partnerships with government, healthcare and behavioral health providers, schools and non-profits. STRATEGY: Create safe environments for Lesbian, Gay Bisexual, Transgender, and Queer/ Increase Questioning (LGBTQ+) youth and young Support adults including the promotion of to Survivors research-supported initiatives such as of Suicide Loss Gay-Straight Alliances, the Family STRATEGY: Acceptance Project, and the Trevor Project. Improve the quality STRATEGY: Utilize community coalitions to increase and quantity of opportunities for prosocial involvement resources available by all community members. to survivors of STRATEGY: Partner with businesses to implement suicide loss by workplace wellness and suicide prevention/ providing postvention strategies. research-supported training opportunities. STRATEGY: Support the local school district in the adoption of evidence-based suicide prevention, intervention, and postvention strategies and policies.
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Increase safe media portrayals of suicide & adoption of safe messaging practices
STRATEGY: Increase positive hopeful communications efforts and support safe communication strategies in all media channels. STRATEGY: Educate stakeholders and media representatives about safe messaging principles through resources like the National Action Alliance for Suicide Prevention. STRATEGY: Use multiple media channels to increase sharing of lived experience stories of recovery from suicide and mental health conditions. Increase Comprehensive Data Collection & Analysis Regarding Risk & Protective Factors to Guide Prevention Efforts
STRATEGY: Partner STRATEGY: Implement STRATEGY: Strategize with the coroners’ the state level suicide and prioritize methods offices to increase fatality review to collect more access to data committee to reduce comprehensive data regarding suicides. gaps in services, regarding LGBTQ improve inter-agency persons’ risk of STRATEGY: Increase collaboration, and suicide ideation and timely availability reduce barriers to suicide fatality. of suicide data to accessing care. key stakeholders involved in prevention efforts.
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Increase Prevention & Early Intervention for Mental Health Problems, Suicide Ideation and Behavior and Substance Misuse STRATEGY: Increase awareness of suicide as a preventable public health problem using research-informed communication that is designed to prevent suicide by changing knowledge, attitudes and behaviors. STRATEGY: Develop and sustain public-private partnerships to advance suicide prevention. OBJECTIVES: 1. SC Suicide Prevention Coalition including workgroups as currently constituted: Youth, LGBTQ, First Responders, Community Awareness, Firearm Safety, Workplace, Zero Suicide, Executive Committee. 2. The SC Suicide Prevention Coalition will provide support and technical assistance to community coalitions statewide to improve infrastructure and ability to address suicide prevention in their local communities. STRATEGY: Promote and support the expansion of school-based mental health services, Mobile Crisis, and Family Resources Pearl Fryar Topiary Gardens Programs in all communities throughout SC. Lee County
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Instill a sense of worth, belonging, and purpose in faith-based settings aith communities are a natural setting for suicide prevention, as spiritual F beliefs and practices tend to help people experience greater hope and meaning in their lives. Things faith-based Faith communities can also provide opportunities for developing positive relationships with others communities can do: and can be an important source of support during • Reach out to individuals who difficult times. you think might be at risk There are nationwide initiatives and resources of suicide, then be supportive specifically aimed at recruiting and guiding faith- by listening to them and based communities in suicide prevention efforts. connecting them to resources • If someone admits to suicidal General spiritual and faith-specific strategies thoughts or makes threats of for suicide prevention efforts can be found: suicide, emphasize the value Faith.Hope.Life of their lives; help them http://actionallianceforsuicideprevention.org/ celebrate reasons for living faith-communities-task-force • Help individuals thinking Suicide Prevention Resource Center: The Role of about suicide build healthy social connections Faith Communities in Preventing Suicide • Create support groups and http://www.sprc.org/sites/default/files/migrate/ in-house services for individuals library/faith_dialogue.pdf who are considering or have attempted suicide, as well as those who have lost someone to suicide.
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Increase access to resources and normalize conversations about suicide in the workplace he majority of people who die by suicide are of working age, and the workplace T offers crucial opportunities to help employees who are struggling with suicidal thoughts, suicide attempts, or the aftermath of a suicide death. The participation of business leaders, employers, managers, and coworkers is critical to the success of suicide prevention among working-age adults. Every place of employment, regardless of size, can offer assistance. For more information, visit: www.theactionalliance.org/communities/workplace Things managers and human resource personnel can do • Post or disseminate suicide prevention re- • Offer appropriate resources for employees sources to employees on a regular basis who experience a loss to suicide outside • Include basic suicide prevention training for the workplace new hires, as well as refresher courses for • Promote worker use of mental health existing employees resources and services • Create a protocol for when an employee • Shift the cultural perspective on mental dies by suicide, including resources for health by making it a priority. Leadership those grieving the loss of their coworker must model this shift, especially, and • Designate certain staff to act as a response clearly communicate employee benefits team during the event of an employee's and answer questions for concern. death by suicide
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Increase Connectedness to Individuals, Family, Community & Social Institutions by Creating Safe & Supportive School & Community Environments
STRATEGY: Promote evidence-based training, policies and protocols for first responders to support them in responding to mental health, substance use and suicide related incidents in the community
THINGS OUR SOCIETY CAN DO EVERY DAY: • Work to eliminate stigmas • Improve willingness to to help normalize identify and support conversations about individuals at risk mental health and suicide of suicide • Support and promote • Expand and improve suicide prevention efforts assistance for housing • Encourage media outlets and unemployment to adopt safe messaging stresses practices about suicide • Make learning about risk factors, protective factors and warning signs a common practice • Familarize ourselves with Colonial Dorchester Ruins resources for those at risk Dorchester County of suicide
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Increase Support to Survivors of Suicide Loss
STRATEGY: Promote and disseminate postvention protocols — including, but not limited to, Connect Suicide Postvention Training — in a variety of settings: workplace, schools, clinical settings, community, and media to promote healing and reduce risk of contagion. Increase Prevention & Early Intervention for Mental Health Problems, Suicide Ideation and Behavior and Substance Misuse STRATEGY: Continue to increase South Carolina’s capacity for evidence-based gatekeeper trainings STRATEGY: Promote the implementation of mental health screening and referrals in work sites, schools, senior centers, and community settings. EXAMPLES: • ASIST • Mental Health First Aid • Question, Persuade, Refer (QPR)
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Answering theCall to Action n South Carolina, a person to Action are strongly dependent important issues to focus our dies every eleven hours by on the will and commitment of joint energies on Isuicide. There are more than stakeholders to take action and to • Recognize the good work 44,000 deaths by suicide each work together. already underway and help year. More lives are lost to suicide Help us fight suicide stakeholders share and than to road traffic accidents or • Engage organizations and coordinate activity homicide. communities so that together • Make us all more accountable The Call to Action has been each of us plays their individual for what we have promised to shaped by what stakeholders be- role in reducing suicide do because we have publicly lieve is important. • Seek to achieve real change by stated our commitment The achievements of the Call prioritizing a few of the most
The Old Mill Lexington County
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• Vital signs: June 2018. National Center for Injury Prevention and Control, Centers for Disease Control and Prevention. 2018. URL: www.cdc.gov/vitalsigns/pdf/vs-0618-suicide-H.pdf
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South Carolina Youth Suicide Prevention Initiative
Final Report Cohort 9, 10, 11, 12 Reporting Period: October 1, 2015 – March 31st, 2021
Suicide Prevention Branch Division of Prevention, Traumatic Stress and Special Programs Center for Mental Health Services Substance Abuse and Mental Health Services Administration Department of Health and Human Services
Written by: Casey Childers, Ph.D. and Jennifer Butler, LISW-CP/S Special Acknowledgement to Brittney Ankrom, MPH
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Table of Contents
Executive Summary ...... 3 SCYSPI Introduction ...... 4 Key Outcomes ...... 7 Lessons Learned...... 12 SC Evaluation and Data ...... 15 COVID-19 Innovations ...... 17 Sustainability and Future Directions ...... 19
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SAMHSA housed within the SC Department of Mental Health (SCDMH)’s Office of Suicide Prevention.
The mission was to reduce suicide deaths and attempts for SC youth and young adults (YYAs). The grant
ended March 31, 2021.
Key Highlights for the 2015-2021 Grant Years: ➢ 216,365 SCDMH screenings (S1) with 20,676 referrals (R1) to suicide-specific care in the SCDMH suicide care pathway.
