This following presentation is the long-overdue plan and proposal to the office of mental health to shutdown the state psychiatric centers and discharge all remaining patients to the community. From long-term care and extended service units, to admissions, adult, children, and adolescent service in-patient treatment wards, I am calling for the complete and final discontinuation of state-level care and the treatment centers in the United States. There is no question that we are at a cross-roads in the future of mental health treatment. Now, more than ever, the call and need for complete access and integration is visible and signals to consumers, and practitioners alike that the mental health system as it stands today does not fit or address the gap in care & treatment in the community. The system instead is still informed by the era of institutionalization and does not help consumers to access services at the most local level where the potential for connectivity and person-centered care are most organically abundant. With further delay, this recommendation challenges the ongoing deferral of full community access and integration in the United States, and disrupts today’s ever more insidious Neo-institutionalization, signaling to the country access to mental health treatment is this country’s first priority in addressing the mental health crisis for consumers which have historically fallen through the cracks of the system.
The future of full integration and access to mental health services resides without question in the community. In order to fully integrate services and consumers into the network of already available mental health programs, we need to finally discharge the remaining patients from long-term state psychiatric centers from their eternal holding pattern to ultimately integrate and help consumers gain access to community resources and most importantly, live amongst other people outside the gates of the institution. Therefore, phase one of the ward closure team manual for community access will target the release, discharge, and re-integration fo consumers back into the community. Later phases will target the establishment of reliable systems of care in which chronic and high risk consumers will have ease of reliable access to services and programs this group will benefit from in leu of hospitalization.
Phase one begins theoretically in the local state governments and municipalities that govern the regulation of mental health treatment. In New York, this means the office of mental health. The commissioner will ultimately need to approve this document, and other similar research that organizes the mass organized discharge of those patients in psychiatric hold. This means, the office of mental health will need to approve funding for ward closure teams to infiltrate the state psychiatric hospital system at every level impacting discharge planning, and community re-integration. In theory, each free-standing unit in every state hospital will need to work side by side with its assigned ward closure teams. Thus, social workers, and psychiatrists, and all in-patient staff charged with the successful discharge of its patients will need to partner with the ward closure teams until the final discharge from the hospital and the last patient re-enters the community.
The crux of phase one will hinge on the funding for staffing these ward closure teams across New York State. Each team will be an interdisciplinary echo of the treatment gaps identified in each hospitals locale. This means, prior to each ward closure team beginning its work on the unit, the hospital will send a memorandum of requirements to the office of mental health which will inform the make up and composition of the teams assigned to each hospital and community. Thus, needs targeting transportation and rural concerns will be staffed by ward closure teams specializing in the needs of rural communities and their mental health systems. More urban based communities with complex spatial and access issues will be staffed with workers adept at handling the mental health concerns of consumers in urban settings.
The planning involved by both the ward closure teams and the existent treatment teams on unit goes beyond assessing the composition of the community. Indeed, ward closure teams will be required to bring with them a full understanding of local existent services in the community, and work side by side with treatment teams on unit to identify the final problems for-seen before each discharge. This means issues of adherence will be measured against connectivity issues in the communities existent health networks. Other issues such as medical co-morbidities will necessitate ward closure teams to gain a full understanding of existent health networks which serve clients with complex medical and psychiatric issues and other complex case management services which freestanding clinics do not traditionally serve. Thus, diagnostic and public policy stakeholders for health, medicine, and and public policy stakeholders for health, medicine, and of chronicity will be counterbalanced with ACT teams and other mobile units such as care managers which go into the community and complete house visits and supply case management services to users of service dependent upon the system of care i.e. certification and re-certification of benefits to keep the service running without pause.
The next major step for phase one to move towards its desired goal occurs just after the assigning of ward closure teams to respective communities and psychiatric centers. This is the moment when the teams infiltrate and gain access to inpatient services and begin working side by side with hospital staff to identify the final concerns prior to discharge. Without question, this will be a process in which patients will work with both the ward closure teams and their treatment teams in the community so post discharge services can be cross-walked with the needs identified by both long-standing clinicians and the new closure teams for one goal: complete access and integration of consumers into the community and the end of institutionalization once and for all.
