Caring for previously hospitalized consumers : progress and challenges in mental health system reform : final report to the Joint Legislative Program Evaluation Oversight Committee - Page 24 |
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Mental Health System Services Report No. 2008- 12- 04 Page 20 of 23ge 20 of 23Page 20 of 21 Nearly one- third of LMEs ( 29%; 7 LMEs) reported limited availability of Assertive Community Treatment Team ( ACTT), a high- intensity service for adults that relies on multidisciplinary staff to provide a full range of treatment services. ACTT is intended to serve acutely ill consumers such as those with a history of multiple hospitalizations. One LME commented that despite having two ACTT teams, there are limited slots for consumers paid for with state funds. Another noted recent Division of Medical Assistance rate cuts for ACTT ( from $ 324 to $ 301 per event, according to the Division’s September Medicaid Bulletin21) were “ a step in the wrong direction.” The only services that were not in short supply in more than one LME were community support, evaluation and management, and intake and assessment— all of which are low- intensity services. LMEs reported difficulty providing access to adequately trained professionals, particularly psychiatrists in their areas. Although MHDDSAS administrators emphasized the importance of following up with a psychiatrist after hospital discharge, only five LMEs reported virtually all ( 91- 100%) of primary mental health providers in their area have access to psychiatric services. One noted many psychiatrists, nurses, and social workers had left in recent years for positions at other agencies ( e. g., Department of Social Services and schools) that offered better pay, benefits, and stability. Eleven LMEs reported a need for more psychiatrists and other appropriately credentialed staff to care for high- need consumers in their area. One added, “ the few providers who might have expertise to work with hospitalized consumers are ‘ booked up’ so that access is not timely.” Some LMEs reported concerns about the quality of services offered by providers. One noted that even when services were available providers had “ little or no ability to do them appropriately;” another reported providers had “ very little idea about how to link consumers with services or other more clinical aspects of serving high- risk consumers.” System fragmentation affected care for previously hospitalized consumers. Comments from survey respondents described frustrations with a lack of continuity in the mental health- care system that made it hard to serve high- need consumers. One phrased it succinctly: “ The fragmentation in design of the whole system makes it almost impossible to appropriately follow and serve these consumers.” As made clear in the list of caveats to the service data, there is a lack of systemic information that fully documents the care consumers receive when multiple funding sources pay for services. Without these data, statewide reform to further improve care for previously hospitalized consumers will remain elusive. Rehospitalizations might be avoided by contacting consumers before they leave the hospital and ensuring continuity of care. Providing continuity is the role of the hospital liaison and LMEs are responsible for ensuring liaisons are in place, but some LMEs do not believe liaisons are able to do the job. One LME administrator who receives discharges from Cherry Hospital reported sometimes consumers are discharged with such short notice that it is extremely difficult to transition them to the community. Other 21 Retrieved from http:// www. ncdhhs. gov/ dma/ bulletin/ pdfbulletin/ 0908Bulletin. pdf.
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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 24 |
Full Text | Mental Health System Services Report No. 2008- 12- 04 Page 20 of 23ge 20 of 23Page 20 of 21 Nearly one- third of LMEs ( 29%; 7 LMEs) reported limited availability of Assertive Community Treatment Team ( ACTT), a high- intensity service for adults that relies on multidisciplinary staff to provide a full range of treatment services. ACTT is intended to serve acutely ill consumers such as those with a history of multiple hospitalizations. One LME commented that despite having two ACTT teams, there are limited slots for consumers paid for with state funds. Another noted recent Division of Medical Assistance rate cuts for ACTT ( from $ 324 to $ 301 per event, according to the Division’s September Medicaid Bulletin21) were “ a step in the wrong direction.” The only services that were not in short supply in more than one LME were community support, evaluation and management, and intake and assessment— all of which are low- intensity services. LMEs reported difficulty providing access to adequately trained professionals, particularly psychiatrists in their areas. Although MHDDSAS administrators emphasized the importance of following up with a psychiatrist after hospital discharge, only five LMEs reported virtually all ( 91- 100%) of primary mental health providers in their area have access to psychiatric services. One noted many psychiatrists, nurses, and social workers had left in recent years for positions at other agencies ( e. g., Department of Social Services and schools) that offered better pay, benefits, and stability. Eleven LMEs reported a need for more psychiatrists and other appropriately credentialed staff to care for high- need consumers in their area. One added, “ the few providers who might have expertise to work with hospitalized consumers are ‘ booked up’ so that access is not timely.” Some LMEs reported concerns about the quality of services offered by providers. One noted that even when services were available providers had “ little or no ability to do them appropriately;” another reported providers had “ very little idea about how to link consumers with services or other more clinical aspects of serving high- risk consumers.” System fragmentation affected care for previously hospitalized consumers. Comments from survey respondents described frustrations with a lack of continuity in the mental health- care system that made it hard to serve high- need consumers. One phrased it succinctly: “ The fragmentation in design of the whole system makes it almost impossible to appropriately follow and serve these consumers.” As made clear in the list of caveats to the service data, there is a lack of systemic information that fully documents the care consumers receive when multiple funding sources pay for services. Without these data, statewide reform to further improve care for previously hospitalized consumers will remain elusive. Rehospitalizations might be avoided by contacting consumers before they leave the hospital and ensuring continuity of care. Providing continuity is the role of the hospital liaison and LMEs are responsible for ensuring liaisons are in place, but some LMEs do not believe liaisons are able to do the job. One LME administrator who receives discharges from Cherry Hospital reported sometimes consumers are discharged with such short notice that it is extremely difficult to transition them to the community. Other 21 Retrieved from http:// www. ncdhhs. gov/ dma/ bulletin/ pdfbulletin/ 0908Bulletin. pdf. |