➢ 27,512 South Carolinians trained in suicide prevention, with 12,450 trained on a clinical level for workforce development (WD2) and 15,062 trained in the community (TR1).
➢ 175 partners collaborating or sharing resources with SCYSPI (PC2). Partners include faith communities, SC Hospital Association, Federally Qualified Health Centers, family and pediatric practices, NAMI-SC, AFSP-SC, MHA-SC, SC Dept. of Social Services, SC Dept. of Health and Environmental Control, DAODAS (SC Drug and Alcohol Commission), SC Dept. of Education, SC Dept. of Juvenile Justice, 45 school systems, military organizations, and nonprofit organizations.
➢ 33 organizations demonstrated readiness to change practices (PD1), with 48 bidirectional partnerships to change practices (T1).
➢ 90 organizations requested or were presented data (A2), including SC Suicide Prevention Coalition, the SC Joint Citizens and Legislative Committee on Children, and media outlets.
➢ 569,088 South Carolinians reached through social media channels (AW1) such as Facebook and Twitter using social marketing campaigns to lower stigma, promote healthy coping strategies, and connection to resources.
➢ An estimated 559,414 South Carolinians reached through 177 events and media stories via radio, television, and magazines. Outreach events have included the statewide AFSP Out of Darkness Walks, events such as health fairs, college campus events, SC Mental Health Awareness Day at the SC Statehouse, statewide conferences on mental health, school programming, and public health issues.
➢ Re-engaging the SC State Suicide Prevention Coalition, with a new SC Suicide Prevention Plan in 2018, with plan updates in progress in 2021.
➢ Piloting the Zero Suicide approach to YYAs within SCDMH, a statewide, centralized mental health care agency serving 100,000 South Carolinians regardless of ability to pay.
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year Garrett Lee Smith grant from SAMHSA. SCYSPI was housed within the SC Department of Mental
Health (SCDMH) Office of Suicide Prevention (OSP). The mission was to reduce suicide deaths and
attempts for SC youth and young adults. SCYSPI ended March 31, 2021.
Theoretical Approach SCYSPI used a public health approach to suicide prevention, an approach recommended by the
CDC for violence prevention, using systems thinking. The public health approach considers how to make
large-scale changes and interventions, so that entire populations are benefitted.1,2 The public health model
to injury prevention has four steps: 1. Define and monitor the problem, 2. Identify the causes, 3. Develop
and test intervention strategies, and 4. Assure widespread adoption. 2
SCYSPI also used the Developmental Evaluation (DE) approach. DE supports innovative and
complex interventions by being grounded in systems thinking. Data continuously drives the program
development process, so that adaptations and changes within complex systems are informed decisions. 3
For example, surveillance data (i.e., key demographics and geographic areas for suicide deaths and
attempts data updated annually) and real time data sources (i.e., EMS Self-Harm Call data and Lifeline
Call data updated quarterly) was used by SCYSPI staff to target systems for intervention. This approach
gave the structure needed to develop activities, supporting the translation of research to practice; but also
a structure to evaluate the process of change as these innovations diffused through systems. Process
evaluation played a significant role in the program evaluation. These activities included reviewing the
SCYSPI logic model annually and updating as necessary, which led to the work plan development for the
grant year. These documents served as the backbone of the program while offering flexibility for change,
or molding to the context, when needed.
DE aligns with using the public health model, as it encourages stakeholder empowerment and
involvement that is participatory in program development. 1-3 In Years 1 and 2, more than 50 stakeholder
interviews were used to: 1. Better understand the complex system contexts, 2. Identify “leverage points”
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Suicide Approach implemented in SCDMH), 3. Elicit buy in, and 4. Fill in data gaps.
Lastly, the Socioecological Model was used to map out SCYSPI activities to further ensure
systems thinking (see Figure 1). 4, 5 SCYSPI aimed to diffuse evidence-based suicide prevention strategies
as an innovation, as reflected in the goals and objectives below. Contextually, some key factors assisted
with applying the public health model to suicide prevention in SC. Having SCYSPI embedded within
SCDMH assisted with innovation diffusion, as SCDMH and other SC state agency structures have
centralized leadership. SCDMH is also unique in that it is one of the few state-run, public behavioral
health care systems in the US providing direct patient care. SCDMH serves more than 100,000, with
offices and services to every county, regardless of their ability to pay.
Figure 1. Socioecological Model Application to SCYSPI Activities
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destigmatize, and to build capacity of partners and communication Reduced number of nonfatal 3. To develop an interagency response to act when someone is suicidal for suicide prevention protocol to use in the event that a suicide attempts by YYA and youth or young adult is determined -Policy and protocol development subpopulations statewide and by county to be at risk of suicide. -Increase use of evidence-based -Resource guides and links to EBPs practices for suicide prevention
4. To raise awareness and knowledge and postvention -Postvention strategy and policy Increased confidence and of YYAs, parents, teachers, and development competency regarding suicide other caring adults about how to prevention among professionals respond to depression, other mental -Increased awareness, knowledge -Campaigns to raise awareness, (mental health, substance use health issues, suicidal ideation and of suicide data and vulnerable attempts. destigmatize and link to help and disorders, juvenile justice, foster populations, resources, and best resources care, etc.) working with YYA Evaluation/QI Indicators Inputs Outcomes Process -SAMSHA award Outputs -Hospital Claims Data on suicide - Level of stakeholder engagement, satisfaction -DMH support attempts (Statewide and Pilot - Progress towards YSPI planned goals and -Stakeholder Interviews County-Level) -Program infrastructure, partners, activities -Goals and Objectives -Vital Statistics Data on Suicide and collaborations - Barriers and facilitators of implementation Use of data for decision making/continual Comparison Deaths (Statewide and Pilot County- -Leadership, vision quality improvement purposes Level) - Training satisfaction 6 -PSI/SPARS Indicators -Quality Improvement/Evaluation -TUPS/TASP - Impact of social marketing -TUSP/TASP - -Zero Suicide Workplan Printed: 7/19/20217/21/2021 2:093:2812:38 PM PM - -South South Carolina Carolina - OMB No. 0930-0168 Approved: 04/19/2019 Expires: 04/30/2022 PagePage 175 63 of of 222 91 Goals and Objectives The Goals and Objectives of the SCYSPI grant and target system may have evolved over, but the main activities remained the same. Above is the logic model that dictated most of the SCYSPI years. Two of the original grant goals that were changed included: ➢ Educate parents, teachers, and other caring adults on the risk and resiliency factors that impact YYA mental health, suicidal ideation, and attempted suicide, how to respond when they believe YYA to be suicidal; and on how to access services ➢ Increase screening of YYA for suicide risk and their access to services. These goals were in essence folded into other goals and the activities associated with these goals
continued. Education activities were embedded in training and social marketing campaigns (Goals 2&4).
Trainings were used as a way to start partnerships and build buy in with key agencies and as an
opportunity to provide clear, consistent messaging about destigmatizing suicide. Secondly, screening
activities were folded into the goal of implementing evidence-based practices (Goal 2). There was also a
change to overall strategy. The biggest change to strategy over the years was the Regional/Pilot County
Approach. Initially, SCYSPI had 4 Regional Coordinators who developed resource guides and worked
specifically at the county-level within their region. Additionally, 2 pilot counties were chosen to
implement county-level strategies around suicide prevention. As SCYSPI progressed, it became clear that
many gaps existed at the state-level due to the centralized infrastructure of many state agencies (e.g.,
SCDMH, SC Dept. of Juvenile Justice, SC Law Enforcement Training, SC Dept. of Health and
Environmental Control). Therefore, the biggest impact could be made at these levels if these agencies
embedded evidence-based practices. Additionally, school district buy-in exploded in Year 3; therefore, it
made sense to move regional coordinators to work with specific systems versus geographic areas.
Key Outcomes 2015-2021 SPARS Data We used SPARS data to not only guide program evaluation, but to inform program activities. This
includes mapping SPARS indicators into our SCYPSI logic model, which is the program’s foundation.
Since SCYSPI used systems thinking, process evaluation was a key indicator of program success to track
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the Zero Suicide approach). Therefore, SPARS data was embedded into the development of the program.
Below are the SPARS Indicator Totals for the 2015-2021 Grant Years:
• 216,365 SCDMH screenings (S1) with 20,676 referrals (R1) to suicide-specific care in the SCDMH suicide care pathway.
