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
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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.