Fresh path to mental health

Fresh path to mental health

The focus is on making clients architects of their own recovery.

by Donna Jackel Rochester Democrat & Chronicle January 25, 2005

"Are you taking your medication?" "Are you hearing voices?"

Those are the types of questions John Robbins, a case manager at the Evelyn Brandon Health Center on Lake Avenue, often asked his clients with severe mental illness.

Now, Robbins has lengthy conversations with them, discussing their lives and hopes for the future.

He used to write up clients' service plans, which determined what types of services they would receive, and then have them sign off on the completed document. Now, Robbins and a client will spend days setting goals and figuring out how to attain them.

What spurred this new approach is a pilot project aimed at transforming how community mental health centers, hospitals and day programs serve adults - and it's saving some money at the same time.

"In the past, we thought people with serious mental illness often couldn't get well. Programs were set up mainly around maintaining people," said Margy Meath, manager of case management at the Brandon Health Center.

Now, she said, the focus is on recovery.

In Monroe County, 650 clients are enrolled in the program, called Western New York Care Coordination, with 2,000 in six counties: Monroe, Erie, Genesee, Wyoming, Chautauqua and Onondaga. Officials at other area counties opted out of joining Care Coordination for various reasons, but may join in the future, said Kathleen Plum, director of the Monroe County Office of Mental Health.

The buzzword at the downtown Rochester offices of Care Coordination is "person-centered planning." Robbins is one of several hundred mental health professionals in the six participating counties who have received this training, which emphasizes empowering patients by asking them what they want, rather than telling them what to do. More staff will be trained next year, said Adele Gorges, program director.

Care Coordination also tailors services to each client and monitors their progress. The end goal is to move clients from sheltered day programs to greater independence and to fuller integration into the community.

A success story

Marcellious Daniels Jr. developed his own service plan about a year ago, with the help of Robbins, his caseworker. The 24-year-old seems to be flourishing. Daniels was diagnosed with schizophrenia four years ago, when he began having hallucinations. Not wanting the illness to derail his life, he continued to hold down two jobs and attend school. The stress proved too much, however, and the young man began cycling in and out of mental hospitals. In his service plan, Daniels identified his strengths, goals, support systems (such as his family) and values. He also listed ways to remain healthy, such as eating healthily and getting enough sleep.

"The planning meeting was like a journal," Daniels said. "I write things down and then come back to it and see how things went."

Daniels also scaled back on his activities: He stopped working and focused on obtaining his GED. He was able to receive Social Security insurance benefits. This fall, he enrolled at Monroe Community College and hopes to learn to become an auto mechanic. Said Daniels: "I've got my life together and I'm staying on the straight line."

Daniels' mother, Sharon Daniels, said that Robbins was always there making sure Daniels' medication was correct and that he was on time for appointments.

"If there was a problem, John would fix it," she said. "John (Robbins) never gave up on him, and we never did either."

Care Coordination is a collaboration among the state Office of Mental Health, county governments, clients and health care providers. The Office of Mental Health pays for the program. Most of the money, which totaled about $500,000 in 2004, is used for training counselors and caseworkers and to pay program administrators, Gorges said.

Each participating county also receives a separate pool of money to pay for services not reimbursed by Medicaid. For one woman, it was money to pay for child care once a week, so she could have a break from her child. The fund also pays for alternative medicines, such as acupuncture, YMCA memberships and some medications not covered under Medicaid. In a 2004 survey of 110 enrollees in Care Coordination, 86 percent said they were satisfied with the range of available services.

To Dr. Jack McIntyre, vice president of behavioral health for Unity Health System, the program's most innovative component is its emphasis on continuity of care. Mental health coverage is inadequate, which often results in fragmented, interrupted care, he said.

The old way of doing things, in which mentally ill people were expected to attend outpatient programs and live in segregated settings, did not promote work or a full life, said Plum.

"Hospitals without walls is what we used to call them," she said. "A lot of people are willing to try this new approach if we give them support."

While it might not be possible for all patients to reach their final goals, they can achieve steps to those goals, said Meath. For example, Robbins had a middle-aged client who was arrested regularly for getting into street altercations. After his training, Robbins tried a new approach: He asked the man what he could do differently to stay out of trouble. The man came up with some suggestions. He hasn't been arrested in eight months and attends GED classes twice a week, Robbins said.

Empowering patients results in emotional, as well as financial, independence. Preliminary data that Care Coordination obtained from the Office of Mental Health show a savings for taxpayers. The average cost of Medicaid-related mental health expenses per program participant fell from $3,549 in 2001 to $3,180 in 2004. The cost of inpatient stays in psychiatric units fell more dramatically, from $1,547 per participant in 2001 to $977 in 2003.

Gorges says the savings in Medicaid "significantly exceeds" the cost of the program.

Care Coordination has funding to enroll 1,100 more people in Monroe County and about 2,800 in all six counties. Enrollment has intentionally been slow to ensure "that we're doing it right," Gorges said. While the program is in its early stages, Gorges said the knowledge gained through Care Coordination will eventually be applied to improve the mental health system statewide.

Improving services for those with severe mental illness and reducing the stigma of mental illness are not new concepts. Patients and their families have been clamoring for these basic rights since the early 1970s.

"Consumers are stepping up," said Brian Phillips, 53, peer and family coordinator for Care Coordination. "It started as almost a militant (movement) and evolved into people like myself who believe in collaborating with providers, government and agencies to improve the mental health system."

Phillips coordinates peer specialists, paid staff and volunteers who have recovered from a mental illness and are willing to use their knowledge of the mental health system to help others.

It is in this way that Phillips found his own niche.

"I recognized I had the ability to know what the problems were and how to fix them. I'm here to help people still struggling and not getting the help they need."

A long battle with major clinical depression that began 18 years ago cost Phillips his business and his 25-year marriage. Treatments didn't seem to help.

"The day things changed for me was when a psychiatrist told me, 'You're not fighting. You're not doing things to save your life.'"

Against advice, Phillips took a low-paying job to get back into the rhythm of life. "Decision-making is so important to recovery," he said. "I decided to go back to work, no matter what."

Traditional services focused on people's deficits, says Phillips. What's needed, he said, is for mental health professionals, and the community as a whole, to see beyond the disability to the person.

"I've met so many people who seem helpless but have strengths and talents," he said. "If you spend time to look for them, you can build on that."

Source: Rochester Democrat & Chronicle

This 'Mental Health E-News' posting is a service of the New York Ass'n of Psychiatric Rehabilitation Services, a statewide coalition of people who use and/or provide community mental health services dedicated to improving services and social conditions for people with psychiatric disabilities by promoting their recovery, rehabilitation and rights. To join our list, please click on the E-News Subscription button.

Last Updated on 01/26/05 webmaster@namiscc.org

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