• 27,512 South Carolinians trained in suicide prevention, with 12,450 trained on a clinical level for workforce development (WD2) and 15,062 trained in the community, including teachers (TR1).
• 175 partners collaborated or shared resources with SCYSPI (PC2). Partners included faith communities, SC Hospital Association, Federally Qualified Health Centers (FQHCs), family practice and pediatric practices, NAMI-SC, AFSP-SC, MHA-SC, SC Dept. of Social Services, SC Dept of Health and Environmental Control, DAODAS (Drug and Alcohol Commission), SC Dept of Education, SC Dept of Juvenile Justice, 45 school systems, military organizations, and nonprofit organizations.
• 48 officially changing practices with technical assistance and guidance from SCYSPI (T1), with 33 organizations demonstrating improved readiness to change practices (PD1), and finally, 12 organizations changing official policies (PD2).
• 90 organizations requested or were presented data (A2), including the SC State Suicide Prevention Coalition partners, the SC Joint Citizen’s and Legislative Committee on Children, media outlets, the QTIP program, and the Institute on Medicine and Public Health.
• 569,088 South Carolinians reached through social media channels (AW1) such as Facebook and Twitter using social marketing campaigns to lower stigma, promote healthy coping strategies, and connection to resources.
Key Accomplishments 1. To strengthen statewide infrastructure to improve behavioral health services to potentially suicidal YYAs.
Having a workforce trained in suicide prevention, organizations collaborating and implementing evidence based (EB) preventions and interventions (Goals 2&3) and raising awareness and lowering stigma (Goal 4) were all part of a statewide infrastructure to improve behavioral health services to potentially suicidal YYA.
However, more specific statewide infrastructure building included:
-Establishing OSP within SCDMH, giving statewide partners a centralized location connecting training information, resources, data, and partnership building. Having this structure also helps OSP apply for additional funding sources to build suicide prevention in SC such as the Adult Zero Suicide grant and the Communities of Care grant with SC Blue Cross Blue Shield Foundation.
-Mapping the system and identifying key leverage points for partnerships to address system-wide gaps as
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-Data mapping so that all available suicide data is used to make programming decisions and is disseminated to partners.
-SCYSPI having strong branding and messaging helped lay the foundation for how suicide prevention is communicated in SC. This has been powerful in overcoming stigma, establishing buy in, and propelled this culture shift forward. This consistent messaging occurred in trainings and through outreach and social media campaigns.
-The re-engagement of the SC State Suicide Prevention Coalition with a new SC Suicide Prevention Plan in 2018 and updates in progress in 2021. The current coalition is chaired by Sen. Katrina Shealy, SCDMH Director Dr. Kenneth Rogers, and AFSP Associate Area Director Vanessa Riley and has more than 30 partners such as SC Hospital Association, SC Dept. of Health and Human Services, SC Dept of Education, SCDMH, SC Veteran’s Affairs and those with lived experience.
2. To implement evidence-based prevention and intervention strategies to increase screening and access to services for YYAs at risk of suicide.
This included working within SCDMH to improve EB suicide prevention approaches, as well as key outside partners to improve the use of EB suicide prevention practices statewide.
-27,512 South Carolinians trained and working with multiple organizations to change practices and protocols.
-2 State Agencies trained 100% of their staff (SC Department of Children’s Advocacy and SC Department of Probation, Parole, and Pardon). SC Department of Veteran’s Affairs has trained 90% of staff and SC Dept. of Health and Environmental Control is finalizing a policy that would mandate 100% of staff trained annually.
-Piloting Zero Suicide to YYA within SCDMH, a statewide, centralized mental health care agency serving 100,000 South Carolinians regardless of ability to pay.
-Working with SC Dept of Education and more than 45 school districts statewide to improve protocols and policies, resources, and training.
-Working with SC Dept of Social Services to provide InPlace® Learning Workforce Development training and services through the SafeSide Youth Suicide Prevention program to 140 DSS employees, group homes, and foster care providers. Of those completing the post-workshop evaluations, 98% reported they would recommend the training to someone in their role.
-Linking YYA in crisis to care through promoting the Crisis Text Line through a hashtag campaign, promoting Lifeline, and developing the Interactive Screening Program, which directly links those having a mental health crisis to SCDMH care. 100 YYAs completed an ISP screener and more than 113 conversations on the Crisis Text Line from Spring 2020 until March 2021 using #HOPE4SC.
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This goal was the most challenging. Needs assessments completed in Years 1 & 2 of the grant made it clear organizations needed to build capacity within before building capacity outside to link a response to other system areas. These efforts to link systems will be a focus as the SC Suicide Prevention Coalition re-evaluates the state plan in 2021. Linking activities between systems included: -Helping to build the link between schools and the SCDMH school-based mental health care program. The first step has been to build SCDMH school-based mental health care program staff’s capacity around suicide prevention. A recent survey indicated 93% of SCDMH school-based mental health care staff responding to the survey have completed at least one suicide prevention training provided by OSP, with most rating the trainings as helpful or somewhat helpful in their work. Most staff also report using the Columbia Screener and Safety Plan as part of their practice, which is embedded within the SCDMH electronic health record, as part of the Zero Suicide approach. -Coordinating meetings between SC non-profits (NAMI SC, MHA SC, and AFSP SC) and SCDMH school-based mental health to discuss working collaboratively to better serve youth in SC. Part of these efforts included a developing a postvention timeline for schools. -DAODAS and SCDMH OSP embedding the Interactive Screening Program within both state agencies. -Other links include linking pediatrics practices and SCDMH as well as the SC Coroners Association to postvention services and OSP. 4. To raise awareness and knowledge of YYAs, parents, teachers, and other caring adults about how to respond to depression, other mental health issues Knowledge and awareness activities occurred in 3 major categories: Social marketing campaigns via social media based on best practices, outreach events occurring in-person or virtually, and media stories, including newspaper, magazines, and television. - As noted above, these social marketing campaigns have reached 569,088 South Carolinians. Social marketing campaign goals have included lowering stigma around mental health and seeking help, warning signs and risk factors, specific high-risk group messaging, program promotion, and connection to resources and coping skills. Social marketing campaigns included the #HopeLivesinSC campaign, which included participation from Gov. McMaster and Lt. Gov. Evette. - An estimated 559,414 South Carolinians reached through 177 events and media stories via radio, television, and magazines. Outreach events have included the statewide AFSP Out of Darkness Walks, community events such as health fairs, college campus events, SC Mental Health Awareness Day at the SC Statehouse, statewide conferences on mental health, school programming, and public health issues. Training Evaluations From October 1st, 2015 until March 31st, 2021, SCYPSI trainings included ASIST, AMSR, SafeTALK, and AS+K? about Suicide to Save a Life. We collected pre-test (n=2,061) and post-test training (n=1,596) evaluations. Most trainees completing evaluations were ages 25-40 (45%) and 41-55 (36%), white (67%) and African-American (29%), female (81%), and not Hispanic (94%). Most had been in their
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Approximately 70% stated the training changed the way they felt about suicide. Specific knowledge, attitudes, and beliefs questions about suicide were included. A comparison showed a shift after the training.
• “I think most suicides can be prevented.” (SA/A 94% vs. 98%)
• “I think people who are suicidal give signs they want to die.” (SA/A 76% vs. 91%)
We also asked questions about their self-efficacy around suicide prevention. These included, “I am comfortable with:”
• “Recognizing the signs when people are at-risk.” (SA/A 84% vs. 99%)
• “Talking directly and openly to a person about their thoughts of suicide.” (SA/A 89% vs. 98%)
• “Connecting a person with thoughts of suicide to help and resources.” (SA/A 92% vs. 99%)
A separate analysis was completed for school personnel, as a separate line of questioning was embedded in the survey for local school system employees to capture organizational barriers specific to that setting. Approximately 15% of participants reported barriers to implementing what they learned into practice. These top barriers included issues with time and resources to properly do suicide prevention, parents, schools, and policy and protocol issues. This information helped inform school-based efforts.
Figure 3. Training Evaluation Top Barriers
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all 46 counties. Due to the centralized structure, embedding the Zero Suicide approach within SCDMH
meant Community Mental Health Centers would follow a standardized protocol and collect the same data
through a centralized electronic medical record throughout the state of SC. SCYSPI started a Zero Suicide
Taskforce for YYA in 2017, made up of Zero Suicide program champions in pilot SCDMH Community
Health Centers, IT and data analysts from SCDMH, and Dr. Casey Childers, as part of the evaluation team.
