Group: Health & Human Services - Department of Human Services

Agency: Human Services

Line Item: Substance Abuse & Mental Health

Function

The Division of Substance Abuse and Mental Health (DSAMH) is the state's public mental health and substance abuse authority. It oversees the 11 local mental health and 13 local substance abuse authorities. Each county legislative body is both a mental health and substance abuse authority. Two or more counties may join together to provide coordinated prevention and treatment services. The division also has general supervision of the State Hospital in Provo. The division establishes minimum quality standards, funding formulas for distribution of public funds, and other public mental health and substance abuse policies with input from various stakeholders.

Both mental health and substance abuse services are delivered either directly by the local authorities (counties) or by local authorities contracting with private providers (such as Valley Mental Health in Salt Lake County). Counties are required to provide a minimum scope and level of service and must provide a minimum 20 percent county fund match. Counties set priorities to meet local needs but must submit an annual plan describing services they will provide.

The Public Local Mental Health System

The state public mental health system serves adults with severe and persistent mental illnesses and children with serious emotional disturbances. The targeted population tends to have less financial and private insurance resources.

Local mental health centers review and evaluate mental health needs and services including those for incarcerated individuals. They prepare plans for mental health funding and service delivery for adults, youth, and children. These plans may include:

• Inpatient care and services;
• Residential care and services;
• Outpatient care and services;
• 24-hour crisis care and services;
• Psychotropic medication management;
• Psychosocial rehabilitation, including vocational training and skills development;
• Community supports, including in-home services, housing, family support services, and respite services;
• Consultation and education services, including case consultation, collaboration with other county service agencies, public education, and public information; and
• Services to incarcerated persons (UCA 17-43-301).

Some local mental health centers provide additional services including housing, clubhouses, consumer drop-in centers, employment and rehabilitation, services to the homeless, forensic evaluations, family respite, nursing home and hospital alternatives, and consumer education.

The Public Local Substance Abuse Authority (LSAA) System

Any person in need of substance abuse services is eligible. However, due to limited resources the number that can be served is restricted. This results in individuals having to wait to receive services. Significant resources are geared toward individuals in the criminal justice system (see also the separate sections of this report on drug courts and drug board). Priorities for services include the following:

• Pregnant women;
• Intravenous (IV) Drug Users;
• Women with dependent children; and
• All others.

For the state to receive the federal Substance Abuse Prevention and Treatment (SAPT) block grant, local substance abuse authorities are required to provide a continuum of the following services:

• Detoxification;
• Prevention services;
• Outpatient services;
• Intensive outpatient services; and
• Residential treatment programs.

Statutory Authority

Utah Code Title 62A Chapter 15 describes the functions and responsibilities of Utah's public mental health and substance abuse treatment and prevention systems. Included in this chapter are the following:

• Part 2: Teen Substance Abuse Intervention and Prevention Act
• Part 3: Commitment of minors to drug or alcohol programs or facilities
• Part 4: Alcohol training and education
• Part 5: Programs for DUI drivers
• Part 6: Utah State Hospital and other mental health facilities
• Part 7: Treatment and commitment of minors in the public mental health system
• Part 8: Interstate compact on mental health
• Part 9: Utah Forensic Mental Health Facility
• Part 10: Declaration of mental health treatment choice

In addition, Utah Code Title 17, Chapter 43 outlines the responsibilities and functions for local county substance abuse and mental health authorities.

Intent Language

Under terms of UCA 63J-1-402, the Legislature intends not to lapse any remaining funds provided by Item 111, Chapter 2, or Item 86, Chapter 392, Laws of Utah 2008 for the drug courts/drug board programs within the Division of Substance Abuse and Mental Health. Expenditure of these funds is limited to drug courts and the drug board.(Supplemental)

Under terms of UCA 63J-1-402, the Legislature intends not to lapse up to $50,000 provided by Item 112, Chapter 2, or Item 86, Chapter 392, Laws of Utah 2008. Expenditure of these funds is limited to computer equipment and software - $50,000.(Supplemental)

