Human Services

SOS Mental Health

Statewide Outcome(s):

SOS Mental Health supports the following statewide outcome(s).

Minnesotans are healthy.

People in Minnesota are safe.

Context:

Mental illnesses can affect persons of any age, race, religion, or income. According to the National Alliance on Mental Illness – Minnesota (NAMI-MN), it is estimated that mental illnesses affect one in five families. Without treatment, the consequences of mental illness for the individual and society are staggering: unnecessary disability, unemployment, substance abuse, homelessness, inappropriate incarceration, suicide and wasted lives. The economic cost of untreated mental illness is more than 100 billion dollars each year in the United States. By ensuring access to services and supports that have been proven to be effective, recovery is possible.

Minnesota’s policy for serving people with disabilities has emphasized a broad array of community-based treatment and support options enabling people to access the most appropriate care as close to their home community and natural support systems as possible. This policy has worked well for many individuals but continues to have gaps for individuals with co-occurring and complex conditions. As a result, these individuals do not move through the system and become “stuck’ in inappropriate levels of care. A bottleneck in the care system results. This occurs in all levels of the mental health treatment continuum including community hospitals, community corrections and State Operated Services (SOS) treatment sites. A shortage of mental health providers has also resulted in a restriction of available capacity in the SOS treatment system.

Strategies:

As part of a broader continuum of care, SOS's Mental Health services provide specialized treatment and related supports for youth and adults with serious mental illness (SMI), emotional disturbances, and co-occurring neurocognitive disabilities. These services are provided in an array of facilities including psychiatric hospitals, intensive residential treatment services (IRTS), and a variety of other service settings. State Operated Services' Mental Health Services are funded with state general fund appropriations. In fiscal year 2012, 2,457 individuals received mental health services from SOS Mental Health programs. An additional 5,030 received dental services within the five dental clinics.

SOS provides quality treatment using a person-centered approach to care. To be successful, care must be provided in a safe and appropriate level of care environment. SOS has developed services at different levels of the continuum to allow clients to move through the mental health treatment system and back to the community.

The ability to safely move individuals from one level of care to another is a challenge due to the limited resources available to clients. Individuals that no longer require inpatient hospital care but who can't be discharged due to lack of community resources reduce the ability to appropriately serve individual who do need inpatient care as beds are full. Though gaps still exist for some clients, many are able to return to their homes and community. SOS continues to reach out to the service system to partner with other community providers in order to assure individuals with mental illness receive the services they need to successfully live in the community. Key current strategies to help clients successfully manage their return to the community are:

·         Ensuring prompt psychiatric follow-up upon their return to a community setting.

·         Working to reduce the number of medications necessary to control each client's symptoms.

Both these serve to support the client's continued effective treatment following their transition to community living.

DHS is also seeking a new Medicaid waiver to redesign the relationship of the Anoka Metro Regional Treatment Center (AMRTC) to the rest of the Medicaid program. Virtually all people receiving treatment services at AMRTC are Medicaid-eligible at admission or would be Medicaid-eligible if the services were available in the community, and a majority are also Medicare recipients. A waiver of the federal law prohibiting Medicaid coverage for persons "residing in institutions for mental diseases" for people receiving services at AMRTC would allow MA coverage and reimbursement while receiving treatment at AMRTC. It also would allow Minnesota to make additional strides in reducing lengths of stay, reserving the AMRTC setting only for the most acute needs, and assisting timely and smooth transitions back to community-based supportive services.

In addition, State Operated Services is undertaking a comprehensive planning process to better define its role in delivering services to person with complex needs. This planning effort is coordinated with state health care reform initiatives, Olmstead planning, courts/law enforcement/corrections planning, and broader healthcare organizations. Agreeing on a shared vision for the role of SOS in the state's safety net between DHS, community providers and stakeholders would put SOS in a better position to collaborate effectively in these other policy-making settings and could result in improved care for people, improved relationships with other providers, a more seamless safety net, and financial savings.

Results:

SOS measures success in the strategies outlined above in the reduction in the length of stay for clients and in the reduction in the number of non-acute bed days. When a client can move through the system and return quickly to the community there is a greater chance they will retain their support system and living arrangement. A key measure of success is the reduction of non-acute bed days which result when a client longer needs inpatient hospital level of care but cannot be discharged for lack of funding or availability of an appropriate placement. Inability to discharge from a hospital setting is costly and restricts the systems flow resulting in individuals who need hospital level of care being held in inappropriate settings including community corrections and emergency rooms.

Performance Measures	Previous	Current	Trend
Average Number of Non-Acute bed days per adult patient1	9.4	8	Improving
Mental Health [post discharge] Follow Up Rate2	73%	75.7%	Improving
The average number of psychotropic medications prescribed at discharge3	2.4	2.3	Improving

Performance Measures Notes:

1.   Previous measures Calendar Year (CY) 2010, fourth quarter and Current measures CY2011, fourth quarter (Source: DHS Public Dashboard)

2.   The percent of clients hospitalized for mental illness who have a follow-up appointment set up within 30 days in place at time of discharge. Prompt follow-up in the community is an important factor in avoiding re-hospitalization. Previous measures CY 2011 and Current year measures CY 2012, 2nd Quarter. (Source: DHS Internal Performance Tracking)

3.   The average number of psychotropic medications prescribed at discharge. Previous measure is third quarter state fiscal year 2011 and Current measure is third quarter state fiscal year 2012. Decreasing prescribed medications increases compliance which in turn results in increased stability following discharge. (Source: DHS Internal Performance Tracking)