This group met monthly and advised on 1. Writing the outpatient Zero Suicide Protocol, 2. How to
operationalize the Zero Suicide policy, with practical, front line feedback, 3. Provided guidance on
evidence-based tools specifically for YYA, and 4. How to embed and report Zero Suicide data elements
within the electronic medical record. This pilot effort led to a subsequent SAMHSA-funded grant Adult
Zero Suicide Initiative in 2018 to further expand these activities to adults served by SCDMH and in other
systems in SC. As with most organizational level change, this dedicated group was met with quite a few
obstacles in the beginning, but successfully helped bring the Zero Suicide approach to SCDMH.
Lessons Learned The Public Health Approach, Socioecological Model, and Developmental Evaluation approach
helped identify key leverage points to accelerate dissemination of evidence-based practices and
knowledge/skills, while also giving the structure needed to the effort. 1-5 In the beginning, SCYSPI was
met with a great deal of resistance. According to findings from key informant interviews (n=9) conducted
February-March 2021, combating the stigma of suicide was the greatest program accomplishment.
Findings from the Key Informant Report stated, “It was described that there was a culture shift across the
state that occurred during the span of the program, in regard to stakeholders becoming willing to discuss
the risk suicide poses to youth and young adults and how they could assist in prevention efforts.” 6
Many people were uncomfortable even saying the word suicide, much less addressing it in the
beginning of SCYSPI. Diligently framing these beginning conversations with partners was very
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programming team was met with messages from some stakeholders that suicide deaths and attempts were
rare and therefore, not a pressing issue. The SCYSPI programming team used data to start the
conversation with groups while addressing suicide myths and stigma head on. According to findings from
key informant interviews, “The presentation of data representing the number and rates of youth suicide
facilitated buy-in for this initiative.” 6 These conversations were framed in a way to not assign blame to
just one system for failing, but in terms taking responsibility for own system and as a way to take care of
one another. The SC state motto was used throughout SCYSPI efforts was “While I Breathe, I Hope.”
SCYSPI programming staff engaged different types of stakeholders, including top leadership and
gatekeepers, and people in the field. According to key informants, as culture shifted, top leadership got
involved. By gaining buy-in for this public health issue, the SC Suicide Prevention Coalition was able to
be relaunched. The Governor and Lt. Governor of South Carolina got involved in the social media
campaigns. Legislation has also begun to be proposed around suicide prevention, which shows the topic is
beginning to be a high priority area of concern. 6 This strategized effort coupled with SCYSPI program
staff staying persistent and passionate about suicide prevention, while having consistent messaging
around myth busting and empowering people through positive message, helped to knock down barriers.
This messaging was consistent through social marketing, events, and media appearances, as well as in
trainings. Trainings often provided SCYSPI a “foot in the door” with partners who remained skeptical.
In the very beginning, SCYPSI often picked partners who were ready to change and spread the word
about early successes to further gain stakeholder buy in and trust, using a positive diffusion of innovation
strategy. Key informants stated: “The main facilitators of the implementation of the SCYSPI were
highlighted to be the persistence of program staff and leadership, as well as the passion for the work
shown by the SCYSPI team. Program leadership held the attitude of, “We will go wherever you let us,
even its it’s in your driveway talking to you about suicide prevention.” 6 Many key informants also
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reach.
Unfortunately, despite all this work to dispel stigma, it was still noted as the greatest barrier moving
forward. Key informants mentioned that conversations around challenging the stigma and conversations
about youth suicide and prevention need to be continued because, “If we don’t talk about it, it’s going to
get worse.” 6
Moving forward, key informants also noted that a data-driven approach should be continued, with
more personal anecdotal experiences shared in public forums to help normalize talking about suicide.
Additionally, more education and public awareness campaigns are needed. Key informants noted that,
“…it can’t just be a one and done thing.” 6 Other strategies mentioned included: 1. Continuing to
incorporate prevention programs within school setting with an emphasis on resiliency; 2. Diversity
inclusion through providing more culturally diverse trainings and partnering with community-based
organizations and community leaders from these populations to lead those efforts; and 3. More inter-
agency collaborations so that transition of care can be more streamlined. One key informant stated this
was important so no YYAs in SC experiencing suicidal ideation or behavior “…die in the cracks.” 6
Moving forward, other barriers mentioned by key informants included SCYSPI being grant funded
with no sustained funding, the mental health workforce shortage in SC to work with at-risk youth, staff
turnover, the overall feeling that suicide prevention is a mammoth task, competing with other pressing
issues in the state, and lastly, the predicted worsening of mental health from COVID-19. Despite these
barriers, the work not only continued in 2020, but accelerated. We end SCYSPI feeling grateful for the
tremendous progress and mindful of the continued needs of South Carolinians.
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Approach and Deliverables
At the start of SCYSPI, no other groups were actively pulling SC suicide data. It was clear since
this data was not being analyzed and disseminated, with little known about SC suicide trends, it was hard
for people to understand the scope of the problem. This affected buy in and programming. In studying
suicide, understanding “how” and “why” it is happening is just as important as answering the “who, what,
when, and where” questions. SCYSPI used a mixed methods approach, where both quantitative (i.e.,
suicide death rates, key demographics affected) and qualitative data (i.e., interviews with those working
professionally in the field, lived experience interviews) told the most comprehensive story of suicide
prevention. Additionally, SCYSPI was built upon the Public Health Model for Violence Prevention and
Developmental Evaluation, where data is driving programming decisions. 1-5 Therefore, it was imperative
for the SCYSPI Evaluation Team to access SC suicide data.
SC has access to data on suicide deaths, through the DHEC SCAN database and the SC Violent
Death Reporting System. SC also has Emergency Department and Hospital Data on suicide attempts
through the SC Integrated Data System (SCIDS) maintained by the SC Revenue and Fiscal Affairs
Office. This serves as a great resource for statewide suicide prevention efforts. It took a couple years to
build key relationships to access this data. This included SC DHEC, SCDMH, SC Revenue and Fiscal
Affairs office, and all state agencies contributing data to SCIDS that we were interested in (SC Dept. of
Juvenile Justice, SC Dept. of Corrections, SC Dept. of Social Services, DAODAS). We established a
SCYSPI Evaluations Committee in Year 1 and had quarterly meetings, engaging key data partners from
the beginning.
The SCYSPI Evaluation Team have produced: ➢ 5 Surveillance Data Reports (i.e., suicide deaths, suicide attempts treated by hospitals, and YRBS results), ➢ 2 SC Stakeholder Interviews Reports, ➢ 1 SC Key Informant Report (n=9). ➢ 5 infographics (2 Surveillance Data, 1 Stakeholder Interviews, and 2 Program Data)
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24. 7 There were 123 suicide deaths in 2019, bringing the total to 559 from 2015 to 2019. Whites, non-
Hispanics, and ages 20-24 have the highest rates of suicide deaths. Demographic trends of concern
include ages 10-14 and 15-19 and whites. 8 There were 7,081 suicide attempts in 2019 for all age groups,
bringing the total to 28,763 from 2016 to 2019. 9 Females, “Other Races”, and age groups between 15-19
have the highest rates of suicide attempts in SC. Demographic trends of concern include females and the
African American and “Other” race groups within the age groups of 10-14, 15-19, and 20-24. Most
common methods used were poisoning/toxic effects and cutting/piercing. 9
Figure 4. SC Youth Suicide Death Numbers by Race (2015-2019)
SC Youth Suicide Death Numbers by Race 100 90 94 89 85 80 77 60
40 27 26 20 20 15 18 0 3 3 4 4 3 2015 2016 2017 2018 2019 White Black Other
Figure 5. SC Suicide Attempt Rates by Age Groups (2016-2019)
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COVID-19 Innovations The COVID-19 pandemic is predicted to likely worsen mental health symptoms for those living
with serious mental illness but may also lead to an increase in new mental health patients. This is due to
factors such as large-scale economic difficulties, including job loss, financial and job stress, childcare and
school-related stress, and increased anxiety and depression. 10-13 With the COVID-19 pandemic, we added
a real time quarterly data report.
Specifically, there was a notable spike in statewide EMS calls for Self-Harm in November and
December 2020. Also of significant concern was the jump in SC Lifeline calls for the 13-24 age group.
