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.
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