Missouri Mental health commission statement

The Missouri Department of Mental Health: A Moment of Opportunity

There is no silver lining to the tragic occurrences in Missouri habilitation centers detailed in newspaper pages over recent months and years. In response to the recent deaths of Rudy Wallace and Michael Pallme, both of whom died at the Northwest Developmental Disabilities Treatment Center in St. Louis , the Missouri Mental Health Commission held a series of statewide public hearings to inquire about potential contributing factors to such tragedies, while awaiting the results of internal and external investigations of these specific events. The Mental Health Commission is a 7-member panel appointed by the Governor (there currently is one vacancy), which has statutory authority to hire the Director of the Department of Mental Health ( DMH ), to maintain expectations for performance in that role, and to advise the Director in all aspects of departmental function. After many years of dedicated service, the current Director, Dorn Schuffman, has announced his decision to retire, effective July 1, 2006 . Consequently, the Commission will use the information garnered from the comprehensive investigations and the recently-completed statewide public hearings, to develop an enhanced set of expectations that will guide the process of selecting and retaining a new director.

Interim updates on these processes are maintained on the Department web site ( www.dmh.mo.gov ). Formal reports, detailed action plans, and longer-term strategies will all soon be generated. But these are just words. It is important for the community to know what is already in progress, and how the information will translate into improved safety and care.

First, we are aware of weaknesses in our system of managing information that would flag unsafe or high-risk conditions within our facilities and in community programs. In February, the Department centralized oversight of all inpatient facilities in order to establish and assure uniform safety and reporting standards system-wide. Parallel processes (two separate lines of communication in case one line fails) for immediately communicating and managing information on actual or potential safety lapses will be established in every facility. In conjunction with Missouri Protection and Advocacy, we are actively revisiting the manner in which data from the facilities and community programs is organized and reviewed at the very highest level of leadership in the Department.

Second, the prevention and response to incidents of alleged or confirmed abuse and neglect need to be strengthened. The role of investigation of these events has been and will continue to be shifted from internal DMH responsibility to external responsibility, recognizing that no system can feasibly or completely externalize all its investigative processes. We will carefully consider implementation of a system of independent ombudsmen, or their equivalent, serving every DMH facility in our system, and explore ways to facilitate critical family and consumer input regarding community programs. Supervisors will increasingly share in the responsibility and accountability for any occurrence of abuse or neglect, but it is abundantly clear that our direct care staff members desperately need higher levels of support, leadership, and continuing education in order to function in their vital role. We are encouraged by the 4 percent across-the-board pay increase proposed by Governor Blunt and approved by the Missouri General Assembly, as well as the cost of living increases for community programs. These are positive steps in assisting our efforts to attract and retain the best qualified caregivers to work in our system. In addition, the Commission has initiated a cost-benefit analysis of the process of accreditation of all habilitation centers and community programs, which by nature, imposes improved and measurable standards for all of the parameters described above.

We will continue to communicate with the Governor's Office and state lawmakers about the challenges facing our state-run institutions. Every Missourian - including providers of mental health care and their superiors, reporters, legislators, and all taxpayers - have a role in embracing responsibility for our most vulnerable citizens. We are grateful to all who will help the Department of Mental Health rise to the occasion.

The Misouri Mental Health Commission

John N. Constantino, Chair, Associate Professor of Psychiatry and Pediatrics, Washington University
George Gladis, Secretary
Mary Louise Bussabarger
Beth Viviano
Ron Dittemore
Phillip McClendon