While SC Lifeline call volume has not overall increased since the pandemic began for all ages, calls have
started trending upward for ages 13-24. In September 2020, the call volume was more than 200 calls
while in December 2020, the call volume was more than 450. 14
*Complete December 2020 data was not available at the time of the Winter 2021 quarterly report and will be included in the Spring 2021 report
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SCYPSI responded to COVID-19 through an increase in training, targeted outreach, social marketing
campaigns, and implementing the Interactive Screening Program. One of these challenges included
changing training platforms so that trainings could continue to be conducted safely. There was a 352%
increase in trainings when looking at the grant year 2019-2020, Q1 and Q2 (502) vs. Q3 and Q4 (2,269).
There was a 210% increase in social media reach when looking at grant year 2019-2020 Q1 and Q2
(46,962) vs. Q3 and Q4 (145,683). Additionally, outreach often occurs at face-to-face events, including
the annual AFSP “Out of the Darkness” walks and various conferences. There were 33 outreach events
held during the 2020 Grant Year, with 10 occurring after the pandemic began. These included virtual
seminars and talks for state organizations such as SC Department of Health and Human Services, school
personnel, college students, and media stories. Lastly, the Interactive Screening Program, which allows
people to reach out to a mental health professional online to be screened and linked to mental health care
has served 671 since its rollout in September 2020, with 100 of those served were between the ages of 18-
24.
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OSP was created in 2019 when the Zero Suicide Initiative grant launched as a way of noting the
work across the entire life span and as a sustainability measure moving forward. SCYSPI was incorporated
into OSP and OSP is embedded within SCDMH. A big SCYSPI accomplishment was getting the Zero
Suicide approach embedded with the SCDMH system, where pilots first took place for youth and young
adults, then expanded to adults when Zero Suicide Initiative was awarded. The Zero Suicide approach, in
itself, is a sustainable practice. Having ownership across all levels of the organization, from front line staff
to program champions to top leadership, encourages it will be embedded into the infrastructure. Getting
feedback from the workforce survey, having process measures, such as a work plan, and continuous quality
improvement indicators, are all sustainability practices. The Zero Suicide Initiative will continue to fund
SCDMH’s work around Zero Suicide and SCDMH will also serve as a hub for training of communities of
learning to share lessons learned and provide technical assistance through the evaluation team around data
collection.
Another key activity of SCYSPI sustainability was to meet with key partners, such as the AFSP-SC,
MHA-SC, and NAMI-SC, etc., to ensure efforts were not duplicated. A training plan was developed with
these training partners so that potential reach is optimized. These partnerships also work on postvention
practices and system changes, specifically connected to preventing suicide.
In 2020, SCYSPI faced challenges of maintaining grant deliverable progress with 3 staff members
leaving during this grant year. We were focused on sustainability after the grant end date, which became
more difficult during the pandemic. The GLS grant funded all of staff and office space, as well as many
training initiatives for our state. We have been successful in building and leveraging partnerships to
continue the vital suicide prevention work with those ages 24 and younger beyond the GLS grant. However,
we are seeing a consistent uptick in the suicide rates in those 10-14 and 15-19. We believe our state will
need on-going funding to decrease these rates and will be pursuing funding opportunities when they become
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suicide. Until we achieve and sustain zero suicide deaths in our state, the work must continue.
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1. Hanson, D. W., Finch, C. F., Allegrante, J. P., & Sleet, D. (2012). Closing the gap between injury prevention research and community safety promotion practice: revisiting the public health model. Public health reports, 127(2), 147-155. 2. National Center for Injury Prevention and Control, Division of Violence Prevention, Centers for Disease Control and Prevention, (2021) The Public Health Approach to Violence Prevention. Retrieved from: https://www.cdc.gov/violenceprevention/publichealthissue/publichealthapproach.html. Accessed 17th, January 2021. 3. Patton, M. Q. (2006). Evaluation for the way we work. Nonprofit Quarterly, 13(1), 28-33. 4. Office of the Surgeon General (US); National Action Alliance for Suicide Prevention (US). 2012 National Strategy for Suicide Prevention: Goals and Objectives for Action: A Report of the U.S. Surgeon General and of the National Action Alliance for Suicide Prevention. Washington (DC): US Department of Health & Human Services (US); 2012 Sep. PMID: 23136686. 5. National Center for Injury Prevention and Control, Division of Violence Prevention, Centers for Disease Control and Prevention, (2021) The Public Health Approach to Violence Prevention. Retrieved from: https://www.cdc.gov/violenceprevention/about/social- ecologicalmodel.htmlAccessed 17th, January 2021. 6. Ankrom, B. (2021). Changing the Way South Carolina Views and Response to Suicide. Key Informant Interviews Report. 7. American Foundation for Suicide Prevention. (2020) Suicide Facts and Figures: South Carolina. Retrieved from: https://www.datocms-assets.com/12810/1589487689-2020-state-fact- sheets-south-carolina.png. Accessed December 14th, 2020. 8. SCAN Data, Department of Health and Environmental Control. 2015-2019. Retrieved from http://scangis.dhec.sc.gov/scan/bdp/tables/death2table.aspx. Accessed on August 31st. 2020. 9. Suicide Attempt Hospital and ED Visits 2016-2019. SC Hospital Discharge Database, Revenue and Fiscal Affairs Office, Health and Demographics Section. 10. Bao, Y., Sun, Y., Meng, S., Shi, J., & Lu, L. (2020). 2019-nCoV epidemic: address mental health care to empower society. The Lancet, 395(10224), e37-e38. 11. Pfefferbaum, B., & North, C. S. (2020). Mental health and the Covid-19 pandemic. New England Journal of Medicine, 383(6), 510-512. 12. Torales, J., O’Higgins, M., Castaldelli-Maia, J. M., & Ventriglio, A. (2020). The outbreak of COVID-19 coronavirus and its impact on global mental health. International Journal of Social Psychiatry, 66(4), 317-320. 13. Ho, C. S., Chee, C. Y., & Ho, R. C. (2020). Mental health strategies to combat the psychological impact of COVID-19 beyond paranoia and panic. Ann Acad Med Singapore, 49(1), 1-3. 14. Childers, C.D. (2021) Real Time Data Report, Winter 2021.
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South Carolina Zero Suicide Initiative
Reporting Period:
October 1, 2019 – September 30, 2020
Suicide Prevention Branch
Division of Prevention, Traumatic Stress and Special Programs Center for Mental Health Services Substance Abuse and Mental Health Services Administration Department of Health and Human Services
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ZSI uses a public health approach to suicide Objective 2.1: To promote suicide prevention prevention, an approach recommended by the as a core component of healthcare services CDC for violence prevention, using systems (NSSP Goal 8) through provision of training thinking. The public health approach to hospital liaison staff, healthcare providers, considers how to make large-scales changes and behavior health providers and interventions, so that entire populations are benefitted.1 The Socioecological Model Objective 2.2.: To promote and implement was used to map out ZSI activities. ZSI aims effective clinical and professional practices to diffuse evidence-based suicide prevention for assessing and treating those identified as strategies as an innovation, as reflected in the being at risk for suicidal behaviors NSSP current goals and objectives below. Goal 9
Current Goals and Objectives Objective 2.3: To embed suicide prevention ZSI’s current goals and objectives include: strategies/activities into the mental health system. 1.Implement ZS approach within SCDMH Objective 2.4: To increase the use of SC Objective 1.1: To implement the evidence- Lifeline so that at least 75% of calls are based ZS Approach in SCDMH handled in-state.
Objective 1.2: To strengthen and revise 3. Leverage the SC State Suicide discharge protocols at SCDMH centers, Prevention Coalition to strengthen emergency departments, and acute care infrastructure systems and partnerships psychiatric hospitals Objective 3.1: In collaborative SC State Objective 1.3: To promote suicide prevention Suicide Prevention Coalition partners to as a core component of healthcare services make fundamental policy changes at a (NSSP Goal 8) through provision of training systemic level that support provision of to hospital liaison staff, healthcare providers, excellent aftercare to suicide attempt and behavior health providers survivors
1
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Below are the SPARS Indicator Totals for initiatives of universal safety planning and the grant year: referral to suicide specific treatments, and launched suicide prevention month • 124,291 SCDMH screenings with initiatives. 11,776 referrals to suicide-specific care in the SCDMH suicide care pathway.
