10/19/2010 Alternatives to Housing Task Force

This is the legislature-mandated task force formed by NC DHHS Secretary Cansler.  The task force is charged with looking at measures that will reduce the numbers of individuals with mental illness hospitalized.  Last time we reviewed the legislation and past studies. They have gathered data since last time but there are still a lot of holes. Below is a summary of the date presented at the meeting.  Unfortunately, I missed the afternoon, which focused on housing model presentations.

Who are we serving and what are their living arrangements?

All LME data is held in the Client Data Warehouse. 87% of clients served by LMEs are in a private residence (children and adults combined); 85% of adults are in a private residence, 5% homeless

• Those not in private residence – looked at NC TOPPS (MH/SA only): at most recent update, close to 20% not in a private residence once they enter treatment. 43% in private residence, 36% residential program, institution or other type of program; 21% in temporary housing or homeless.

o The task force is focusing is on that 21%

• For those in a residential program, over half receiving treatment (but nowhere near all)

• Co-occurring MH/SA has greater needs – housing status quite different from MH and SA alone

• Those not in housing have higher number of crises, ER trips, nights in hospital, jail and arrests.
o Questions about whether any indicators in data about services and outcomes? NC TOPPS doesn’t track services but could match claims data

o They were going to seek data from the chronic homeless population counts
o Wake county estimates high end users 1-5% of SPMI (Wake has 10% of state population)

Data from State Operated Services – HEARTS, Healthcare Enterprise Accounts Receivable Tracking System – tracks Medicaid and IPRS patients

o Different definitions used in HEARTS – if sleeping on a couch, considered private residence (LME considers temporary residence)

o Their data is adults and kids, chart is 91% of all discharges

 5% to homeless shelter (would be higher if just looked at adults) – 8% cite homeless as a prior – state operated services is supposed to oversee discharges to homeless shelters – Wake Med rep says numbers much higher (1,000 he estimates)

 Really low numbers across the board in community placements

 A lot of MR/MI coming into hospitals

 Their data indicates 56% to private residence but many task force members questioned that statistic, one reason being that many of those folks bounce out of there in a short period of time

 Wake estimates 15% entering state hospistals are homeless

 Identified issue - LMEs still not following up quickly enough

 Shelters see people coming out with too few meds, can’t get into psychiatrist quickly enough – state operated services says they give people 1 week of meds

 $20K in New Freedom funding to implement Olmstead

 Don’t have recidivism numbers

 The task force should start with group discharged to homeless shelters

Effective Use of State Hospitals from Community Systems Progress Report April – June 2010

o In that quarter only 34% with stays of 7 days or less, Wake Med says more people waiting in ERs – but clients are higher acuity

o Much improved since 2006

o Only 53% of consumers discharged from state psych hosp were seen within 7 days following discharge; we don’t know what service was billed within 7 days

o 7% readmission within 30 days; 18% readmission within 180 days

o There is a meeting next week (now this week) between LMEs and hospitals

• Must be coordination regardless of state hospital or private hospital

• Durham Center pilot project started in July – tracking 50 repeat consumers who touch multiple systems in community; serve 500+ through care coordination; have a whatever it takes fund focused on recovery; biggest challenge was getting providers to buy into it – bringing it to LMEs attention and tell them what the wraparound services are that the person needs; quarterly quality of life services; housing is the key factor for these individuals; doing one year of rental assistance

Crisis Services

o Walk-In Psych Centers – 66 centers served 110,296 Jan-June 2010: 3.7% referred from state facility, ER, community hospital psych bed; 1.1% referred to state facility, etc.

o Community Hospitals 887 persons served over 15 mos ending Sept 2010 (this is just the 3 way contracts and previously existing psych units)

o Can get more data for beds in 3 way contracts

DOC Data, John Carbone

o Started by distinguishing them from jail system

o DOC has an M grade system for prisoners (M1-M5)

o Depending on source, data is all over the place – different diagnoses, different definitions

o LME-prison liaisons? Not statewide. Dr. Carbone said that would be wonderful. This needs to be formalized. Laura Yates oversees everything in community, including housing, not a designated housing specialist

o They have a study draft looking at Dix patients and those in corrections to identify cross-over – should be finished by the end of this year.

o Placement in the community is becoming harder because of funding.

o Prisons give inmates 30 days of medication upon release. Virginia mails meds to inmate’s residence or where they are going to receive treatment.

LME Housing Needs Assessment

o Average number of additional units needed = 415 housing units per LME (23 LMEs) – includes mh/dd/sa

o LMEs identified needs – services and supports, housing top barriers

Those who are homeless are neediest – a group to target; less data on where people end up after discharge but can target those knowingly being discharged to homeless shelters

May recommend looking at matched data looking at individuals across the systems
Unfortunately, a constant theme is money.  Any change to funding is seen as an expansion, even if the change will result in cost savings overall across systems.