Caring for previously hospitalized consumers : progress and challenges in mental health system reform : final report to the Joint Legislative Program Evaluation Oversight Committee - Page 22 |
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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.
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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 22 |
Full Text | 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. |