RD539 - Report on Funding for Outpatient Services for Youth and Young Adults – December 1, 2016

Executive Summary:
The majority of individuals with serious mental illness experience the first signs of illness during adolescence or early adulthood, and long delays often occur between symptom onset and treatment. International data demonstrate that transition-age youth and young adults, generally defined as those ages 16-25, have high rates of behavioral health problems as compared to other adult age groups, but seek and participate in treatment at the lowest rate of all adult age groups. The reasons for this disparity include:

• Young adults’ desire to disconnect from parental authority once they reach the age of majority at age 18;
• Challenges in accessing available treatment in the adult behavioral health system; and
• Programming that does not currently “speak” to the needs of young people.

With a peak onset occurring between 16-25 years of age, serious mental illnesses, especially those which include psychosis as a major symptom, can derail a young person’s social, academic, and vocational development and initiate a trajectory of escalating disability. Youth who are experiencing their first episode of psychotic illness are often frightened and confused, and struggle to understand what is happening to them. They also present unique challenges to family members and service providers, including demonstrating irrational behavior, aggression against themselves or others, difficulties communicating and relating, and conflicts with authority figures. Research demonstrates that the delivery of early intervention services to this population, which is at high risk of poor outcomes such as cycling psychiatric hospitalization, substance abuse, homelessness and involvement with the criminal justice system, is essential to improving outcomes.(*1)

The tragic shootings at Virginia Tech in 2007 and Sandy Hook Elementary School in 2012, as well as other recent incidents of high-profile violence perpetrated by young people with untreated mental illness, have drawn national attention to the behavioral health needs of this population. As a result, federal and state officials have placed a priority on enhancing behavioral health treatment for transition-age youth and young adults.

In addition to the recommendations of the Governor’s School and Campus Safety Task Force here in Virginia, the need to expand services to this population resulted in the Obama Administration in 2014 requiring states to expend a percentage of their federal Community Mental Health Services Block Grant (CMHSBG) funds on the treatment of youth and young adults experiencing their first episode of psychotic illness. The current requirement is that states “set aside” 10 percent of CMHSBG funds for this population, increasing from five percent in last fiscal year. In Virginia, this set-aside was an additional $1,293,174 in federal funds in FY 2016 for these services, increasing to $1,315,960 in the current fiscal year. During the 2014 session, the General Assembly appropriated the $4,000,000 in General Funds dollars referenced in Item 315.Y for this population.

When combined with the CMHSBG funds for first-episode psychosis services, DBHDS is utilizing a total of $5,293,173 in FY 2017 to support the implementation of a new evidence-based clinical practice called Coordinated Specialty Care (CSC), which provides team-focused behavioral health services to transition-age youth and young adults ages 16-25 who have emerging serious mental illness. Specifically, CSC addresses the treatment needs of youth and young adults who have experienced their first episode of psychosis, which is often an indicator of the emergence of serious mental illness such as schizophrenia. Eight CSBs are being funded to implement CSC under this initiative, which will be described in the following sections of this report.
(*1) McFarlane, W.R., et al. (2014). Reduction in incidence of hospitalizations for psychotic episodes through early identification and intervention. Psychiatric Services, 65(10).