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

              Mental He
alth System Services Report No. 2008- 12- 04
Page 18 of 23
challenges. Administrators from all 24 Local Management Entities ( LMEs)
completed an online survey for this evaluation. Under reform, LMEs were
charged with overseeing and developing community- based services
delivered by private providers within their catchment area. The evaluation
survey asked LME administrators about the present- day ( i. e., fall of 2008)
ability of providers in their area to care for previously hospitalized
consumers, the availability of services ( as listed in Exhibit 9) in their area,
and perceived barriers to serving previously hospitalized consumers ( a
copy of the survey instrument is in Appendix B; a list of LME county
membership appears in Appendix C).
As expected, results confirmed many LMEs face difficulties in caring for
previously hospitalized consumers. Eighteen of the 24 LMEs reported
trouble providing some services, and some struggled more than others. As
shown in Exhibit 10, at least five LMEs reported limited or no ability to
provide each of nine features of care to previously hospitalized
consumers. 19
LMEs noted trouble providing many moderate- and high- intensity
services. Specific types of services, mostly those of high and moderate
intensity, were in short supply in many LMEs. For example, nearly two-thirds
( 63%) had limited or no intensive outpatient/ day programs for
children or adults.
Division of Mental Health, Developmental Disabilities and Substance Abuse
Services ( MHDDSAS) administrators have made recent efforts to increase
crisis services as a way to reduce hospitalization. Despite these efforts,
however, half ( 12) of the LMEs commented on the shortage of mobile crisis,
crisis respite, and/ or residential crisis. 20 A majority reported limited or no
availability of residential crisis services for adults ( 58%) and children
( 75%). One LME has two mobile crisis teams that have been “ very
successful,” but the administrator said it needs a third team. This same LME
has a six- bed residential crisis unit but its administrator believes it needs
twice that number. Another LME commented, “ 24/ 7 regional crisis is
available, but this region lacks mobile crisis and residential crisis” ( emphasis
in the original).
Claims data reflected lower levels of service follow- up among consumers
with substance abuse, and LME responses suggested residential facilities
and outpatient services for this group were in short supply in some areas.
Ten LMEs noted the need for increased capacity, including detoxification
( especially state- funded services), residential treatment facilities ( in
general and for women and their children), and intensive outpatient
services.
19 Two LMEs— Albemarle and Johnston— reported no or limited ability to provide any of the nine features, whereas seven LMEs—
Beacon, Mental Health Partners, Durham, East Carolina, Mecklenburg, Onslow- Carteret, and Orange- Person- Chatham— were not
challenged in any or in at most one feature.
20 Residential crisis consists of community- based residential facilities intended to provide an alternative to hospitalization.