All General Funds appropriated to the Division of Substance Abuse and Mental Health line item are contingent upon expenditures from Federal Funds - American Recovery and Reinvestment Act (H.R. 1, 111th United States Congress) not exceeding amounts appropriated from Federal Funds - American Recovery and Reinvestment Act in all appropriation bills passed for FY 2009. If expenditures in the Division of Substance Abuse and Mental Health line item from Federal Funds - American Recovery and Reinvestment Act exceed amounts appropriated to the Division of Substance Abuse and Mental Health line item from Federal Funds - American Recovery and Reinvestment Act in FY 2009, the Division of Finance shall reduce the General Fund allocations to the Division of Substance Abuse and Mental Health line item by one dollar for every one dollar in Federal Funds - American Recovery and Reinvestment Act expenditures that exceed Federal Funds - American Recovery and Reinvestment Act appropriations.

All General Funds appropriated to the Division of Substance Abuse and Mental Health line item are contingent upon expenditures from Federal Funds - American Recovery and Reinvestment Act (H.R. 1, 111th United States Congress) not exceeding amounts appropriated from Federal Funds - American Recovery and Reinvestment Act in all appropriation bills passed for FY 2010. If expenditures in the Division of Substance Abuse and Mental Health line item from Federal Funds - American Recovery and Reinvestment Act exceed amounts appropriated to the Division of Substance Abuse and Mental Health line item from Federal Funds - American Recovery and Reinvestment Act in FY 2010, the Division of Finance shall reduce the General Fund allocations to the Division of Substance Abuse and Mental Health line item by one dollar for every one dollar in Federal Funds - American Recovery and Reinvestment Act expenditures that exceed Federal Funds - American Recovery and Reinvestment Act appropriations.

Funding Detail

For analysis of current budget requests and discussion of issues related to budgets covered by this subcommittee click here.

Program: Administration

Function

DSAMH Administration coordinates all public substance abuse prevention and treatment programs as well as all public mental health programs in the state. DSAMH Administration also provides consultation and technical assistance to the local authorities and centers, administers state and federal grants, collects data, evaluates programs, and prepares required reports. It is responsible for development of administrative, fiscal, and service standards for local mental health centers and substance abuse authorities. The office also has general oversight of the State Hospital and works with the State Office of Education and other agencies for the establishment of substance abuse prevention programs. It also administers the Driving under the Influence (DUI) program and the alcohol servers program.

Funding Detail

Program: Community Mental Health Services

Function

The Community Mental Health Services program develops, coordinates, and evaluates mental health services. The program is funded with the following federal grants:

• Information Systems Grant: This federal grant is used to develop common data indicators across all of the mental health centers that are consistent, compatible, and conform to national indicators.
• Homeless Mentally Ill: The division distributes this federal PATH grant to mental health centers for specialized services to the homeless mentally ill. This is an annual grant.
• Mental Health Block Grant: This grant, which is passed through to the local mental health authorities on a formula basis, provides funding for the development of a statewide system of care for adults with serious mental illness and children with serious emotional disturbances.
• Passages Grant: A new SAMHSA grant awarded to DSAMH on October 1, 2009 for the development of transitional services for young adults with serious emotional disturbance in two of Utah's most rural counties - San Juan and Tooele.

The following state-funded programs are also budgeted in this program:

• Competency Evaluations: The state is responsible for determining an individual's competency to stand trial for a crime.
• Omnibus Budget Reconciliation Act (OBRA) of 1987: This act requires the state to assess the appropriateness of placement for mentally ill persons residing in nursing facilities. This assessment is done using the Preadmission Screening and Resident Review (PASRR).
• Pre-school Autism Program: This program provides funds to several areas of the state to develop and operate programs for pre-school children with autism.

