Model Shared Definition of SMI

Model Shared Definition

Develop a common vocabulary around which to focus planning both among local partners and in comparing efforts across California counties.  Essentially, this is a common language version of the WIC definition.

Align treatment eligibility criteria for publicly funded mental health treatment

The definition is ideally customized by a county adding on to it.

Serious Mental Illness (SMI)

Specific diagnoses and significant difficulties functioning over a period of time.

Nationwide, the estimate is 4% of population with SMI, and 17% within jails.

California Welfare and Institutions Code (WIC) definition of SMI

Definition drives public funding of mental health services.

Medi-Cal specialty mental health (county mental health plans) use WIC definition.  Using the definition in Title 9 of the California Code of Regulations to make a clinical determination – qualifies for Medi-Cal speciality mental services or Medi-Cal managed care plan.

Mental Health Services Act (Proposition 63) funded treatment and services use WIC

Board of State and Community Corrections’ Mentally Ill Offender Crime Reduction (MIOCR) grant program use WIC

Activities of Daily Living (ADL)

Ability, or inability to perform routine daily activities like bathing, dressing, feeding oneself, etc.  WIC uses this to measure for functional impairment

Screenings for SMI during intake

During jail booking, an assessment is given (standardized and doesn’t require  being a clinician).  Helps for appropriate mental health followup (inside jail and outside).  Helps for jail staff to appropriately work with the inmate.

Financial Focus of Model Shared Definition

Intention is to help counties focus scare resources on those with significant treatment needs – stretch the dollars as much as possible.  Ideally categorized so that public funding is available.

Counties ideally engage in cross-systems planning – custom to each county in terms of needs and available resources.

Strategy: Maximize Medi-Cal Reimbursements (enroll people if possible).   Shifts from general funds for expenditures to Medi-Cal.

Strategy: Target criminal justice populations with all available Medi-Cal programs

Strategy: Improve Medi-Cal administrative Activities and Targeted Case Management billing – maximize federal reimbursements

Strategy: Re-examine Medi-Cal County Inmate Programs – shift hospital costs from jail to Medi-Cal; working with Hospital Presumptive Eligibility Program

Data Focus

Identify programs currently responding to each of the four measures (how many people with SMI in jail; how long staying in jail; how many connected to community-based treatment upon release; how frequently do they recidivate)

Using baseline data to measure program capacity, identify service gaps, recognize opportunities to expand existing services.

Update Board of Supervisors to make local funding requests.  Support requests for state and federal funding opportunities.