MS Discretionary Funding Fiscal Year 2023

The Mississippi Delta is known for extreme hardship and poverty. Our roads are mired with decades of human struggle and risk factors for mental health issues. In response, Community Students Learning Center (CSLC) and partners invite the SAMHSA to forge a new ROAD to wellness. ROAD: Rural Opportunities for Access and Development establishes mental health (MH) awareness trainings, decreases stigma, expands workforce training capacity, and results in expanded access and availability of trauma-informed, culturally, linguistically appropriate mental health services. MS Dept of MH’s Region 6 (HRSA MH Catchment Area #6). Comprised of 12 Delta counties (Attala, Bolivar, Carroll, Grenada, Holmes, Humphreys, Issaquena, Leflore, Montgomery, Sharkey, Sunflower, and Washington), each is designated as rural4 and a Health Professional Shortage Area (HSPA)5 in primary care, dental, and mental health. Contributing Factors and Demographics Averaged Across Twelve Counties Population Black White Poverty Child Poverty Mental Distress Grandparents Raising Grandchildren 18,101 36.25% 31.92% 30.45% 41.42% 15.08% 45.16% Severe Housing Problems Uninsured Poor Health Insufficient Sleep Social Isolation 18.50% 16.75% 28.08% 37.67% 86.83% Source: Robert Wood Johnson Foundation & U.S. Census Bureau A decade after being sued by the Southern Poverty Law Center7 for failing to meet the needs of Medicaid-eligible children with mental health needs, Mississippi remains stuck at bottom of national rankings for adult and child access to MH care.8 Within the state, access is the worst in the Delta.8,9,10 HRSA specifies Region 6 as a MH “High Needs Geographic HPSA” giving it a dismal score 21 out of 26.5While access is low, risk factors and needs are high. Poverty is rampant. Yet, it is black Delta residents who shoulder the brunt; unequally facing poverty THREE times the rate of white residents (Black: 48.5%; Whites 15.9%).12Even worse, more than twice as many black children live in poverty.11 Moreover, research indicates that 86.8% adults overuse prescription drugs in the Delta.13Snapshot Delta ROAD Implementation  Train/Certify instructors in Evidence-based Practice (EBP): Mental Health First Aid (MHFA)  MHFA instructors provide MHFA trainings to Target Training Recipient Groups  Graduates/completers of MHFA are known as “Mental Health First Aiders.”  Trainings prepare MH Aiders to: Recognize the signs and symptoms of, psychological distress/crisis, substance misuse, and/or mental disorders particularly SMI and/or serious emotional disturbances SED. Respond appropriately & safely to adults with MH disorders using de-escalation techniques. Refer adults with the signs or symptoms of mental illness to mental health services. SAMSHA says effective prevention saves $18 per $1 invested. Thus, with this $625,000 investment - ROAD will save an estimated $11.2m. Further, it allows us to build ROADs to health/wellness where none have been before.

Mississippi’s Certified Community Behavioral Health Clinic (CCBHC) program will support the redesign of the state’s behavioral health (BH) delivery system to meet the needs of all Mississippians. Our focus is adults who have serious mental illness (SMI), children and youth with serious emotional disturbance (SED), and people with substance use disorders (SUD) and co-occurring disorders (COD), with priority for access to rural and minority populations. Mississippi is one of the most rural U.S. states-- 60.0% of 2.9 million residents reside in rural areas. Ranked 49th in the U.S. for poverty, 19.4% (vs. 12.8% nationally) of Mississippi households live below the federal poverty line.i. Rural populations experience poverty rates higher than their urban counterparts (20.5% vs. 16.7%, respectivelyii). African American (31.3%) and Native American (36.1%) populations experience higher rates of poverty compared to Whites (12.1%)iii and African Americans predominate in rural Mississippi's regions, which are some of the most impoverished areas in the country.iv Children and youth experience higher rates of poverty (28%) vs. adults aged 18 to 64 (17.6%) and those aged 65 years and older (13.8%).v In 2021, nearly half the adult population (42.7%) reported experiencing symptoms of anxiety and depression,vi however more than half (59.3%) of adults with any mental illness report not receiving treatmentvii and 70.0% of Mississippi children with major depression are not receiving treatment vs. 60.3% nationally.viii 80% of Mississippians live in a health professional shortage areaix and gaps are particularly acute in rural areas.x Mississippi’s goal for the Planning Grant is to transition its statewide network of 12 CMHCs to adopt the CCBHC model for integrated care delivery during the Demonstration. This will be informed by robust stakeholder engagement and begin with two CMHCs that serve Mississippi’s most underserved rural and urban populations: the Delta and Gulf Coast regions. CMHCs already provide CCBHC services but must expand their workforce, enhance their practice, and increase their community access points by adopting a common set of tools, approaches, and organizational commitments. DMH will engage CCBHC consumers, youth, family members and communities in its Steering Committee, supporting Workgroups, and an Advisory Council to ensure they solicit meaningful feedback in the development, implementation, and ongoing monitoring of the Planning Grant. The CCBHC Planning team will: 1) expand telehealth; 2) optimize a new certification process to credential unlicensed mental health professionals to create a more sustainable and diverse workforce within the BH system; 3) establish a Prospective Payment System (PPS-1); 4) prepare an application to participate in the CCBHC Demonstration Program; 5) enhance the data collection and reporting capacity to support the evaluation of impact on access, quality, scope of services, and cost of BH services; and 6) train providers on continuous quality improvement. We will serve approximately 13,000 people during the Planning Grant period.