Funding Detail

Program: Mental Health Centers

Function

Under Utah law, county governing bodies are the local public mental health authorities and, as such, are charged with delivering mental health services to residents of their counties. The Division of Substance Abuse and Mental Health provides policy and administrative direction to local mental health authorities. The counties have organized eleven local mental health centers, with some counties combining resources to serve a region. Seven of the local mental health centers are operated by a single county or multiple counties and four of the centers are private nonprofit corporations providing services through contract from counties. The various centers are listed below:

• Bear River Mental Health (Private): Box Elder, Cache, and Rich counties
• Davis Behavioral Health (Private): Davis County
• Weber Human Services (County): Weber and Morgan counties
• Valley Mental Health (Private): Salt Lake, Summit, and Tooele counties
• Northeast Counseling Center (County): Daggett, Duchesne, and Uintah counties
• Four Corners Mental Health (Private): Carbon, Emery, and Grand counties
• Wasatch Mental Health (County): Utah County
• Heber Valley Counseling (County): Wasatch County
• San Juan Mental Health (County): San Juan County
• Southwest Center (County): Beaver, Garfield, Iron, Kane, and Washington counties
• Central Utah Mental Health(County): Piute, Sevier, Juab, Wayne, Millard, and Sanpete counties

The division contracts state and federal funds to provide mental health services with these local mental health authorities based on local plans. Statutorily, local authorities must provide at least a 20 percent match for state funds received to fund services described in their plans (UCA 17-43-301(4)(a)(x)). The plan must include services for adults, youth, and children. Services must include, but are not limited to the following: inpatient services, residential and outpatient care and services, 24-hour crisis care, psychotropic medication management, psychosocial rehabilitation, case management, community supports (such as in-home services, housing, family support, and respite services), and consultation and education services.

Funding Detail

Local centers also directly draw down Medicaid funding as well as local funds required to match state funds.

Program: Residential Mental Health Services

Function

The purpose of this program is to provide community-based residential services to children and youth in order to prevent or reduce inpatient hospitalizations. Funding is allocated to centers where adolescents and children are placed. Once children are stabilized, the funding is used to provide wrap-around services that will keep children and youth in their families and communities. The wrap-around services that are developed are specific to the child and family's needs. Approximately 39 children and youth were served in state fiscal year 2009.

Funding Detail

Program: State Hospital

Function

The Utah State Hospital (USH) is an Institution for Mental Disease (IMD) that complements the local mental health centers by providing specialized services not available in community settings. The hospital's population includes adults and children for whom no appropriate, less restrictive environment is currently available. Various services are provided for four groups of people: 1) pediatric services for children and adolescents, 2) forensic services for those found not guilty of crimes by reason of insanity, guilty and mentally ill, or not competent to proceed with court actions, 3) specialty services for geriatric patients and patients being prepared for transfer into the community, and 4) services for adults.

The adult patients in the Utah State Hospital are not eligible for Medicaid funding because of regulations associated with the federal Omnibus Reconciliation Act (OBRA) of 1987. These regulations define any nursing facility with 40 percent or more mentally ill residents as an IMD and then prohibit Medicaid funding for residents between the ages of 22 and 65 living in an IMD.

The adult and geriatric services provide 182 beds to the community mental health centers as prescribed by state statute. The beds available for use by the local mental health centers are allocated according to population. UCA 62A-15-611 governs the adult allocation and UCA 62A-15-612 governs the pediatric allocation. The statute indicates that as the state population changes, the distribution of beds available to the local centers should be reviewed and reallocated.

Funding Detail

Program: State Substance Abuse Services

Function

While most division funds are passed through to local substance abuse authorities, the division retains some funds for statewide programs. The division may retain up to ten percent of the $17.1 million federal Substance Abuse Prevention and Treatment (SAPT) block grant funds for statewide programs. State substance abuse services include:

• State Office of Education which provides curriculum and training in drug abuse prevention for Utah schools.
• Department of Corrections which provides substance abuse treatment services at the Utah State Prison.
• University of Utah which provides counseling education, clinical services, evaluation, and data analysis and operates the Utah School of Alcoholism and Other Drug Dependencies.
• Drug Free Schools and Communities is a specific federal grant to local authorities to provide prevention and education.
• Award for Strategic Prevention Framework - State Incentive Grant (SPF-SIG) was received by DHS September of 2006. This grant is to: 1) prevent the onset and reduce the progression of substance abuse, including childhood and underage drinking, 2) reduce substance abuse related problems in the community, and 3) build the infrastructure and capacity of prevention programs at the state and community level. This grant provides funding of $2.1 million annually through September 2011.

