The Mental Health Task Force is moving ahead full steam on the Indicator Improvement Initiative and its mission to promote system change using root cause analysis and results based accountability around specifically selected behavioral health community indicators.

The first three months of this initiative earlier in the year, focused on building stakeholder support for indicators to become a national model of a mentally healthy community. When choosing indicators, data elements that communicate broadly across various sectors of the community were examined that directly lead to positive behavioral health results and have information systems to support our efforts in a timely fashion.

Resulting are the following FIVE INDICATORS:

1. The percentage of individuals with serious mental illness in the Travis County Jail (Criminal Justice Indicator);
2. The number of individuals readmitted to publicly funded psychiatric hospital beds within thirty days of discharge (Readmission Indicator);
3. The number of children discretionarily removed from school throughout Austin Independent School District (School Removal Indicator);
4.  The percentage of individuals presenting to emergency departments with primary substance use disorders (Substance Use Indicator); and
5. The percentage of individuals presenting to a variety of behavioral health treatment settings who report moderate to significant housing instability (Housing Instability Indicator).

The Mental Health Task Force continues to play an important role as an Advisory Committee for all five indicators. The six supporters of the Indicator Improvement Initiative (Integral Care, the City of Austin, Travis County, St. David’s Foundation, Hogg Foundation and the Bazelon Center for Mental Health Law) serve as the Executive Committee. Each indicator has a Steering Committee to guide system change recommendations related to the area of analysis.

Progress around these indicators will be incremental. Our initial work is centered on the following three indicators:

Criminal Justice Indicator

While multiple interventions have taken place in our community at each sequential intercept related to the interface between the behavioral health and criminal justice systems, we have observed a steady increase in the number of individuals in Travis County jails that have a severe mental illness. In an attempt to address this growing problem, a root cause analyses is being conducted on a number of individuals with behavioral health issues who have frequent law enforcement contacts. Austin is also one of five communities across the country selected to participate in the Performance Improvement Initiative. This grant is intended to generate ideas about ways to prevent law enforcement interactions in mental health cases.

Our analysis has revealed some surprising data, and a full report with recommendations will be ready by the end of year one.

Readmission Indicator

The Mental Health Task Force has also conducted a root cause analysis of all readmissions to publicly funded hospital beds between September 2009 and May 2010 to identify potential causative factors for this highly undesirable outcome. These results were presented to the Crisis Implementation Committee, who has agreed to serve as the Steering Committee on this indicator and to the Psychiatric Stakeholder’s Meeting in August. A further analysis will include all readmission cases in FY 2010, as well as a cost analysis of these events. It is our hope that the results of our data analysis will drive future funding for behavioral health services in our community.

School Removal Indicator

The Child and Youth Mental Health Planning Partnership serves as the Steering Committee for an analysis of discretionary school removals for youth in Austin Independent School District. While a trend analysis done earlier this year revealed that removals have actually decreased in recent years, Austin Independent School District’s rate of discretionary removals is higher than other urban areas in the state. We will again be conducting a root cause analysis to determine how many of those removals are related to behavioral health issues and how this outcome might have been averted.

Steering Committees for the remaining two indicators will be formed in the fall of 2010, stay tuned or visit mentalhealthtaskforce.org  for more details!