Caring for previously hospitalized consumers : progress and challenges in mental health system reform : final report to the Joint Legislative Program Evaluation Oversight Committee - Page 7 |
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Mental Health System Services Report No. 2008- 12- 04 Page 3 of 23 Background Since the introduction of a new array of mental health, developmental disabilities, and substance abuse services in March of 2006, concerns about cost and service utilization management prompted the North Carolina General Assembly to question the effectiveness of mental health services system reform. In response to these concerns, the General Assembly Joint Legislative Program Evaluation Oversight Committee directed the Program Evaluation Division to evaluate Division of Mental Health, Development Disabilities and Substance Abuse Services ( MHDDSAS) service delivery, quality, and outcomes. One goal of reform was to increase community- based services and reduce hospitalization. The United States Supreme Court’s Olmstead decision in 1999 provided strong guidance for reform. Delivering the opinion of the Court, Justice Ginsberg wrote, States are required to place persons with mental disabilities in community settings rather than in institutions when the State’s treatment professionals have determined that community placement is appropriate, the transfer from institutional care to a less restrictive setting is not opposed by the affected individual, and the placement can be reasonably accommodated, taking into account the resources available to the State and the needs of others with mental disabilities. In keeping with this decision, a central goal of mental health system reform in North Carolina was ensuring all but the most acutely ill consumers would be served in the least restrictive ( i. e., non- hospital), community- based settings. Legislation passed in 20013 transformed mental health, developmental disabilities, and substance abuse services into a community-based system intended to increase access to appropriate services. The MHDDSAS State Plan of 20014 describes specific goals for the system with the intent to provide mental health services in the community to support and maintain functioning among individuals requiring care. More troubled individuals at risk for hospitalization would receive more intensive community- based services, such as comprehensive crisis intervention, with the potential to keep consumers out of the hospital through local outpatient care. For consumers acutely troubled enough to require hospitalization, the capacity in community hospital psychiatric units would be expanded so that more consumers could remain in their community even when they needed inpatient care. At the highest level of intervention, the most troubled consumers with mental illness would be served in state psychiatric hospitals. Sorely needed substance abuse treatment capacity would be increased, both with outpatient services and more beds in inpatient facilities. Reform, then, aimed to reduce hospitalizations overall by expanding and strengthening community- based services, increasing the number of consumers served in community hospitals, and increasing substance abuse treatment capacity. State psychiatric hospitals would be reserved for the 3 2001 Sess. Laws, 2001- 437, § 1.1. 4 MHDDSAS State Plan 2001: Blueprint for Change. Available at http:// www. ncdhhs. gov/ mhddsas/ stateplans.
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Title | Caring for previously hospitalized consumers : progress and challenges in mental health system reform : final report to the Joint Legislative Program Evaluation Oversight Committee - Page 7 |
Full Text | Mental Health System Services Report No. 2008- 12- 04 Page 3 of 23 Background Since the introduction of a new array of mental health, developmental disabilities, and substance abuse services in March of 2006, concerns about cost and service utilization management prompted the North Carolina General Assembly to question the effectiveness of mental health services system reform. In response to these concerns, the General Assembly Joint Legislative Program Evaluation Oversight Committee directed the Program Evaluation Division to evaluate Division of Mental Health, Development Disabilities and Substance Abuse Services ( MHDDSAS) service delivery, quality, and outcomes. One goal of reform was to increase community- based services and reduce hospitalization. The United States Supreme Court’s Olmstead decision in 1999 provided strong guidance for reform. Delivering the opinion of the Court, Justice Ginsberg wrote, States are required to place persons with mental disabilities in community settings rather than in institutions when the State’s treatment professionals have determined that community placement is appropriate, the transfer from institutional care to a less restrictive setting is not opposed by the affected individual, and the placement can be reasonably accommodated, taking into account the resources available to the State and the needs of others with mental disabilities. In keeping with this decision, a central goal of mental health system reform in North Carolina was ensuring all but the most acutely ill consumers would be served in the least restrictive ( i. e., non- hospital), community- based settings. Legislation passed in 20013 transformed mental health, developmental disabilities, and substance abuse services into a community-based system intended to increase access to appropriate services. The MHDDSAS State Plan of 20014 describes specific goals for the system with the intent to provide mental health services in the community to support and maintain functioning among individuals requiring care. More troubled individuals at risk for hospitalization would receive more intensive community- based services, such as comprehensive crisis intervention, with the potential to keep consumers out of the hospital through local outpatient care. For consumers acutely troubled enough to require hospitalization, the capacity in community hospital psychiatric units would be expanded so that more consumers could remain in their community even when they needed inpatient care. At the highest level of intervention, the most troubled consumers with mental illness would be served in state psychiatric hospitals. Sorely needed substance abuse treatment capacity would be increased, both with outpatient services and more beds in inpatient facilities. Reform, then, aimed to reduce hospitalizations overall by expanding and strengthening community- based services, increasing the number of consumers served in community hospitals, and increasing substance abuse treatment capacity. State psychiatric hospitals would be reserved for the 3 2001 Sess. Laws, 2001- 437, § 1.1. 4 MHDDSAS State Plan 2001: Blueprint for Change. Available at http:// www. ncdhhs. gov/ mhddsas/ stateplans. |