Funding Detail

Program: Local Substance Abuse Services

Function

By statute, county governing bodies are designated as the local substance abuse authorities and are authorized to deliver community substance abuse services to people in their counties. The Division of Substance Abuse and Mental Health sets policy and provides statewide administration. The division contracts with local authorities and passes state and federal SAPT funds through to the local substance abuse authorities based upon locally developed plans. Counties may join together to either provide services or contract for services including prevention, intervention, and treatment. The substance abuse authorities are required by law (UCA 17-43-201(4)(k)) to provide a minimum 20 percent match for state funds received to fund services described in their plans. There are currently 13 substance abuse centers in the state: Bear River, Weber, Davis, Salt Lake, Heber Valley Counseling, Central Utah, Southwest, Four Corners, San Juan, Uintah, Summit, Utah, and Tooele.

Funding Detail

Program: Driving Under the Influence (DUI) Fines

Function

The division oversees the Intoxicated Driver Rehabilitation Account. The account receives 7.5 percent of the surcharges levied on persons convicted of either a felony or a class A or class B misdemeanor. These fees on fines are appropriated to the division. This funding is then distributed to the 13 local substance abuse authorities by formula to support education, intervention, and treatment services for drivers convicted of driving under the influence. The formula is driven by overall population figures.

Funding Detail

Program: Drug Offender Reform Act (DORA)

Function

Senate Bill 202, Drug Offender Reform Act (DORA), was passed during the 2009 General Session of the Legislature reducing the scope of DORA from a statewide initiative for both probationers and parolees to serving probationers only in six local substance abuse authority areas. DORA was designed to expand offender access to treatment, provide for smarter sentencing by judges, and provide increased community supervision. This legislation was predicated on a three-year DORA pilot program, created in 2005, which operated in the Third Judicial District Court in Salt Lake County as well as a statewide initiative enacted in 2007 via Senate Bill 50 of the same title.

With regard to the DORA program, Senate Bill 202 requires the Utah Substance Abuse and Anti-Violence Coordinating Council (USAAV) to provide ongoing oversight for implementation and program functioning, evaluation of impacts and results, development of an implementation plan, and approval of plans submitted by local substance abuse authorities. The Department of Human Services then allocates funds for approved plans and monitors contracts according to approved plans and contractual requirements.

Funding Detail

The Legislature appropriated approximately $3.1 million for Fiscal Year 2010 for DORA treatment and supervision. Of that amount, $2,092,700 was allocated to the Department of Human Services for the purposes of assessing and treating drug offenders in the substance abuse authority areas identified by USAAV which include Cache, Weber, Davis, Salt Lake, Utah, and Washington/Iron counties. These funds were appropriated with $83,300 in ongoing funds and $2,009,400 in one-time funds.

Initial implementation for DORA required increasing provider and Adult Probation and Parole capacity throughout the state. This increased capacity included hiring treatment professionals across the state to provide treatment services. While offenders began receiving treatment and assessment under this legislation on July 1, 2007, most areas across the state were not staffed to capacity until December of 2007. As a result of this methodical implementation, approximately $2,000,000 of non-lapsing funds remained unexpended at the end of FY 2008.

During the 2008 Second Special Session of the Legislature, DORA funds were decreased by $2,000,000 of non-lapsing and an additional $773,000 from the FY2009 ongoing base budget. During the 2009 General Session of the Legislature, DORA funds for FY 2009 were reduced by $1.1 million for assessment and treatment. As a result, local authorities significantly scaled back the services provided to DORA participants and stopped admitting any new offenders into the program. The impact to this budget is detailed below.

Program: Drug Courts

Function

Utah's first drug court was started in 1996 in Salt Lake County with funds from the U.S. Department of Justice, Salt Lake County, and other sources. Currently, 29 of the 35 drug courts operating in the state receive funding from the Department of Human Services.