• 4,287 South Carolinians trained in suicide prevention at a clinical level in the mental health care workforce.
• 26 partners collaborating with ZSI in the 2020 Grant Year. Partners included Federally Qualified Health Centers (FQHCs), health care systems, Mental Health America- Greenville, and the SC Office of *Zero Suicide Champions from The Probation, Parole, and Pardon Department of Inpatient Services (DIS) Services. dressed up as superheroes to encourage staff to take their workforce surveys. Key Program Accomplishments Listed below are the key program We would like to highlight some of our accomplishments for the 2020 Grant Year: community mental health centers. Aiken- Barnwell Mental Health Center participates 3
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(CALM) at the start of their employment. Goal 2: Statewide Organizations OSP offers additional trainings based upon Implementing ZS needs within the agency. DBT Cohort 3 ZSI hosted our third ZS academy in the training started in early November. SCDMH summer of the 2020 grant year for the introduced an online training, “Introduction following: SC Hospital Association, SC to Zero Suicide” that is now required for all Department of Health and Environment DMH employees. This training will Control (SCDHEC), SC Primary Healthcare introduce them to the initiative and how this Association, a community hospital, 6 impacts each area of our agency. Staff will FQHCs, DAODAS, the SC Office of Rural also take the online course, Talk Saves Lives Health and 2 DMH teams. They began their for the Workplace by AFSP, which has been EDC consultation calls in September 2020. modified to be SC specific. OSP certified 24 SCMDH staff members as trainers in AMSR SCDHEC for Health and Behavioral Health SCDHEC leadership announced on Sept. 24, Professionals for both inpatient and 2020 that they are now adopting the full ZS outpatient settings. They were also certified framework. ZSI is providing technical as trainers in AMSR for direct care staff for assistance on policy and protocol both inpatient and outpatient settings. These development and training. SCDHEC trainers included 7 inpatient staff and 17 manages all public health clinics in the state, outpatient staff from across our state. OSP where they provide direct client care to trained 75 clinicians in CAMS and 50 underserved populations. Additionally, clinicians in CBT-SP, as well as had the SCDHEC is responsible for the SC response second DBT cohort (35 clinicians) complete to COVID-19. We feel this commitment to
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Start. ZSI also started training the entire SC Hospitals, FQHCs, and Medical Systems: Department of Probation, Parole and Pardon ZSI had 6 community partners from hospital Services (711 employees) in Start. They will systems around the state participate in the be the first state agency and the first SC law third ZS Academy this summer. Partner enforcement agency to train their entire updates include: workforce, including their State Director, in • Atrium Health: 150 people have suicide prevention. We also trained the completed care in their suicide care Kershaw Co. Probate Court staff in Start and pathway; one nurse out on possible are examining whether to extend this training to other probate courts across the state. 6
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SCDVA and County Veteran Service Offices: The SC Division of Veteran Affairs and County Veteran Service Offices had 91 employees complete the START training. Their goal is train 100% of their staff
statewide.
Lifeline ZSI provides $100,000 in funding to MHA- GC, as the sole Lifeline call center in SC, to increase the Lifeline answer rate by 5%. At the beginning of this grant, Lifeline calls in SC were only being answered in the 864 area code (11 counties) and were only answering 5% of those. Last year, we saw that rate Goal 3: Leverage the SC State Suicide increase to 19%. As of Dec. 2, 2019, Lifeline Prevention Coalition to strengthen calls are now answered for all SC area codes. infrastructure systems and partnerships MHA-Greenville County acquired a new phone system that would allow more The SC State Suicide Prevention Coalition capacity, better efficiency in tracking met quarterly in the 2020 Grant Year, with a calls/data, and would allow for remote focus on the state’s mental health care working, which was seen as a great need response to COVID-19. A subcommittee was given the COVID-19 pandemic. Calls to the formed in December 2019 to update the state Lifeline appear to be stable during COVID- plan. Revised mission statement and goals 19, thus far. However, we have seen have been approved, with a focus on more challenges when call center staff were system level changes, including relevant state impacted by exposure to the virus. We legislative work, including seeking more continue to monitor the impact of the legislation for suicide prevention funding.
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recruited and appointed a Project 2025 ZS has responded through an increase in Champion who is putting together a team to training, targeted outreach, including help promote the public education of firearms planning and implementing the Interactive and suicide prevention. Two potential Screening Program, and using real time data volunteers have been recruited with the task sources to understand how to better target of educating localized firearms providers or resources to key geographic areas and dealers in suicide prevention. AFSP-SC is demographic groups.
planning to identify a National Shooting In addition to SCDMH making a full switch Sports Foundation SC contact in order to from in-person visits to virtual care during begin a partnership in suicide prevention the COVID-19 pandemic, agency wide suicide screenings for patients over ages 25 Goals 4&5: Improve the collection of suicide went up 6% (Q1 & Q2 (60,428) vs. Q3 & Q4 prevention and surveillance data and Design (63,838)), while referrals to suicide-specific and implement social marketing campaigns care went up 10% (Q1 & Q2 (5,621) vs. Q3 & Q4 (6,155)). These are key indicators of Please see COVID-19 Challenges and the ZS approach, and these efforts not only Innovations section for updates continued at SCDMH during the pandemic but increased. Goal 6: Promote and implement postvention Another challenge was conducting trainings services virtually, so that trainings could continue to ZSI provided AFSP Healing Conversation be conducted safely. There was a 788% materials to all of the SCDMH centers to increase in people trained when looking at Q1 distribute when there is a death in their area. & Q2 (434) vs. Q3 & Q4 (3,853). Continuing
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resources to help connect them with mental health and addiction services. The ISP has
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REFERENCES
1. The Public Health Approach to Violence Prevention. (January 2019). Centers for Disease Control. Accessed on November 1, 2019. https://www.cdc.gov/violenceprevention/publichealthissue/publichealthapproach.html
2. Patton, M. Q. (2006). Evaluation for the way we work. Nonprofit Quarterly, 13(1), 28-33.
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20. Support of State Partners - Required for MHBG
Narrative Question The success of a state's MHBG and SABG programs will rely heavily on the strategic partnership that SMHAs and SSAs have or will develop with other health, social services, and education providers, as well as other state, local, and tribal governmental entities. Examples of partnerships may include:
• The SMA agreeing to consult with the SMHA or the SSA in the development and/or oversight of health homes for individuals with chronic health conditions or consultation on the benefits available to any Medicaid populations;
• The state justice system authorities working with the state, local, and tribal judicial systems to develop policies and programs that address the needs of individuals with M/SUD who come in contact with the criminal and juvenile justice systems, promote strategies for appropriate diversion and alternatives to incarceration, provide screening and treatment, and implement transition services for those individuals reentering the community, including efforts focused on enrollment;
• The state education agency examining current regulations, policies, programs, and key data-points in local and tribal school districts to ensure that children are safe, supported in their social/emotional development, exposed to initiatives that target risk and protective factors for mental and substance use disorders, and, for those youth with or at-risk of emotional behavioral and SUDs, to ensure that they have the services and supports needed to succeed in school and improve their graduation rates and reduce out-of-district placements;
• The state child welfare/human services department, in response to state child and family services reviews, working with local and tribal child welfare agencies to address the trauma and mental and substance use disorders in children, youth, and family members that often put children and youth at-risk for maltreatment and subsequent out-of-home placement and involvement with the foster care system, including specific service issues, such as the appropriate use of psychotropic medication for children and youth involved in child welfare;
• The state public housing agencies which can be critical for the implementation of Olmstead;
• The state public health authority that provides epidemiology data and/or provides or leads prevention services and activities; and
• The state's office of homeland security/emergency management agency and other partners actively collaborate with the SMHA/SSA in planning for emergencies that may result in M/SUD needs and/or impact persons with M/SUD conditions and their families and caregivers, providers of M/SUD services, and the state's ability to provide M/SUD services to meet all phases of an emergency (mitigation, preparedness, response and recovery) and including appropriate engagement of volunteers with expertise and interest in M/SUD.
Please respond to the following items: 1. Has your state added any new partners or partnerships since the last planning period? Yes No
2. Has your state identified the need to develop new partnerships that you did not have in place? Yes No
If yes, with whom?
