October 26, 2017
Bucks, Chester, Delaware, Montgomery and Philadelphia 2 State Hospitals closed – Philadelphia State (1989) & Haverford State (1997) Closed approximately 1550 state hospital beds since 1990 via Community Hospital Integration Project Programs(CHIPPs) First in PA to begin HealthChoices (1996) First to develop Regional CHIPPs Model (2000/01) 2 SE REGION SAP Presentation 5/22/17
Supports recovery and inclusion in the community Provides a continuum of treatment options and array of support services Is dynamic and tailored to individual needs Supports inclusion and recovery Supports opportunities for wellness Source: SE Regional MH Services Office 2017
4 OUTREA REACH CH SERV RVIC ICES ES A service designed to locate, engage, assess, intervene and link individuals. Outreach services are fundamentally mobile and may focus on persons in specific settings or with complex needs such as personal care boarding homes, shelters, or dual issues such as mental illness and drug & alcohol or mental illness and a history of incarceration CRISI SIS S INTERVENTI ERVENTION N SERVI VICES CES Services available 24 hours a day by phone, walk-in or mobile to intervene when individuals are in crisis or in a psychiatric emergency. Emergency services are provided if the person needs inpatient care, crisis facilitates those arrangements CRISIS SIS RESIDEN IDENTI TIAL Very short term residential service, generally about five (5) days, intended for non-hospital stabilization and as an alternative to admission to an inpatient psychiatric hospital Source: SE Regional MH Services Office 2017
5 CASE MANAGEME GEMENT NT A service designed to assure the consumer and his/her needs are matched with appropriate services Continuity of care ensuring that when there is a shift from one service to another, or needs change or from one service network to another occurs, that the consumer and/or his/her needs are not lost in the shift. Monitoring to ensure that appropriate services are being provided to the consumer. Types vary in intensity of support and are matched to individual needs. Source: SE Regional MH Services Office 2017
6 OUTPAT PATIENT IENT Provides clinical assessment and treatment to persons living in the community. Individual, group and family psychotherapy as well as psychiatric services (evaluation & medication monitoring). Intensive Outpatient treatment (IOP) is a combination of services delivered each week PARTI TIAL L HO HOSPIT ITAL Provides comprehensive therapeutic & rehabilitation services to persons living in the community. Programs include medication monitoring, individual & group psychotherapy, & activity-focused therapy. 2-5 days/week PSYCHIAT HIATRIC C REHA HABILI BILITA TATI TION/CL N/CLUBHOUS UBHOUSE E SERV RVIC ICES ES Programs geared toward enhancing skills, training and prevocational services, and socialization to help persons live more productive lives in the community. Facility based or mobile. Self-directed & goal-oriented Source: SE Regional MH Services Office 2017
7 COMMUNITY NITY TREAT EATMENT MENT TEAM (CTT) TT) or ASSERTI ERTIVE VE COMMUNITY NITY TREATM EATMEN ENT T (ACT) T) All inclusive Primarily Mobile Multidisciplinary team On call 24/7 PEER R SUPPORT PORT SERVI VICES CES Certified Peer Specialists (CPS) Consumer operated agency, group, or drop-in center Common ground Source: SE Regional MH Services Office 2017
8 EMPLO LOYMENT MENT RELATED ATED SERVI VICES CES Focus on a supported employment model to get persons into competitive employment rather than lengthy job training and pre-vocational skill training Office of Vocational Rehabilitation Pre-employment skills and training Employment specialist, benefits counseling services, and job coaching while on the job PSYCHIAT HIATRIC C INPATI TIENT ENT CARE For acute stabilization and short-term hospital based treatment Offers psychiatric and clinical services in a secure setting Could be voluntary or involuntary Source: SE Regional MH Services Office 2017
