Alternatives to Hospitalization Task Force Meeting September 16

Beth Melcher, Assistant Secretary for Mental Health, Developmental Disabilities, and Substance Abuse Services Development and Flo Stein, Division of Mental Health, are co-chairing the task force. The task force is composed of LME staff, providers, consumers, public housing agencies, Department of Corrections, DHHS and Housing Finance Agency staff.

The purpose is to determine the cost-effectiveness of supportive housing as an alternative to institutionalization. Recommendations are due to the legislature by January 31, 2010, so proposed recommendations will be made to the department in December. Duties of the Task Force are listed in the Study Bill - SESSION LAW 2010-152, SENATE BILL 900, Section 18.

Overview of North Carolina Reports and National Studies

Angela Harper, housing specialist at DMH discussed how important it is to look at the service system. Angela reviewed past studies and recommendations, including: 2001 IOM Task Force on Long Term Care; MH/DD/SAS Commission Task Force on Housing in 2004 Housing for North Carolinians with Disabilities; 2005 Report of DHHS Study Group to NC Study Commission on Aging - Study of Issues Related to Persons with Mental Illness in Long-Term Care Facilities; 2006 NC Institutional Bias Study Combined Report prepared for NC DHHS; 2007 Final Reports and Gaps Analysis submitted by consultant to MH/DD/SAS LOC; 2008 Study of Rules and Regulations Regarding Housing Individuals with MI in the Same Facility Vicinity as Individuals without MI, submitted by DHHS to NC Study Commission on Aging; 2008 DHHS & NCHFA Interim Plan for Efficient and Effective Use of State Resources in the Financing and Development of Independent and Supported living Apartments for Persons with Disabilities, presented to MH/DD/SAS LOC, and the 2009 final plan of the same title presented to the MH/DD/SAS LOC in 2009; Pilot Program to Reduce State Psychiatric Hospital Use and to Increase Local Services for Persons with MI through DHHS DMH in 2009 (4 LMEs); Housing for People with MI: Update of a Report to the President’s New Freedom Commission by TAC in 2007; Governor’s Association Supportive Housing in 2007; Permanent Supportive Housing: An Evidence-Based Practice by SAMHSA in 2010.

Presentation on Alternatives to Hospitalization Historical Data

The group discussed how to gather the data called for in the legislation, which calls for the gathering of data on frequent users of psychiatric beds (State and community) and emergency departments. CCNC has a grant to gather this data but it won’t be done in time for this study. Wake is doing its own study that can be used as a sample to help make the business case for alternatives to hospitalization. They define a frequent user as 3 or more hospitalizations to a state hospital (because that’s the info they have) or 10 or more in a lifetime.

Group Discussion:
•The group discussed shared living options. John Owen discussed a program in West Virginia. The group would like to see any other helpful reports.
• DOC members discussed transition issues, criminal record history and special issue of sex offenders.
• Simply Home in Asheville uses technology to monitor people at home. Through telehealth we can do supportive services like medication management. Studies in Wisconsin were done. Arc is looking at some of the same applications.
• Must look at start-up costs for services, telehealth, etc. With current rates, can’t ever recoup start-up costs.
• Use peer support as a bridge, extension of ACTT teams. How do you support the services?
• Host homes were a good model – people in recovery hosted others. A lot of people connected through AA.
• Need to address the issues of silos in the report.
• Must consider transportation and transportation costs – tied to isolation, employment, etc.
• Can also consider pilot programs.