In 2020, DMH received a federal grant of $6,403,686 to provide support to South Carolinians in rural areas who are experiencing mental health and substance use crises or have unmet treatment needs. The primary focus of the initiative is a Mobile Response Program serving nine counties beginning in 2021, called the Highway to Hope Mobile Response Program (H2H). H2H will serve both adults and children in some of the most rural areas of South Carolina, utilizing nine RVs operated by DMH staff from the three DMH mental health centers that serve those areas.
DMH’s First Responder Support Team (FRST) provides clinical support statewide to support the mental health needs of first responders. FRST began in Charleston County with services from the Charleston-Dorchester Community Mental Health Center in 2007. In 2020, FRST expanded statewide. DMH provides support to the SC Law Enforcement Assistance Program (SC LEAP). SC LEAP is a partnership including SLED, the South Carolina Department of Natural Resources, the South Carolina Department of Public Safety, and the South Carolina Department of Probation, Parole, and Pardon Services, to provide support to law enforcement and other first responders statewide. DMH MHPs provide support in local debriefings and post-critical incident seminars. Clinicians involved in this collaboration are trained in Eye Movement Desensitization & Reprocessing as well as Critical Incident Stress Management.
In 2021, DMH is embedding an MHP with the Richland County Sheriff’s Office who will respond alongside an ununiformed officer to calls involving mental health situations for de-escalation and crisis response.
The South Carolina Department of Mental Health (SCDMH) has a diverse portfolio of strategic partnerships that contribute to the achievement of its mission: to support the recovery of people with mental illnesses. Included in the portfolio are other Printed: 7/19/20217/21/2021 2:093:2812:38 PM PM - -South South Carolina Carolina - OMB No. 0930-0168 Approved: 04/19/2019 Expires: 04/30/2022 PagePage 204 of1 of222 2 departments of South Carolina State Government; entities representing service providers, advocates, associations, and other stakeholders; and educational institutions in South Carolina and other states. The number of such partnerships, however, is likely to increase as the Department constantly scans its environment to capitalize on its collective wisdom to describe the future as clearly and comprehensively as possible, and to identify partners who will affect positive outcomes for the citizens of the State of South Carolina, especially those impacted by mental illnesses.
Evidence of the support of state partners is best represented by the active role of certain agencies (listed below) in serving on the South Carolina Mental Health State Planning Council (Planning Council).
South Carolina Department of Health and Human Services South Carolina Department of Juvenile Justice South Carolina Department of Social Services South Carolina Department of Vocational Rehabilitation South Carolina State Housing Finance and Development Authority South Carolina Department of Alcohol and Other Drug Abuse Services
SCDMH also maintains contracts, memorandums of agreement, and other working-level documents with agencies that demonstrate specific efforts and endeavors on which SCDMH and these agencies are partnered. Such relationships include the South Carolina Emergency Management Division, South Carolina Department of Environmental Control, and the South Carolina Department on Aging.
Additional partnerships are evidenced by the 800+ schools in which SCDMH has placed a Mental Health Professional, relationships which require a contractual basis and philosophical agreement.
The South Carolina Department of Mental Health has affiliations with more than 60 educational institutions in South Carolina and more than 5 other states. DMH works closely with independent advocacy organizations to improve the quality of life for people with mental illness, their families, and the citizens of South Carolina.
The DMH’s affiliation with the University of South Carolina includes activity therapy, clinical counseling, medical students, nursing students, social work, psychology interns, psychology graduate studies, and residents and fellows in psychiatry.
DMH has contracts with the University of South Carolina’s School of Medicine (USCSOM) and Department of Neuropsychiatry and Behavioral Science. There has been a long collaborative relationship between DMH and the Department of Neuropsychiatry and Behavioral Science at the USCSOM, which provides clinical consultation and training delivery to DMH staff on a range of clinical topics.
Residents from the MUSC Residency Training Program receive educational experiences and supervision in Psychiatry through scheduled rotations at the Charleston Dorchester Mental Health Center (CDMHC). CDMHC is involved with learning collaborative including DMH, the Crime Victim’s Center at MUSC, and the Dee Norton Lowcountry Children’s Center. This initiative revolves around Trauma-Focused Cognitive Behavioral Therapy. Residents train with CDMHC’s First Responder Support Team and Mobile Crisis. Medical students rotate regularly though CDMHC throughout the academic year. DMH has a contract with MUSC to provide forensic evaluation of adult criminal defendants in 10 counties in South Carolina.
It should be noted that the information provided above serves only as a sample of the diverse portfolio of strategic partnerships that is maintained by the South Carolina Department of Mental Health. These relationships demonstrate recognition by each agency that solutions to the issues facing individuals with mental illnesses are not constructed in isolation, but require overlapping layers to address what are often times overlapping conditions and situations.
See also “Planning Steps – Step 1– Assess the Strengths and Organizational Capacity of the Service System to Address the Specific Populations” for additional examples. Please indicate areas of technical assistance needed related to this section. Not Applicable OMB No. 0930-0168 Approved: 04/19/2019 Expires: 04/30/2022
Footnotes:
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21. State Planning/Advisory Council and Input on the Mental Health/Substance Abuse Block Grant Application- Required for MHBG
Narrative Question Each state is required to establish and maintain a state Mental Health Planning/Advisory Council to carry out the statutory functions as described in 42 U.S. C. 300x-3 for adults with SMI and children with SED. To meet the needs of states that are integrating services supported by MHBG and SABG, SAMHSA is recommending that states expand their Mental Health Advisory Council to include substance misuse prevention, SUD treatment, and recovery representation, referred to here as an Advisory/Planning Council (PC).SAMHSA encourages states to expand their required Council's comprehensive approach by designing and implementing regularly scheduled collaborations with an existing substance misuse prevention, SUD treatment, and recovery advisory council to ensure that the council reviews issues and services for persons with, or at risk, for substance misuse and SUDs. To assist with implementing a PC, SAMHSA has created Best Practices for State Behavioral Health Planning Councils: The Road to Planning Council Integration.69 Planning Councils are required by statute to review state plans and implementation reports; and submit any recommended modifications to the state. Planning councils monitor, review, and evaluate, not less than once each year, the allocation and adequacy of mental health services within the state. They also serve as an advocate for individuals with M/SUD problems. SAMHSA requests that any recommendations for modifications to the application or comments to the implementation report that were received from the Planning Council be submitted to SAMHSA, regardless of whether the state has accepted the recommendations. The documentation, preferably a letter signed by the Chair of the Planning Council, should state that the Planning Council reviewed the application and implementation report and should be transmitted as attachments by the state.
69https://www.samhsa.gov/sites/default/files/manual-planning-council-best-practices-2014.pdf
Please consider the following items as a guide when preparing the description of the state's system: 1. How was the Council involved in the development and review of the state plan and report? Please attach supporting documentation (meeting minutes, letters of support, etc.) using the upload option at the bottom of this page.
a) What mechanism does the state use to plan and implement substance misuse prevention, SUD treatment and recovery services? The South Carolina Department of Alcohol and Other Drug Abuse Services is responsible for the mechanisms to plan and implement substance misuse prevention, SUD Treatment, and recovery services related thereto.
b) Has the Council successfully integrated substance misuse prevention and treatment or co- Yes No occurring disorder issues, concerns, and activities into its work?
2. Is the membership representative of the service area population (e.g. ethnic, cultural, linguistic, rural, Yes No suburban, urban, older adults, families of young children)?
3. Please describe the duties and responsibilities of the Council, including how it gathers meaningful input from people in recovery, families, and other important stakeholders, and how it has advocated for individuals with SMI or SED.
Please see the attached South Carolina Mental Health State Planning Council Bylaws; specifically, Article II.
As a function of the South Carolina Mental Health State Planning Council's classification as a body politic, it publishes each year, and places on the SCDMH website, a Notification of Meeting Schedule (see attached) which provides an opportunity for the public to interface with the Planning Council and SCDMH.
Please also see Letter from South Carolina Mental Health State Planning Council Chairperson. Please indicate areas of technical assistance needed related to this section. Not Applicable
Additionally, please complete the Advisory Council Members and Advisory Council Composition by Member Type forms.70
70There are strict state Council membership guidelines. States must demonstrate: (1) the involvement of people in recovery and their family members; (2) the ratio of parents of children with SED to other Council members is sufficient to provide adequate representation of that constituency in deliberations on the Council; and (3) no less than 50 percent of the members of the Council are individuals who are not state employees or providers of mental health services. OMB No. 0930-0168 Approved: 04/19/2019 Expires: 04/30/2022
Footnotes:
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Notice is hereby given that at the November 18, 2020 meeting of the South Carolina Mental Health State Planning Council (Council), the Council approved the dates and times upon which it will convene its meetings in 2021.
