Executive Director, New York Association of Psychiatric Rehabilitation Services (NYAPRS)
In our final post on AOT Harvey Rosenthal explores the role of evidenced-based wraparound services in providing better mental health care outcomes.
Outpatient commitment typically involves mandating individuals to accept the same treatment approaches that have already failed or deterred them in the past. We know a lot more about how to help people in severe distress, but these methods are typically not offered or are not sufficiently available. These include a number of evidence based approaches like
- Transitional Supports: using critical opportunities to engage people when leaving inpatient and detox facilities and prisons and jails
- Individualized Care Management: organizing care across multiple behavioral and physical health and social systems that operates from shared information and offers real time response
- Housing First and other harm- and homelessness-reduction models: offering individuals what they most need to be safe even if they’re not currently willing to take medications or stop using alcohol and drugs
- Person-centered Planning Tools: utilizing Wellness Recovery Action Plans and Advance Directives
- Criminal Justice Diversion and Re-entry Services: using court-based mental health workers, Crisis Intervention Teams, and better prison discharge plans and support services
- Peer and Family Supports: incorporating peer crisis warm lines, respite houses, outreach, bridger and wellness coaching as well as family-to-family support
- Employment and Education
- Evidence-based Medicine: relying upon the latest research, providing more individualized care, and utilizing less drugs over a shorter period of time
Reimbursement and Outcomes System Changes are Critical
We now know how to offer vastly improved outreach, engagement, and follow-up services, but most of these supports are either under-resourced or not available at all in local communities. Implementing these approaches may require additional federal, state, and local funding, but they may also be funded by redirecting funds from the avoidable use of costly emergency room and hospital stays.
Further, systems and providers typically offer the services that offer the outcomes for which they’re paid. Reimbursement models must move from paying for participation in the same old programs to tying payment to individualized and innovative approaches that demonstrate success. Affordable Care Act-related reforms that make greater use of managed care’s flexibility and focus on outcomes are already demonstrating greatly improved results for the individual, as well as realizing cost savings for the community. Reforms that restructure care through integrated health home provider networks are also recognizing similar benefits.
Investment in relationship building is crucial, however if these programs are going to be successful. We must be willing to pay up front for an engagement process that can take as long as 3 to 6 months.
Someday we’ll look back on service systems that were so unable to engage some individuals in distress that we turned to the criminal justice system to force that engagement, and hold ourselves accountable. We will wonder how it was that we let ourselves off the hook with views like “this is the best they can do” and therefore “this is the best we can do.” Now is the time to rewrite that history.
This is a time for collaboration, not contentiousness. Murphy and Barber should forge an alliance that advances proposals that they already share. Both sides agree that we need to enhance services for families, veterans, children, students, people who are at risk for suicide, and criminal justice-involved individuals, and create programs that improve the responsiveness of our workforce. Let’s hope they can roll up their sleeves and get the work done.
- Which parts of Harvey Rosenthal’s arguments for broad services and meaningful engagement resonate for you?
- Which examples of engagement and community-based services have you experienced, and how did they help (or not help)?
- How can we motivate our legislators to adopt policies that recognize the benefits of a more relationship-based, broader services model of client engagement?