Seminole Community Community Seminole Mental Health Center Mental - - PowerPoint PPT Presentation

Seminole Seminole Community Community Mental Health Center Mental Health Center

Assisted Outpatient Treatment Assisted Outpatient Treatment Florida Model AOT Project Florida Model AOT Project 11/14/2005 11/14/2005

What is it What is it

• Court ordered outpatient treatment or assisted

Court ordered outpatient treatment or assisted

• utpatient treatment for people with severe mental
• utpatient treatment for people with severe mental

illness illness (i.e., schizophrenia, bipolar) (i.e., schizophrenia, bipolar)

• Enacted in June 30, 2004 by Governor Bush

Enacted in June 30, 2004 by Governor Bush

• Effective January 1, 2005

Effective January 1, 2005

Why is it needed Why is it needed

• Improved quality of life for clients and family

Improved quality of life for clients and family

• Increased public safety

Increased public safety

• Decrease costs of emergency services/legal services

Decrease costs of emergency services/legal services

• More efficient use of criminal justice system resources

More efficient use of criminal justice system resources

Improved Quality of Life Improved Quality of Life

• More than 15,000 Floridians with untreated

More than 15,000 Floridians with untreated mental illness are homeless mental illness are homeless

• 10

10-

• 15 times more suicides among the mentally ill

15 times more suicides among the mentally ill

Increased Public Safety Increased Public Safety

• More than 1000 homicides in the US are

More than 1000 homicides in the US are committed each year by people who have committed each year by people who have untreated mental illness untreated mental illness

• People with untreated mental illness are nearly 3

People with untreated mental illness are nearly 3 times more likely to be a victim of violent crime times more likely to be a victim of violent crime

• Nationally it is estimated that people with

Nationally it is estimated that people with mental illnesses are killed in police altercations at mental illnesses are killed in police altercations at a rate 4 times greater than the general public. a rate 4 times greater than the general public.

Decreased Cost of Emergency Decreased Cost of Emergency Services Services

• Community based treatment is approximately 10 % of inpatient

Community based treatment is approximately 10 % of inpatient hospitalization costs. hospitalization costs.

• 540 individuals in FL

540 individuals in FL had eight or more Baker Act emergency had eight or more Baker Act emergency examinations in one 24 month period (2000 to 2001), averaging examinations in one 24 month period (2000 to 2001), averaging at least one every three months. at least one every three months. One individual alone accounted One individual alone accounted for 41 Baker Act examinations (in 2002) for 41 Baker Act examinations (in 2002) at an approximate cost at an approximate cost

• f $81,000
• f $81,000 –

– not including court costs, law enforcement not including court costs, law enforcement resources, or long resources, or long-

• term treatment.

term treatment.

More effective use of justice system More effective use of justice system

• 16

16-

• 17% of the state jail and prison inmates in

17% of the state jail and prison inmates in Florida or approximately 16,000 Florida or approximately 16,000-

• 17,000 people

17,000 people suffer from a serious mental illness in 2000. suffer from a serious mental illness in 2000.

• Florida law

Florida law-

• enforcement officials handle about

enforcement officials handle about 100 Baker Act commitments/day compared to 100 Baker Act commitments/day compared to 71 daily burglary arrests. 71 daily burglary arrests.

Outcomes being measured Outcomes being measured

Objective: Objective:

• Use of emergency

Use of emergency services i.e., crisis unit, services i.e., crisis unit, state hospital, private state hospital, private hospital, emergency hospital, emergency transport services transport services

• Arrests, days of

Arrests, days of incarceration, cost of incarceration, cost of incarceration incarceration

• Homelessness

Homelessness Subjective: Subjective:

• Perceived quality of life

Perceived quality of life

Hospital and Jail Days before and after Hospital and Jail Days before and after AOT Petition AOT Petition --

• - Ulster County Clients

Ulster County Clients

4284 588 1338 199 500 1000 1500 2000 2500 3000 3500 4000 4500 Hospital Jail Before AOT After AOT

Hospital and Jail Cost before and after Hospital and Jail Cost before and after AOT Petition AOT Petition --

• - Ulster County Clients

Ulster County Clients

$2,356,200 $32,340 $147,180 $21,890 $0 $500,000 $1,000,000 $1,500,000 $2,000,000 $2,500,000 Hospital Jail Before AOT After AOT

Hospital and Jail Days with Enhanced Hospital and Jail Days with Enhanced Services and AOT Petition Ulster County Services and AOT Petition Ulster County

For this group of clients enhanced services was not effective e For this group of clients enhanced services was not effective enough to stabilize and they nough to stabilize and they needed a court order to follow treatment plan. needed a court order to follow treatment plan.