The meetings will be held from 10:00AM to 12:00PM on the following dates in Room 323 of the South Carolina Department of Mental Health Administration Building, located at 2414 Bull Street, Columbia, SC, unless otherwise notified.
January 20, 2021 March 17, 2021 May 19, 2021 July 21, 2021 September 15, 2021 November 17, 2021
Please note that the Council may also convene subcommittee meetings on the same dates. Additional information will follow. Please refer to the published agenda for each respective date to determine if subcommittee meetings are intended.
For additional information, please contact Stewart Cooner, Deputy Director of Administrative Services, at 803-898-8632, or via email at [email protected], or via postal mail at 2414 Bull Street, Suite 302, Columbia, SC 29201.
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Advisory Council Members For the Mental Health Block Grant, there are specific agency representation requirements for the State representatives. States MUST identify the individuals who are representing these state agencies.
State Education Agency State Vocational Rehabilitation Agency State Criminal Justice Agency State Housing Agency State Social Services Agency State Health (MH) Agency.
Start Year: 2022 End Year: 2023
Name Type of Membership Agency or Organization Represented Address,Phone, and Email(if Fax available)
SC Department of Vocational Harriet Abner State Employees Rehabilitation
Others (Advocates who are not State South Carolina National Guard Suicide Chris Allen employees or providers) Prevention
Others (Advocates who are not State Brian Ambrose Charleston Police Department employees or providers)
Versie Bellamy State Employees SC Department of Mental Health
Deborah Blalock State Employees SC Department of Mental Health
SC Department of Alcohol and Other Drug Hannah Bonsu State Employees Abuse Services
Family Members of Individuals in Recovery Zee Brown (to include family members of adults with SMI)
Family Members of Individuals in Recovery Jenah Cason (to include family members of adults with SMI)
Marilla Copeland Parents of children with SED/SUD
Becky Davis State Employees SC Department of Education
Ann-Marie Dwyer State Employees SC Dept of Health and Human Services
Individuals in Recovery (to include adults Raj Gavurla with SMI who are receiving, or have received, mental health services)
Individuals in Recovery (to include adults Lloyd Hale with SMI who are receiving, or have received, mental health services)
Marcy Hayden State Employees SC Commission for Minority Affairs
Others (Advocates who are not State Joan Herbert employees or providers)
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Louise Johnson State Employees SC Department of Mental Health
Amy Jolly Providers Work-In-Progress
Family Members of Individuals in Recovery Bill Lindsey (to include family members of adults with SMI)
SC State Housing Finance and Renaye Long State Employees Development Authority
Brett Macgargle State Employees SC Department of Juvenile Justice
Pheobe Malloy Parents of children with SED/SUD
Family Members of Individuals in Recovery Mandy Medlock (to include family members of adults with SMI)
Elizabeth Morris State Employees Clemson University
Timothy Nix State Employees SC Department of Social Services
Family Members of Individuals in Recovery Melissa Reitmeier (to include family members of adults with SMI)
Kenneth Rogers State Employees SC Department of Mental Health
Family Members of Individuals in Recovery Carol Rudder (to include family members of adults with SMI)
Individuals in Recovery (to include adults Janie Simpson with SMI who are receiving, or have received, mental health services)
Maria Beth Smith Parents of children with SED/SUD
Individuals in Recovery (to include adults Tray Stone with SMI who are receiving, or have received, mental health services)
Others (Advocates who are not State Janet Upthegrove employees or providers)
SC Department of Disabilities and Special Steven Von Hollen State Employees Needs
Individuals in Recovery (to include adults Sissy Weaver with SMI who are receiving, or have received, mental health services)
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Advisory Council Composition by Member Type
Start Year: 2022 End Year: 2023
Type of Membership Number Percentage
Total Membership 45
Individuals in Recovery* (to include adults with SMI who are receiving, or 5 have received, mental health services)
Family Members of Individuals in Recovery* (to include family members of 6 adults with SMI)
Parents of children with SED/SUD* 3
Vacancies (Individuals and Family Members) 6
Others (Advocates who are not State employees or providers) 5
Persons in recovery from or providing treatment for or advocating for SUD 0 services
Representatives from Federally Recognized Tribes 0
Total Individuals in Recovery, Family Members & Others 25 55.56%
State Employees 14
Providers 1
Vacancies 5
Total State Employees & Providers 20 44.44%
Individuals/Family Members from Diverse Racial, Ethnic, and LGBTQ 13 Populations
Providers from Diverse Racial, Ethnic, and LGBTQ Populations 0
Total Individuals and Providers from Diverse Racial, Ethnic, and LGBTQ 13 Populations
Youth/adolescent representative (or member from an organization serving 0 young people)
* States are encouraged to select these representatives from state Family/Consumer organizations.
Indicate how the Planning Council was involved in the review of the application. Did the Planning Council make any recommendations to modify the application? The South Carolina Mental Health State Planning Council is actively recruiting potential candidates for membership. In an effort to fill its 6 vacancies in the category of "Total Individuals in Recovery, Family Members & Others" and its 5 vacancies in the category of "Total State Employees & Providers," the Nominating Committee of the South Carolina Mental Health State Planning Council (Council) is planning to review the Council's membership roster. OMB No. 0930-0168 Approved: 04/19/2019 Expires: 04/30/2022
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22. Public Comment on the State Plan - Required
Narrative Question Title XIX, Subpart III, section 1941 of the PHS Act (42 U.S.C. § 300x-51) requires, as a condition of the funding agreement for the grant, states will provide an opportunity for the public to comment on the state block grant plan. States should make the plan public in such a manner as to facilitate comment from any person (including federal, tribal, or other public agencies) both during the development of the plan (including any revisions) and after the submission of the plan to SAMHSA.
Please respond to the following items:
1. Did the state take any of the following steps to make the public aware of the plan and allow for public comment?
a) Public meetings or hearings? Yes No
b) Posting of the plan on the web for public comment? Yes No
If yes, provide URL: Please see the following page for a summary of the steps the State took to make the public aware of the plan and allow for public comment.
The MHBG Application and MHBG Report are available at: https://scdmh.net/public-information/reports/ c) Other (e.g. public service announcements, print media) Yes No
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Steps to Request Public Comment on the FY2022-2023 Mental Health Block Grant Application
Regarding steps the State took to make the public aware of the plan and allow for public comment: On August 2, 2021, members of the South Carolina Mental Health Commission were notified via email of the availability of the draft FY2022-2023 Mental Health Block Grant Application. On August 2, 2021, members of the South Carolina Mental Health State Planning Council were notified via email of the availability of the draft FY2022-2023 Mental Health Block Grant Application. On August 2, 2021, specific South Carolina mental health advocate organizations were notified via email of the availability of the draft FY2022-2023 Mental Health Block Grant Application. On August 2, 2021, members of the general public were notified of the availability of the draft FY2022-2023 Mental Health Block Grant Application via SCDMH’s standard procedure to provide statewide public notice by sending a ‘media alert’ notification to all daily and non-daily newspapers in the state. 17 daily newspaper contacts were notified. 35 non-daily newspaper contacts were notified. On August 2, 2021, members of the general public were notified of the availability of the draft FY2022-2023 Mental Health Block Grant Application via creation of an event on SCDMH’s 23 Facebook pages. On August 2, 2021, members of the general public were notified of the availability of the draft FY2022-2023 Mental Health Block Grant Application via SCDMH’s internet and intranet home pages on which were placed banners of announcement. A Notice of Availability of Mental Health Block Grant Application and Report was placed in three newspapers representing the Upstate, Midlands, and Lowcountry regions of South Carolina: The Greenville News (March 2021, August 2021); The State Newspaper (March 2021, August 2021); and, The Post and Courier (March 2021, August 2021), respectively. Public comment was requested via letter, email, and telephone. As of August 30, 2021, _____ recommendations for modifications to the final draft FY2022-2023 Mental Health Block Grant Application were offered by the South Carolina Mental Health State Planning Council.*
*Italics indicates proposed language. Subject to change as applicable.
[End]
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