9 Ge Generic ric Housin ing Su Support orted ed Liv ivin ing g Se Servic ices es Receive in-home support where the individual lives Varies in level of needs Varies in ancillary supports the individual receives Source: SE Regional MH Services Office 2017
10 Lic icens nsed d and nd Spe peciali ialized ed Ment ntal al Health lth Resi sident dential ial Sup uppo port rts s Based on MH needs for support in the community Various types and levels of care Limited availability By application through the County MH Offices Source: SE Regional MH Services Office 2017
Type pes s of Spe peciali cialized d Ment ntal l Health lth Resi sident dential ial Pro rogra rams ms Community Residential Rehabilitation (CRR) All Inclusive Residential Treatment Facilities (RTFA) Long Term Structured Residence (LTSR) Specialized Personal Care Homes (SPCH) Specialized CRRs, Regional Programs (varies) Ava vailabil ability ty and d capacity acity differs ers in each h County nty
Census POPULATION AT NSH effective 10/24/2017 Civil wait list from CIVIL Census as In CIVIL with Legal Forensic Census Forensics/CJ ** of 10/24/2017 restriction/CJ HOLD as 10/24/17 eff 10/15/17 Bucks 17 1 3 1 Chester 10 4 3 0 Delaware 16 7 22 1 Montgomery 24 5 or 6 18 1 Philadelphia 53 42 62 11 TOTAL 5 County 120 54 108 14 others 2(York, Butler) TOTAL 122 *** Based on Regional MHSvc Civil population CJ related Status Update as of 07/2017
October 2015 ACLU – filed against DHS “ delays exceeding seven days in transferring Plaintiffs and Class A members to the state hospitals for treatment violate the laws” January 2016 – DHS 1 st Settlement January 2017 – NSH Civil Section Closure Announcement May 2017 – ACLU filed injunction vs DHS (118 persons discharged and new placements developed) May 2017 – DHS 2 nd Settlement terms
May 2017 – DHS 2 nd Settlement terms a. By 12/15/17: Create a new "minimum security" unit at Norristown State Hospital, which will consist of 50 new forensic beds for mentally ill defendants. (28 new and 22 existing civil will be converted for forensic use) b. 12/15/17 Add an additional 29 community mental health beds within the next six months, divvied between Allegheny County (7 + 12) and Philadelphia (10). c. By March 15, 2018, 30 "civil beds" at Norristown State Hospital, meaning beds for mentally ill people outside of the criminal justice system, will move into the community as specified in their CSP and will be converted to forensic beds (provided that no patient who is currently in a civil bed that the services have not yet been developed for that patient) 2017/18 SE Regional Forensic Treatment Center
January 2017 – NSH Civil Section Closure Announcement Clinical Assessment process = July 2016-June 2017 PHASE 1, 2, 3 community planning for closure NSH CIVIL CLOSURE by 12/31/2018
Clinical ical Risk Assessme ment t project ct 140 Total assessme Total assessments nts 115 120 assigned assigne 102 100 Assessments nts 80 comp completed leted 60 Declined/R Decli ned/Refus used/Re d/Re 40 move moved fro d from asse assessme ment t list ist 20 13 0
Assessment ment Reco commended mmended LOC 24/7 S 24 /7 Str tructu cture red N d Non on Secur cure 9% 12% Re Reside sidential Tr Trea eatme tment 8% Sec Secure 24/7 ure 24/7 reside esidential ial treatment treatmen Inpatient Inpat ient Hos Hospital pital LO LOC 71% CRR o RR or Su r Supported pported Livin Living
PHASE 1 PERIOD 8/1/17-12/1/17 PHASE 2 PERIOD 12/1/17 - 3/15/18 PHASE 3 PERIOD 3/15/18 - 12/31/18 PHASE 4 PERIOD 1/1/19 - post Civil Closure
TABLE #1 BED CLOSURES/ DISCHARGES CHART PHASE 4 Period - Post Civil Bed Closure - PHASE 1 PERIOD PHASE 2 PERIOD PHASE 3 PERIOD NEW SERFTC CURRENT CIVIL POPULATION AS OF 7/1/18 – 12/31/18 (FY COUNTY 8/1/17-12/1/17 12/1/17 - 3/15/18 3/15/18 – 6/30/18 9/11/17 18/19) 1/1/2019 "CIVIL- CIVIL" PROPOSED CJ POP IN 22 30 POPULATION DISCHARGES CIVIL AS OF 9/11/17 # dependant on how many persons in FTC NEW / EXPANDED PROGRAM TYPE E-RTFA E-CRR OTHER DEVELOPMENT NEW SE Forensic Treatment Center Bucks 16 1 4 3 0 1 (ID Waiver) 8 or 9 Chester 6 4 4 0 1 2 Delaware 6 9 4 1 6 or 8 Montgomery 18 5 4 2 12 Philadelphia 9 45 0 0 10 2 or 3 10 6 10 to 15 TOTAL 55 64 16 6 11 22
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