ACUTE-CRISIS PSYCHIATRIC SERVICES DEVELOPMENT INITIATIVE

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ACUTE-CRISIS PSYCHIATRIC SERVICES DEVELOPMENT
INITIATIVE

• DC Hospital Association
• Department of Mental Health
• June 30, 2004

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DMH PROPOSALS

• SHIFT ALL CIVIL ACUTE CARE TO GENERAL AND
  SPECIALTY HOSPITALS
• EXPAND ALTERNATIVES TO HOSPITALIZATION
• CREATE EXTENDED OBSERVATION SERVICES
• EXPAND ASSERTIVE COMMUNITY TREATMENT
• EXPAND CRISIS RESIDENTIAL SERVICES
• EXPAND CRISIS INTERVENTION AND STABILIZATION
  THROUGH MOBILE CRISIS SERVICES
• BETTER UTILIZATION OF CARE COORDINATION

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2001 Dixon Court Ordered Plan

• acute care services for both children and
  adults will be provided under agreements with a
  number of willing and qualified local acute care
  hospitals.
• these agreements are important because
  general hospitals can be reimbursed for
  Medicaid-eligible psychiatric admissions and will
  very likely be less stigmatizing, and more likely
  to result in integrated healthcare and shorter
  lengths of stay (based on national statistics)
  than emergency admissions to Saint Elizabeths
  have been.

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Why provide all acute care for adults in
community hospitals?

• Persons with psychiatric illnesses need first
  class medical care
• High incidence of associated medical illnesses
• State psychiatric hospitals not equipped to
  provide medical care

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Why provide all acute care for adults in
community hospitals?

• Saint Elizabeths and all state and free
  standing hospitals are Institutes for Mental
  Diseases (IMDs) and are not eligible for Medicaid
  for patients between ages 22 and 64

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Why provide all acute care for adults in
community hospitals?

• Patients do better when they integrated health
  care
• Persons with a mental illness want treatment in
  the community--where they go for other medical
  care
• Persons with a mental illness tend to do better
  when they choose the treatment setting

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DMH has prepared for shift

• Access HelpLine (AHL) provides 24/7 care
  coordination---AHL takes 900 calls a week and
  helps triage and track all new crisis and urgent
  referrals, enrolls consumers into the Mental
  Health Rehabilitation Services (MHRS) system
• Civil commitment statute has been modernized
  involuntary patients are more easily managed in
  community hospitals

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DMH has prepared for shift

• In less than 3 years, a 40 million and growing
  outpatient rehabilitation services developedDMH
  also operates its own administration services
  organization internal to DMH certifying
  providers, managing provider relations,
  adjudicating and paying claims, managing
  transfers, conducting quality improvement
  activities,
• 27 community outpatient providers certified by
  DMH for a range of community services most of
  these providers are Core Service Agencies meaning
  they serve as the clinical home for consumers.

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New Facility at St Es

• The City is constructing a 292 bed facility that
  will accommodate 175 forensic and 117 long term
  civil patients
• Size of new facility based on Court Ordered Needs
  Assessment conducted in 2001
• 3 buildings to be renovated to accommodate a
  larger population if needed
• Construction will be completed in early 2007

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In FY 2005, DMH will contract for acute care in
DCHA Hospitals

• Option 1 Community-wide Purchasing Plan
• Option 2 Acute Care Network
• Option 3 Hospital Single Purchase Plan

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Option 1 Community-Wide Purchasing Plan

• DMH purchases psychiatric acute care service from
  any hospital who provides care to indigent
  persons
• DMH provides prior authorized coverage for up to
  15 days based on DMH medical necessity criteria

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Option 2 Acute Care Network

• DMH contracts with 2-4 hospitals who commit
  sufficient beds to meet need
• DMH and Hospitals will work closely in a network
  approach to assure admissions can be managed---up
  to 15 day lengths of stay

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Option 3 Single Hospital Plan

• A single hospital makes a proposal to shift beds
  from the Saint Elizabeths complement to manage
  the psychiatric acute care program
• DMH will issue a single contract for days based
  on projected need, with an approved 15 day length
  of stay

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Childrens Crisis System

• Closed DMH Childrens Crisis unit October, 2002
• CNMC had seen 80 of the Districts ER
  psychiatric visits for children and youth
• CNMC has a contract to see all children DMH
  supplements CNMC with 2 social workers for crisis
  stabilization and continuity of care

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Additional Childrens Services

• 2 Mobile Crisis Teams2nd one to be added in
  August, 2004
• Multi Systemic Therapy Teams (MST)up to 4 teams
  to be added this calendar year
• Intensive in-home servicesbegun in 2002, being
  expanded this year
• Preferred provider agreements for Intensive Care
  Managementto begin in September, 2004

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Adult Crisis System needs more.

• District hospital's EDs at or above capacity
• EDs poorly connected to the Mental Health System
• Based on contemporary practice the City needs to
  expand crisis alternatives
• DMH and APRA agree to combine efforts to improve
  system no wrong doorneeded for persons with
  substance abuse and psychiatric problems

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Adult Crisis System needs more.

• Breakdown in continuity of care of consumers
  leaving St Elizabeths and acute hospitals
• Community Service Agencies certification
  requirements include their meeting emergent,
  urgent and routine accessgreater compliance
  needed

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DMH Proposal for Psychiatric Emergency and Crisis
Services

• DMH-Hospital Emergency Departments develop
  cooperative agreements for DMH to come on site to
  assist with intervention, disposition and
  transport
• Mobile Crisis Teams expand and become primary
  mode of DMH crisis intervention, 24-7

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DMH Proposal for Psychiatric Emergency and Crisis
Services

• Extended Observations Units expand capacity to
  serve persons in crisis for up to 72 hours when
  hospitalization not indicated but additional
  stabilization is needed
• Expand Crisis Residential Capacity by up to 8
  beds
• Expand Assertive Community Treatmentdouble
  capacity in FY 2004-2005

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Next Steps

• DMH will solicit interest in Option 1, 2 or 3
  this month with projected start
  date---October-December 2004.
• DMH committed to Crisis Expansion beginning in
  early 2005 Fiscal Year, will solicit proposals
  for expansion in July and August
• DMH will host discussions on Collaboration with
  EDs to begin immediately

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Contact Information

• Marti Knisley
• Director
• 202-673-2200
• Marti.knisley_at_dc.gov

• Steve Steury
• Chief Clinical Officer
• 202-673-1939
• Steve.steury_at_dc.gov