Caring for previously hospitalized consumers : progress and challenges in mental health system reform : final report to the Joint Legislative Program Evaluation Oversight Committee

              Mental Health System Services Report No. 2008- 12- 04
Page 11 of 23
option that is easier to pursue than securing community- based services. A
lack of adequate crisis services was blamed for overuse of hospitals by
another administrator: “ More intensive non- hospital crisis services are
needed in order to prevent utilization of inpatient hospitalization.”
Finding 3. As expected, consumers discharged from community hospital
psychiatric units were more likely to receive services than those
returning to the community from a state facility. One assumption of
reform was that consumers served in community- based hospitals would
achieve better integration into the community and less disruption after
discharge. Presumably, closer connections exist between community- based
hospitals and local outpatient service providers, and therefore consumers
discharged from these hospitals would be more likely to receive
community- based services. 13
Consistent with this assumption, most of the consumers ( 69%) discharged
from community hospital psychiatric units in 2006 received outpatient
services in 2007 ( see Exhibit 6). This level of follow- up was only exceeded
among those discharged from private psychiatric hospitals, where 81% of
consumers ( all but one of whom were children) received services. There was
a significant difference14 in rates of follow- up between state and non- state
( i. e., private and community) hospital facilities: just half ( 50%) of consumers
discharged from state psychiatric facilities received follow- up community-based
services.
Consumers discharged from state Alcohol and Drug Addiction Treatment
Centers had the lowest rate of follow- up ( 41%). MHDDSAS administrators
suggested treating consumers with substance abuse problems is difficult for
several reasons. First, there was a lack of intensive outpatient substance
abuse services in 2007, which remains the case today in spite of reform.
Second, most consumers with substance abuse do not have Medicaid
coverage. As a result, many go untreated after discharge. Third, whereas
hospital liaisons triage care for mental health consumers in most Local
Management Entities, there are fewer liaisons for consumers hospitalized
with substance abuse problems. Finally, many consumers with substance
abuse may be noncompliant with treatment protocols even when follow- up
is attempted.
13 A map of the location of facility types represented in this evaluation can be found in Appendix A.
14 Pearson χ2 = 1062.80, p < .001.