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Bed reduction
begins
(December
2006 Issue)
By Phyllis Hanlon
This September, the Massachusetts Department of Mental Health (DMH)
began the process of discharging patients deemed appropriate for
community living, as recommended in a March 2004 Inpatient Facility
Report.
Patricia Mackin, DMH chief of staff, indicates that the state has
discharged 236 patients from eight state hospitals. "These individuals
were sent to residential and group homes and supported housing,"
she says and notes that the state has contracted with vendors and
state-operated programs to ensure a smooth transition. "We are following
the patients on a daily basis," she says. "Some of the more serious
cases have case managers."
Mackin reports that to date, the process has been relatively uneventful
with few setbacks. "We're proud that the recidivism rate is extremely
low. Some of the people that we thought would be the most difficult
have been released without incident," she says. The state expects
to discharge an additional 32 inpatients by June 30, 2007.
Before beginning the discharge process, the Commonwealth evaluated
a number of factors that could impact the success of the program.
"Part of the routine is always looking for an appropriate setting.
We also looked at a realistic goal," Mackin says.
In spite of the shift to community-based care, Mackin cites the
need for hospitalization in certain instances. "We'll always need
inpatient settings. There's no getting away from that," says Mackin.
Massachusetts, however, is attempting to reduce its inpatient census
whenever possible. "Two years ago, we started with 900 inpatients.
Our goal is to get that down to 740," she says.
Wayne F. Dailey, Ph.D., senior policy advisor at the Department
of Mental Health and Addiction Services in Connecticut, says that
recent efforts to deinstitutionalize patients took place when his
state closed one psychiatric hospital in December 1995 and a second
in October 1996. "This left us with about 800 psychiatric beds statewide,
a significant portion of which are for forensic patients," he says.
Forensic patients occupy 30 percent of the current 858 state-operated
beds, according to Dailey.
Dailey explains that the patients discharged in 1995 and 1996 were
placed in community settings or transferred to the remaining operating
hospital, which was expanded at that time to accommodate the influx
of patients. He says, "Since then, there has been relatively little
change in the inpatient census." Dailey adds that Connecticut contracts
with the general hospital in the state for acute inpatient psychiatric
care when necessary. "They provide more care for the uninsured,
those who get no entitlement and insurance benefits," he says.
Dailey says that Connecticut aims to treat individuals in the community
rather than in a medical facility. "By design, we have a low number
of psychiatric beds. We prefer rehabilitation and community-oriented
care," he says. "[Hospitalization] should be used sparingly and
only for people who need that level of care and only for that duration
of time that care is needed."
New Hampshire launched its community-based program approximately
20 years ago when it closed a significant portion of the existing
state hospital, according to Udo Rauter, Ph.D., director of psychology
at New Hampshire Hospital. "We had a large campus then. Fifteen
years ago, they moved to a single state-of-the-art facility with
a capacity of fewer than 200 beds. It was a major deinstitutionalization
process," he says.
According to Rauter, during the past eight years, the number of
beds for involuntary acute admissions has decreased significantly.
In 1998, 100 beds existed; four years later that number was down
to 22, he says.
Rauter notes that New Hampshire Hospital attempts to discharge
patients before they become institutionalized. "The hospital wasn't
built to be a permanent institution. But you always have an ideal
and then there's reality," he says. "One handicap is an increased
demand from a program connected to prison that sends patients to
the hospital. Their diagnoses are creating resistance by the community.
Risk management prefers that those patients stay in the hospital."
In spite of fewer inpatient beds, Rauter admits that some patients
still await community placement. "We have 30-plus patients on any
given day waiting for discharge. Sometimes it takes six months to
find the proper placement for these patients," he says. He reports
that between 2000 and 2003, the number of group home beds decreased
from 52 to 17 because of a reduction in federal dollars. Rauter
explains that NAMI is aware of the dilemma. "They are advocating
on behalf of the hospital," he says. The legislature has also appointed
a 30-member commission to address the problem.
While hospital admissions have declined, community mental health
centers, which coordinate group home admission and follow up, have
seen an upsurge in their patient census, according to Rauter. Last
fiscal year, these centers experienced a ten percent increase and
this year's rate will equal or surpass that figure, he says.
Rosanna Czermak, executive director of the Vermont Psychological
Association, consulted with Alexandra Forbes, M.A. the organization's
legislative chair and head of Five Rivers Network, Inc. who indicates
that no initiative to reduce inpatient beds currently exists in
the Granite State.
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