Drug Courts is a judicial process that offers nonviolent drug abusing offenders intensive court-supervised drug treatment as an alternative to jail or prison. The local area substance abuse authorities and private contractors provide treatment services.

Each drug court has its own eligibility criteria. However, most look at both a potential participant's legal history as well as the clinical severity of the addiction. In most drug courts, offenders enter a guilty plea which is then held in abeyance for the duration of the program. The charges are then dismissed upon successful completion of the program.

Drug court participants are enrolled in the program for approximately 73 weeks. Treatment counselors develop individualized treatment plans. The participants are randomly tested for drug use from one to four times a week. The drug court judge reviews compliance with the treatment plan during weekly court reviews. In most programs, participants must be clean for at least six months to graduate. Failure to comply with any element of the program or having a positive drug test may result in immediate court action such as being taken to jail. Compliance and progress in the program are rewarded with praise from the court and a gradual decrease in supervision.

Statutory Authority

During the 2000 General Session, the Legislature passed uncodified material in HB 281, Drug Courts and Drug Board Pilot Project, defining the drug court program, allowing for its expansion, setting criteria for participation in the program, and establishing reporting requirements. It also created a coordinated disbursement process involving the executive directors of the departments of Human Services and Corrections as well as the State Court Administrator. HB 281 also established a Drug Board Pilot Project in Davis and Weber counties and outlined participation and reporting requirements.

Utah has four distinct drug court models

In Utah, four distinct drug court models exist. In addition to the adult felony drug courts, there are programs that focus on juveniles, adult misdemeanants, and parents involved in civil child welfare custody cases.

Adult Felony Drug Courts: Utah has nineteen functioning adult drug courts located in Carbon, Emery, Grand, Weber, Davis, Iron, Juab, Millard, Tooele, Salt Lake, Utah, Washington, Box Elder, Cache, Uintah, Wasatch, Sanpete, San Juan, and Sevier counties. Eighteen of these programs receive funding from the Department of Human Services.

Juvenile Drug Courts: There are four juvenile drug courts in Utah, Weber, Tooele, and Salt Lake counties. Juvenile drug courts involve parents and the schools in the creation of the treatment plan. All four of these programs receive funding from the department.

Misdemeanor Drug Courts: Six misdemeanor drug courts have been established in Salt Lake and Davis counties. These programs are operated at the justice court level. These programs focus on offenders who have been arrested on alcohol or marijuana charges. None of these programs receive funding from the department.

Dependency Drug Courts: Seven dependency drug courts deal with cases where a parent's substance abuse could result in loss or restriction of parental rights. Their primary purpose is to assist in determining whether reasonable efforts have been made in reunification cases involving substance-abusing parents. They operate similarly to adult and juvenile drug courts. There are operational dependency courts in Salt Lake, Grand, Emery, Weber, Carbon, Washington, and Utah counties. All seven dependency drug courts receive funding from the Department of Human Services.

Allocation from Tobacco Settlement Funds

UCA 51-9-201 allocates funds from the General Fund Restricted - Tobacco Settlement Account first to the Department of Health for the Children's Health Insurance Program, second to the Department of Health for alcohol, tobacco, and other drug programs, then to drug courts and drug board, and finally to the University of Utah Health Sciences Center.

Funding Detail

Drug courts also receive funding directly from federal and local agencies.

Program: Drug Boards

Function

Drug Boards provide community-based services to drug involved parolees to help them reintegrate into their communities after release from prison. Drug Boards is a program similar to drug courts, but is offered by the correctional system to individuals leaving prison and entering parole. Instead of judges and a courtroom, the official in charge is a representative from the Board of Pardons and the location is a hearing room. In this case, the potential punishment is the threat of having parole lifted and returning to prison. The incentive is the same as in drug courts. Progress in the program is rewarded with praise from the board and support from peers and continued parole.

Funding Detail

The 2000 Legislature appropriated a total of $510,000 from the Tobacco Settlement Restricted Account to start a pilot drug board program in Davis and Weber counties. This amount included $77,400 to the Board of Pardons, $81,700 to the Department of Corrections, and $350,900 to the Department of Human Services.