The Mississippi Department of Mental Health's (DMH) FY 2022 Cooperative Agreements for States and Territories to Build Local 988 Capacity grant is designed to increase state response to 988 calls, chats, and text by ensuring all contacts originating in Mississippi are answered by an instate Lifeline crisis call center. Mississippi has 24/7 primary and backup coverage for all 82 counties in the state. The state maintained an average in-state answer rate of 90% for July - December 2021. Mississippi has continuously improved its capacity to handle Lifeline calls statewide. Over the past several years, the state has increased its answer rate percentage from 46% to now 90%. DMH's partnership with Mississippi's two Lifeline crisis centers, CONTACT The Crisis Line and CONTACT Helpline, will allow the state to achieve the following goals. (Goal 1) Increase the capacity of the Lifeline Centers to meet crisis contact demand for the projected volume of calls and follow-up for the first year of 988 implementation. (1.1) By August 31, 2022, CONTACT The Crisis Line will hire eight new staff; (1.2) By August 31, 2022, CONTACT Helpline will hire four new staff; (1.3) By August 31, 2022, CONTACT The Crisis Line will purchase technology funded by this grant to increase capacity; (1.4) By August 31, 2022, CONTACT Helpline will purchase technology funded by this grant to increase capacity. (Goal 2) Maintain 24/7 primary and backup coverage within the state to ensure all calls originating in the state are first routed to a Mississippi Lifeline Center. (2.1) By September 30, 2022, staffing and technology funded by this grant will be in place to meet the increased demand of call volume to ensure sufficient capacity to maintain 24/7 in-state coverage of all Lifeline calls originating in the state; (2.2) By the end of the first year of the grant, the Centers will have maintained an average 90% or higher in-state answer rate for Lifeline calls; (2.3) By the end of the second year of the grant, the Centers will have maintained an average 90% or higher in-state answer rate for Lifeline calls. (Goal 3) Increase collaboration among Mississippi Lifeline Centers and crisis system partners to unify 988 response. (3.1) By the end of the first year of the grant, at least 70% of the Community Mental Health Centers will enter a formal agreement with CONTACT The Crisis Line and CONTACT Helpline; (3.2) By August 31, 2022, DMH will have developed a training curriculum addressing referral protocols, resources, and crisis response; (3.3) By the end of the first year of the grant, DMH will have trained 50% of 988, Mobile Crisis Response Teams, and Crisis Stabilization Unit staff on referral protocols, resources, and crisis response; (3.4) By the end of the second year of the grant, DMH will have trained 100% of 988, Mobile Crisis Response Teams, and Crisis Stabilization Unit on referral protocols, resources, and crisis response. CONTACT Helpline and CONTACT The Crisis Line will receive funding through contracts from the Mississippi Department of Mental Health to maintain and expand the workforce to respond to increased Lifeline call volume due to 988 implementation.

Summary: AWARE in Mississippi (AWARE MS) is a partnership between the MS Department of Education (MDE), the MS Achievement School District (MASD), MS Department of Mental Health (MDH), our state’s Federation of Families organization, community providers, and multiple programs across three MS universities (MSU, USM, UMMC). AWARE MS aims to increase mental health awareness, foster resilience, and strengthen access to trauma-informed, culturally responsive, and family driven mental health services and supports in Humphreys County and Yazoo City School Districts (the LEAs). Both districts are housed within the MASD, a distinct SEA that aims to transform persistently failing MS public schools. Led by the University of Mississippi Medical Center, AWARE MS will collaborate to develop and improve a school-based continuum of awareness, prevention, training, and service linkage and delivery focused on the MASD and primed to scale to other Mississippi LEAs across the state. Population: 3250 school-aged youth (K-12) and 535 school staff in Humphreys and Yazoo City School Districts. Both MASD districts are located in the Mississippi (MS) Delta region, a rural and underserved region with significant rates of child adversity and poverty. MASD districts have significantly higher proportions of Black youth (Humphreys = 97%; Yazoo City = 98%) than state averages. Prevalence of childhood mental health (MH) disorders in MS is higher (20%) than U.S. estimates, and nearly 66% do not receive treatment—the worst rate in the U.S. Both MASD districts are in HRSA-designated mental health professional shortage areas. Goal 1. Increase awareness and literacy among teachers, school-based staff, caregivers, and community organizations to identify and respond effectively to school aged youth MH problems and co-occurring needs. Key Objectives: Implement MH awareness, suicide prevention and postvention programs; disseminate a trauma-informed toolkit for school staff and parents. Expected to reach a 4-year total of 2200 unique individuals. Goal 2. Enhance resiliency and MH well-being for all school-aged youth through implementation of a social-emotional learning (SEL) curriculum integrated into general curriculum and linked to school-wide implementation of trauma-informed principles. Key Objectives: Implement SEL curriculum and training with teachers to promote SEL in students. Offer trauma-informed trainings to youth serving adults and parents. Expected to reach a 4-year total of 1830 unique individuals across students, teachers, school staff, and parents. Goal 3. Improve a multi-tiered system of support via a robust suite of training and workforce capacity building activities to school staff and parents that provides MH promotion, prevention, and intervention services along a public health continuum to meet students’ needs. Key Objectives: School-wide universal screening for MH, adverse childhood experiences and suicidality; implement suite of universal prevention programs; provide on-demand consultation and distance learning for mental health therapists. Expected to reach a 4-year total of 9100. Goal 4. Increase and improve student and family access to culturally relevant, and trauma-informed school and community-based activities and services through a coordinated system of care across LEAs, community agencies, and LEA, SEA, and school-based policy development. Key Objectives: Coordinate community referral pathways, develop/implement (a)crisis response and (b) school safety and threat/violence prevention plan with multidisciplinary team. Expected to reach a 4-year total of 200 individuals.