2317 2067 588 970 365 199 500 1000 1500 2000 2500 Hospital Days Jail Days Before Enhanced Enhanced Petition

Results of the Duke Study Results of the Duke Study

Objective Data Objective Data

• Decrease in arrest rate (74%)

Decrease in arrest rate (74%)

• Decrease in violence (up to 50%)

Decrease in violence (up to 50%)

• Decrease in hospital admissions (74%)

Decrease in hospital admissions (74%)

• Decrease in length of stay (by 20 days)

Decrease in length of stay (by 20 days)

• Decrease in victimization (43%)

Decrease in victimization (43%)

Results of the Kendra Law Patient Interviews Results of the Kendra Law Patient Interviews Subjective data Subjective data

• 75 percent reported that AOT helped them gain

75 percent reported that AOT helped them gain control over their lives control over their lives

• 81 percent said that AOT helped them to get

81 percent said that AOT helped them to get and stay well and stay well

• 90 percent said that AOT made them more

90 percent said that AOT made them more likely to keep appointments and take medication likely to keep appointments and take medication

History History

• Least restrictive environment

Least restrictive environment

• Deinstitutionalization of the mentally ill/community

Deinstitutionalization of the mentally ill/community mental health center mental health center

• Lack of services/under funding

Lack of services/under funding

• Public awareness of a problem via high profile cases

Public awareness of a problem via high profile cases

• 40 states pass AOT legislation

40 states pass AOT legislation

• Kendra's Law enacted in NY

Kendra's Law enacted in NY [41st state to adopt] [41st state to adopt]

• 42 states pass AOP legislation

42 states pass AOP legislation

• TAC and Florida Sheriff

TAC and Florida Sheriff’ ’s Association team up to s Association team up to increase public awareness increase public awareness

• Passage of SB700 by Governor Bush in FL

Passage of SB700 by Governor Bush in FL

Where we are today Where we are today

• Implementation stage

Implementation stage

• SCMHC under grant working with Treatment

SCMHC under grant working with Treatment Advocacy Center (TAC) to develop Model AOT Advocacy Center (TAC) to develop Model AOT Program for Florida. Program for Florida.

Criteria Criteria

Must meet standard of Clear and Convincing Must meet standard of Clear and Convincing Evidence Evidence 1) Age 18 or older 1) Age 18 or older 2) Diagnosis substantiated by 2 professionals 2) Diagnosis substantiated by 2 professionals 3) Unable to survive in community as evidenced 3) Unable to survive in community as evidenced by history and current behaviors by history and current behaviors 4) History of non 4) History of non-

• compliance with treatment

compliance with treatment

Criteria (continued) Criteria (continued)

5) Two involuntary admissions within 36 mos 5) Two involuntary admissions within 36 mos

• or
• r-
• two incidents of received treatment in a forensic

two incidents of received treatment in a forensic

• r correctional facility
• r correctional facility
• or
• r-
• 1 or more violent acts toward self and/or others

1 or more violent acts toward self and/or others within 36 mos period within 36 mos period

Criteria Criteria

6) Due to mental health is unlikely to voluntarily 6) Due to mental health is unlikely to voluntarily comply with treatment and refused voluntary comply with treatment and refused voluntary placement placement 7) Needs Treatment to prevent relapse or 7) Needs Treatment to prevent relapse or deterioration deterioration 8) Will benefit from Treatment 8) Will benefit from Treatment 9) Other least restrictive means judged 9) Other least restrictive means judged inappropriate or unavailable (not necessarily inappropriate or unavailable (not necessarily tried) tried)

The Process The Process

• Person must meet criteria

Person must meet criteria

• Proposed Treatment Plan devised.

Proposed Treatment Plan devised.

• Petition filed in county where person resides

Petition filed in county where person resides

• Public defender appointed with 1 court working day

Public defender appointed with 1 court working day and state attorney represents the state and state attorney represents the state

• Hearing within 5 working days

Hearing within 5 working days

• Clear and convincing evidence presented

Clear and convincing evidence presented

• Court ordered into Involuntary Outpatient Treatment

Court ordered into Involuntary Outpatient Treatment

Obstacles Faced Obstacles Faced

• Educating the community

Educating the community

• Networking/Coordination/Communication

Networking/Coordination/Communication

• Lack of Resources

Lack of Resources

• Changing old patterns of thinking i.e.., violation

Changing old patterns of thinking i.e.., violation

• f one
• f one’

’s civil liberties s civil liberties

Non Non-

• compliance

compliance

If in clinical judgment of a physician, person has If in clinical judgment of a physician, person has failed or refused to comply with Treatment failed or refused to comply with Treatment and and efforts were made to solicit compliance efforts were made to solicit compliance and and person person may may meet criteria for involuntary meet criteria for involuntary examination, examination, then then person can be brought back into the receiving person can be brought back into the receiving facility. facility.

Anosognosia Anosognosia

The single largest reason why individuals with The single largest reason why individuals with schizophrenia and bipolar disorder do not take schizophrenia and bipolar disorder do not take their medications. This impaired awareness of their medications. This impaired awareness of illness is caused by damage to specific parts of illness is caused by damage to specific parts of the brain, and affects approximately 50 percent the brain, and affects approximately 50 percent

• f individuals with schizophrenia and 40 percent
• f individuals with schizophrenia and 40 percent
• f individuals with bipolar disorder.
• f individuals with bipolar disorder.