It appears that “mental health homes” are the hot new items in the public mental health system. Nationwide.
The Affordable Care Act, Obama’s health care initiative, contains incentives for the tates to establish the homes and incorporate them into their treatment systems. The primary objective is to help States get more bang for their Medicaid buck by promoting “one-stop shopping” or an integrated health care approach, whereby individual agencies or teams will provide primary health care, dental care and mental health treatment to their enrolled patients. New York State, after negotiating sharp cutbacks in its Medicaid budget with its principal stakeholders—voluntary hospitals, 1199s, non-profit providers and consumers, has embraced the homes and intends to make them the centerpiece of its downsized mental health system.
The persons intended to be the primary beneficiaries of the new “homes” will be the persons with serious mental illnesses who are the State’s constitutional responsibility, who possibly have the greatest need for integrated health care and, up until now, have always encountered the most intractable barriers to health care access.
To be more specific, the persons targeted for the homes will be those the State has been concerned with since the dawn of deinstitutionalization: the so-called “heavy users” of services, the estimated 10 percent of all patients who account for 90 percent of system expenditures. These are the folks who are considered treatment resistant – they don’t particularly like being in treatment and don’t believe they benefit from it—and the folks who have the highest recidivism or re-hospitalization rates.
They are also the persons at greatest risk for homelessness, persons who usually have forensic histories, histories of physical and sexual abuse, or histories of past or current substance or intoxicant abuse. Finally, they are the persons most likely to have myriad psychiatric diagnoses, to take cocktails that combine multiple psychiatric medications, to suffer from metabolic diseases like diabetes or heart disease associated with those myriad psychiatric medications, and to be dead by age 55—again largely as a consequence of prescribed neuroleptics. Historically—witness Courtenay Harding’s Vermont Longitudinal Study—we know that the best way for people like these to survive the system is to leave it.
In any event, every ten years or so, the employees of the New York State Office of Mental Health develop an innovative program designed to promote the rehabilitation, recovery, and more recently, “wellness—of persons with serious mental illnesses. I was around and active in the system for most of these programs, but not for the newest, the mental health homes. (I retired in 2010 as the Director of FEGS’s NYC Case Management Programs.)
I was present for the first, Intensive Case Management, which, again, was aimed at the “heavy users” and was the first to embrace psychosocial rehab principles: client-centered, client-driven, rooted in client strengths in an a collaborative relationship.Data compiled by the State indicted that ICM helped but, since it didn’t adequately relieve families of their burden of care, ACT Teams were added to the scene in the mid-1990s and beyond. The clients targeted by ACT teams became those who were most treatment resistant. When neither ICM nor ACT could sufficiently protect the public from crazy and dangerous mental patients, AOT (assisted outpatient treatment) became law in 1999.