Oneida Co Commissioner Highlights Success Hospital Downsizing Initiative

Acting Commissioner's Message by Kristin M. Woodlock, OMH Acting Commissioner

This year, the Acting Commissioner's Message will focus on people or places in New York State that are leading the way to the behavioral health system of the future. This month, in our "Be the Change Spotlight", we hear from Oneida County. Be the Change Spotlight- Oneida County by Linda Nelson, Commissioner- Oneida County Department of Mental Health Oneida County's response to the closure of two adult wards at the Mohawk Valley Psychiatric Center and the transfer of one ward to Hutchings Psychiatric Center in Syracuse has demonstrated that opportunities often come gift-wrapped as challenges and also that when dedicated state and local professionals work as a team, the end result of their diligence is success.

Be the Change Spotlight- Oneida County by Linda Nelson, Commissioner- Oneida County Department of Mental Health

Oneida County's response to the closure of two adult wards at the Mohawk Valley Psychiatric Center and the transfer of one ward to Hutchings Psychiatric Center in Syracuse has demonstrated that opportunities often come gift-wrapped as challenges and also that when dedicated state and local professionals work as a team, the end result of their diligence is success.

"What has impressed me about the work done by the Oneida County Department of Mental Health and the state Office of Mental Health is the tremendous focus on making this transition work for the people who depend upon the mental health system. What I have seen from their work is that our community has made a very big step in the transformation from the era of institutionalization of patients to a well-developed community care system. I know there is always more work to be done, but the work done to date is an outstanding example of service to the community," said Oneida County Executive Anthony J. Picente, Jr.

Roughly one year ago, upon learning of the change, Oneida County embraced the opportunity to closely analyze the impact this would have on the continuum of care and the provision of services. We were particularly concerned about the impact on the three area 9.39 hospital inpatient units. We gathered data on admission rates, length of stay and overall occupancy rates. To date, there has been only a slight increase in these areas. We did, however, have several issues to resolve in learning how to better partner with Hutchings given that they were further away and new players and processes were required. The Department of Mental Health continues to facilitate meetings to assist our local hospitals.

The overall question that we were forced to tackle initially was; where could we best intervene within the outpatient system to divert patients from long term, expensive hospitalization?

With helpful, consistent technical assistance from the OMH Syracuse Field Office, it was determined that there were two points in service delivery where we could make a difference in avoiding emergency room visits and long term inpatient stays. The two points are at the crisis level and the forensic level given that patients who do not receive adequate care end up either in the emergency rooms or in jail.

Based on our analysis and data, we proposed that additional funding would be required to meet these shortages that would emerge as a result of the closures.

We proposed hiring four additional staff for the Mobile Crisis Assessment Team (MCAT). Expanded coverage at the 911 Emergency Response Center would place a crisis worker there for the majority of hours to be available to the dispatchers and callers to diffuse the situation and determine if law enforcement or the crisis team or both need to be activated. Additional MCAT staff is used to stabilize and prevent crises from re-occurring, provide suicide prevention and intervention and a variety of peer supports. We will measure effectiveness of these efforts and the desired outcomes include: a reduction in the number of individuals re-hospitalized within less than 30 days, improved cross systems response to crises, improved training for crisis responders, and an increase in utilization and compliance with outpatient mental health services.

Resources were also allocated to support a transportation program for family members from Oneida County visiting patients at Hutchings Psychiatric Center.

At the forensic level, we proposed expanding services to support diversion and post-release services and case management within the Utica Mental Health Court. Discharge planning done at Oneida County jail will be followed up by forensic case managers who pick up where the jail discharge planners leave off. We anticipate that this will improve the compliance rate for engagement in community supports, reduce homelessness, reduce recidivism rates and re-involvement with the criminal justice system and reduce emergency and inpatient treatment. These staff are not housed at the jail but in the community. They arrange transportation, home visitations, attend case management consultations with providers and serve as the liaison between providers and mental health staff at the jail and monitor the court process. A specific and specialized Mental Health Court case manager performs assessments, refers accepted candidates to appropriate service providers (including mental health, addictions, housing, medical, financial), develops and implements individualized service plans, attends case consultations, and acts as the liaison with the broader mental health system and Mental Health Court.

Additionally, Oneida County will enhance the Adult Single Point of Access and Accountability (ASPOA/A) services to function in a more coordinated, efficient manner which will serve to divert unnecessary referrals to emergency departments and inpatient admissions. We will accomplish this through coordinating and managing related data and developing an integrated database and reporting system to coordinate services based on an analysis of the data. This integrated data set will include the receipts, distributions, openings and closing of over 1,000 referrals annually for care coordination and residential services, approximately 2500 annual hospital admissions and discharges, reports on Mental Hygiene Law 9.41, 9.45 and 2209 custody transports which together totaled over 1433 in 2011. The department is also responsible for the oversight of approximately 20 Assisted Outpatient Treatment referrals, and approximately 55 Criminal Procedure Law 730 examinations annually.

This integrated database will provide an accurate view of the service history of the most vulnerable individuals. The county department of mental health will serve as the "Hub" of critical information to be available to the larger community to coordinate services.

The people we serve are those who benefit from these enhancements, which have been funded by the State Office of Mental Health and implemented in a partnership that does not worry about turf, only results. We continue to operationalize the various components as partners. We look forward to measuring the effectiveness of our efforts and will make needed adjustments. What has been developed by the state and the county is a major step forward for not only our agencies, but above all for our communities and the people in them.

http://www.omh.ny.gov/omhweb/resources/newsltr/2013/Jan/acting_commissio ners_message.html