NYAPRS Note: In recent years, New York State has moved to a policy of front loading dollars to create innovative new programs that are proving essential to the efforts of those looking to make a successful transition from state hospitals to local communities….and to prevent their and others’ avoidable admissions or readmissions.
NYAPRS and MHANYS worked successfully over this last budget session with state legislative leaders and the Administration to see that a proposed $5.5 million cut to Reinvestment program was restored.
The following piece highlights the value of new peer-run or supported respite and warm line programs and bridger services.
2016-17 OMH Budget: Reinvesting in Community-Based Care
OMH News May 2016
This year’s OMH budget continues the Transformation Plan’s reinvestment in community-based care – funding an array of services to help individuals make the transition from state psychiatric centers to the least restrictive settings.
“This will be the third year of full reinvestment, bringing the full annual commitment to $81 million,” said Emil Slane, OMH Deputy Commissioner and Chief Fiscal Officer. “These are funds that would have been otherwise spent on avoidable state inpatient hospitalizations.”
As a result of this ongoing community investment, OMH estimates that 200 vacant inpatient beds can be closed in the upcoming fiscal year, making an additional $22 million available to invest in community services.
Reinvestment Brings Results
The 2016-17 State Budget fully annualizes the previous two years of pre-investment, and provides an additional $11 million – annualizing to $22 million – to further strengthen the overall community mental health safety net. Results so far have been promising.
During the last two state fiscal years, OMH has used reinvestment funding to develop new mobile crisis teams, expand clinic services, provide additional peer support services, and fund additional supported housing units – helping more than 10,000 new individuals receive services since these programs began.
“Because of these efforts, the average daily inpatient census in OMH civil adult and children’s psychiatric centers declined by nearly 6% in 2015,” Slane said. “During the same period, OMH’s new Transformation Plan services reached thousands of new individuals in communities. This puts OMH firmly on the path toward balancing its resources to provide people with more appropriate and effective community treatment and support.”
OMH is dedicating a significant share of its 2016-17 funding to help long-stay inpatients with complex medical and behavioral health needs make the transition to more appropriate settings in the community by developing partnerships with skilled nursing facilities. By helping these individuals move to more-integrated and less-restrictive community settings, OMH is freeing-up inpatient capacity and increasing its ability to provide intermediate care.
Expanding Services in Communities
Housing Options Made Easy, Inc., of Gowanda is one example of a local agency that has expanded its services through reinvestment, helping clients in six Western New York counties receive help in their own communities. For example, since its Eagle’s Nest Respite House in the Southern Tier opened in November 2015, nearly 86% of its guests have been diverted from hospital stays. Eagle’s Nest Respite, a program of Housing Options Made Easy.
Some were diverted from high-end interventions due to a dual diagnosis of a developmental disability and a mental health issue. One client, who was discharged from Buffalo Psychiatric Center, was able to use the respite to prevent a return. Others would have gone to the Buffalo Psychiatric Center if hospitalization was needed.
“Nearly all guests reported that the respite helped them stay positive,” said Joseph Woodward, Housing Options Executive Director. “Most people reported that the respite had helped them avoid a hospitalization. The repeat guests we had, used the respite again to avoid hospitalization.”
Eagle’s Nest has helped participants find peer support and the continued interaction has helped the participants avoid a hospital stay. This has led to the start of a peer-support group that meets once a month at an outside location. The respite also follows up with clients at 30, 60, 90 and 180 day intervals. All follow-ups track how the guest is feeling since leaving the respite, and whether the respite stay helped the guest avoid going to the hospital.
Not only has the program helped patients, it’s saved money. Based on an average length of stay at Eagle’s Nest of five days, the average cost of savings per guest that diverted from the Mental Health Department at WCA Hospital in Jamestown was $7,000, for a total savings of about $245,000.
However, because the average length of stay at WCA is closer to 11 days, the total would be much higher at $436,100. Housing Option’s Warmline program in Chautauqua and Cattaraugus counties also continues to help divert people from a hospital stay. The program has opened a texting line for people who are more comfortable texting than actually talking to people.
“Callers who repeatedly call the Warmline say that having the service helps them stay well and avoid the hospital,” Woodward said. Funding from the reinvestment grant is allowing them to look forward and expand services.
“We’re developing a ‘tool kit’ for all guests who come to the respite,” Woodward said. “This will be given to them at checkout, and will include community resource lists, support groups in the area, and other phone numbers and programs that offer support.” The respite is planning to offer the Whole Health Action Management program which offers training and peer group support to encourage resiliency, wellness, and self-management of physical health and behavioral health.
‘A Place Where They Can be Listened to’
Reinvestment funding has given East House and the Mental Health Association of Rochester the means to collaborate on developing a peer respite program to help individuals both during and after their stay. Open for a full year as of May 7, Affinity Place is a peer-run respite house in Rochester that’s set up much like a neighborhood bed-and-breakfast. “There had been a great deal of discussion about priorities for the region,” said Gregory Soehner, President and Chief Executive Officer of East House, which runs the program. “We determined that a hospital diversion program run by peers would be a priority.”
After East House and MHA were awarded Reinvestment funding at the end of 2014, a great deal of legwork needed to be done before they could open, such as hiring staff, adapting one of its properties for a new purpose, and making the community aware of the program.
“Affinity Place is designed to be comforting and relaxing,” Soehner said. “We refer to people who stay with us as our ‘guests.’ They check-in and check-out like one would at a ‘B-and-B.’ They stay in single rooms. They get their own room key. And we’ve included little touches to help them feel like they’re not in a residential program – such as guest books with a list of community resources and things to do.” Guests can stay up to five days.
“We don’t operate on a medical model, because that’s not the design of the program,” said Cheri Reed-Watt, Director of Residential Services. She noted that the facility is entirely run by peers, there are no physicians, psychiatrists, or nurses on staff. “A lot of times, people don’t need to be hospitalized. They just need a place to stay where they can be listened to and put things in perspective.”
The admission process is set up so that people can get in quickly, often with just one phone call. Guests can come and go as they need to. Many of the guests work full time, then they can return to the house at the end of the day and get the support that they are looking for. “Our guests are offered an opportunity to take a survey at check-out,” Reed-Watt added. “The results have been overwhelmingly positive. They’d often like to stay longer.”
‘Wouldn’t Exist if it Hadn’t Been for Reinvestment’
Guests can receive additional support after they check out from the Mental Health Association of Rochester. Each guest is offered the ability to work with a peer support specialist for up to 60 days after leaving Affinity Place.
“The peer support specialist helps them to address the issues that led to their needing a residential stay,” said Patricia Woods, the Mental Health Association’s Chief Executive Officer. “We assist them during this transition period. We’ll work on establishing healthy behaviors, developing strategies for handling difficult situations, finding community and social supports, and referring them to employment services. We’ll offer variety of services based on what the client wants to see happen in their life.” Woods said that 75% of the program’s clients have accepted the community services offered by MHA.
“This was one of the projects our agencies wanted to start, but we didn’t yet have the resources,” Woods said. “This program wouldn’t exist if it hadn’t been for the Reinvestment funding.” In addition, Affinity Place offers a warm line, which is available to individuals who reside within the six counties it serves. This service is available 24 hours a day, seven days a week and has received more than 3,000 calls in the past year.