HOW MOPRA BEGAN--- THE MOPRA JOURNEY TO DATE---

MOPRA’S FUTURE

Missouri Psychiatric Rehabilitation Association Conference25th Annual Meeting

Sept 16-17, 2010

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“To know where we are going, my dear Watson, it is rather

important that we remember where we have been.”

A Quote I wish Sherlock Holmes had said.

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HOW MOPRA BEGAN: 1974-1982• MOPRA Beginnings: Deinstitutionalization of Missouri state hospitals and the

vision of community support services for state hospital patients.

• Conflict of the deinstitutionalization mission with the mission, values and goals of the CMHC movement and the “workaround ” strategy—State Hospital Community Placement.

• The partnerships of the Community Support Programs with state hospital community placement programs.

• The Pioneering Gang of Five: (Cheung, Graue, Hawley, Melise, Van Sant).

• Special connection of the CSPs with evolving advocacy organizations for people with serious mental illness—NAMI, State advisory councils, and the consumer movement

• Beginnings of consumer empowerment and the clubhouse tradition.

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CREATION OF MOASPRS AND GROWTH OF THE CSP MOVEEMNT: 1982-1987

• The Community Support Network becomes the “Missouri Association of Psychosocial Rehabilitation Services” (MOAPSRS)--Chinese Hakka word for ‘Americans sure create stupid acronyms!’.

• MOASPRS annual meetings begin: focused on best practice in community program design, building alliances with the state and developing peer support services.

• MOASPRS consisted of 10 freestanding CSPs and a few PSR programs within CMHCs who embraced the deinstitutionalization movement.

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THE ERA OF MEDICAID CONVERSION: 1987-1994

• The state’s fear of cost overruns if Medicaid reimbursement is allowed for specialty mental health, Addiction and DD programs.

• Development of CPRC and other Medicaid programs for DMH consumers.

• Opposition of CMHCs to the loss of fund flexibility for their multipurpose mission.

• The potential for conflict between MOASPRS and CMHCs--overlapping missions and dilution of the “Administrative Agent” role.

• The diminished role of community placement programs in the state hospitals.

• The uneasy alliance between CMHCs and “affiliated community support programs”.

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EXPANSIONIST ERA: 1994-2001

• Rapid growth of CSP/CPRC Services statewide.

• Era of economic plenty for State and Nation.

• The threat of risk-based, capitated managed care Medicaid carveouts for BH services.

• Diversification of the MOAPSRS membership base and the potential loss of the pioneer spirit.

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HOLDING THE GAINS: 2002-2010• The economic downturn in the first half of the decade:

Risk to established programs.

• The growth of “systems management”.

• The shifting state-provider relationships.

Continued erosion of the CSP pioneer partnership perspective; and

Evolution of the era of state-to-provider program monitoring.

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THE FUTURE?: 2010-2020• Severe economic downturn—possible “sea change” in state and national

macro-economics?

• The new deinstitutionalization movement? The Olmstead Mandate Affordability of psychiatric institutions without disproportionate share funding

• National Healthcare reform: What is the benefit? Does it include specialty MH services? Will Parity save

us? Who administers the plans? What will happen to the ABD population?

• Other New Frontiers?: Supported living models—the DD influence? Employment? Consumer self-directed or peer supported services? High Risk patient management: Health care homes for high risk consumers?

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MOPRA’S CALL TO ACTION?• Analyzing the environments:

Is America in a fundamental economic sea change? How would that affect MOPRA?

If the second wave of deinstitutionalization is real, how is MOPRA situated to take advantage?

What are the implications of National Health Care Reform for MOPRA?

Is Managed care still a risk? If so, how does MOPRA respond?

The interface of Physical and Behavioral Health?

• Are there still new Frontiers? Does MOPRA still have pioneers?

• Revisiting MOPRA’s uniqueness: strengths and weaknesses.

• Renewing the state-MOPRA sense of partnership?

• The engaged consumer?

• Technology?

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