In order to achieve this feat, this plan, and each of its phases will require not only community support, buy in from stakeholders in mental health and public policy, but the shared dream and goal of a society without walls and restrictive barriers placed for consumers with chronic and long-standing mental health conditions typically assessed and slated for long-term ongoing round the clock care that a state institution provides its patients. Thus, the vision and scope of this plan, and its future teams charged with the final solution and an end the era of Neo-institutionalization is clear as day: full community access and integration of all community mental health programs and the elimination of a level of care that is both dated and obsolete in the context of supplying full meaning to de-institutionalization.
Mental health is a community and public health need, and the fallacies and misnomers of the old system shall never again point towards locking up people and sending the “problem” patients to long-term care units far away from the community and its resources. We need only provide access and engender new pathways for consumers to gain access to its many lines of care already existent in the systems of care in New York State and all regulatory bodies with a vested in interest in mental health treatment.
Neo-Institutionalization is complex, insidious, and must be stopped! Therefore, the ward closure operations manual is two fold. The first wave of operations targeted the state psychiatric centers with a global assessment of the outlying communities, and the express needs of consumers being discharged. Wave two will target the overhaul of treatment silos, and installations already in the community requiring more integrated access for consumers. There is no question the resources are already there in the community. This presentation is a proposal on how to re-configure existing structures that serve mental health treatment and parcel it out to users of services.
The success of wave two will hinge upon the elimination of free-standing treatment silos. This means, any and all treatment programs which discriminate and choose to openly serve only subgroups or “high-functioning” users of services will be given a mandate by the office of mental health to broaden its scope of functioning or be subject to loss of licensing and funding. Example of programs which only cater to a small niche of “qualified” users of services include out-patient setting refusing to accept state sponsored insurances for consumers which are presently disabled and reliant upon Medicaid and other service dollars. Conversely, treatment centers which open their doors to all consumers, or, are cited for re-structuring, and successfully re-configure their clinics, group practices, and day treatment centers will be awarded funding to commit to on-site projects and community out-reach.projects to extend services further into the community.
The next segment of phase is an ongoing community mental health surveillance and hygiene drill to run the course of the re-integration and expire after the final discharge from the locale’s state psychiatric center. Under the assumption that the influx of new chronic users of services will test the limits of the community’s local emergency rooms, community hospitals, and largely increase the census of health centers delivery of mental health treatment, this surveillance and hygiene study will serve to bridge gaps existing in each community during the critical phase of mass organized discharges from the state psychiatric centers. The study will be monitored and fed into a statewide planning commission for full community access and integration. From there, larger, more global planning can take place and be used as a model for other state regulatory bodies interested in eliminating another dated level of care and deferred recovery of its patients.
The planning and hygiene study will ultimately be interpreted and measured up against the re-structuring efforts already underway in the community. Gaps identified in care from the hygiene and surveillance study will be taken seriously and once verified, local community planners in mental health, managers, and community stake holders in mental health will be charged with identifying solutions to the problem. Given the latitude required to make changes at this local level, it is the recommendation of this proposal that county community Mental Health departments and SPOA (Single Point of Access) committees spearhead the final structural adjustments to the system of care. Ultimately, the office of mental health will begin the drafting of new regulatory codes which promote and encourage the end of Neo-Institutionalization. This means, codes will be enacted which discourage extended hospitalizations and other prolonged ongoing treatment without end. Such treatment pathways, while not forbidden, will spark red-flags at the community mental health office, and in Albany alike, and such programs will be monitored for future compliance with integration and access practices.
At the root of it, this is a recommendation and call to arms for regulators at the state and federal level to revamp and raise the bar higher for promoting best practices amongst practitioners and public health stakeholders in mental health. With this said, research suggests the delivery of mental health treatment must go on without interruption from either hospitalization or from falling into a gap in available treatment at the local level . Given so many community treatment settings are either inaccessible and do not target the provision of resources for consumers to continue in their recovery on their own terms and in their own community we can assume the next logical step in creating a culture equipped and ready to take on the crisis in mental health care will mean practitioners and law bodies will pay close attention to this recommendation and due their diligence. The urgent roll out and implementation of ward closures in the United States and everywhere consumers are in psychiatric hold without hope of accessing services in their community.