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How to How to Get Services for Someone with Severe Mental Illness
Prepared by NAMI PA, Main Line (www.nami.org/sites/NAMIPAMainLine)

Help in a Mental Health Crisis
If you or someone you know is having a mental health crisis, you can call 911 (e.g. if there is immediate danger of physical harm) or you can call one of the crisis lines listed below.  These crisis lines provide access to staff who are specifically trained for dealing with mental health crises and may provide better help and reduced risk that a mental health crisis will result in an arrest.  Someone is available 24 hours/day, 7 days/week to assess the situation, arrange for an in-person evaluation, and/or make referrals as needed. 

Chester County            610.918.2100 or 877.918.2100
Delaware County          610.352.4703
Montgomery County     610.279.6100 or 800.452.4189
Philadelphia County     215.685.6440

You can also call one of the following national hotlines to be referred to the closest crisis center:
800.SUICIDE (800.784.2433)
800.273.TALK (800.273.8255)

Overview of How to Get Services
Individuals with good private health insurance can find excellent care from private providers and/or community mental health centers.  Many individuals with severe mental illness will find it necessary, or at least helpful, to apply for some or all of the following publicly supported services:

• disability income from the Social Security Administration

• Medicaid and/or Medicare health insurance which is available to disabled individuals

• community mental health services provided by each county, including case management which can provide access to housing and many other services.

Each of these services is described below, and additional helpful resources are listed at the end.  For additional information and recommendations, contact your local NAMI affiliate (www.nami.org). 

Disability Income
The federal Social Security Administration (SSA) determines who is eligible for Supplemental Security Income (SSI) and Social Security Disability Income (SSDI).  Disabled people who have very low or no income and savings and have not worked or paid into Social Security may be eligible for SSI.  People who have worked and paid Social Security taxes may be eligible for SSDI, at varying rates depending how much they contributed.  Applying for disability income can be a cumbersome process and many people are rejected initially.  It is a good idea to understand the guidelines before applying so that all required information is included in the application. 

Helpful resources

• SSA’s official website, www.socialsecurity.gov, is an excellent resource to learn everything you need to know about disability, including eligibility guidelines, benefits and the application process.  You can even apply for disability online.
• Social Security Hotline - 800.772.1213 (7 a.m.-7 p.m., Monday through Friday).  SSA can send pamphlets that explain the benefits and rules for applying for disability.  The best times to call are early morning or early evening.   You can also get information and apply online (www.ssa.gov). 
• Disability Rights Network – 215.238.8070 - offers free services to help clients obtain SSDI or SSI and has information about how employment affects government benefits like Medicaid and Medicare.
• Some lawyers who specialize in disability law can help a person obtain SSDI or SSI.  Often they do not require a fee until the person receives disability, even if the process takes several attempts and several years.  The lawyer usually gets a percentage, typically 25% of the first payment, which is the accumulated amount, retroactively, from the date the person first applied for disability, even if it was several years ago.

Publicly Funded Medical Insurance
Medicaid (also known as Medical Assistance) is a federal and state government program that provides health insurance coverage to certain low income persons if they meet state-established income and resource standards and other eligibility requirements.  To learn about eligibility requirements and benefits or to apply for Medicaid go to www.compass.state.pa.us or go to your local County Assistance Office.  People who have SSI are automatically eligible for Medicaid.

In Southeastern Pennsylvania most people who have Medicaid must enroll in a managed care program called Health Choices.  There are three plans from which to choose:  AmeriChoice, Health Partners and Keystone Mercy Health Plan, and members must go to providers affiliated with these plans for all of their medical services.  For mental health and substance abuse services, people in the Health Choices program must use designated behavioral health vendors, depending on the county in which they live. 

Medicare is a federal program that provides health insurance to Americans who are over age 65 or those who are younger than 65 and meet the Social Security Administration’s (SSA) standard for long-term serious disability.  People with disabilities who are younger than 65 generally must wait two years from the date they were determined to be eligible before their Medicare coverage actually becomes effective.

• The Medicare program includes:
  Part A - hospital insurance, including skilled nursing, some home health care, and hospice services.  Part A is an automatic benefit.
• Part B - physician and outpatient services, some home health care, durable medical equipment, and ambulance services.  Part B is a voluntary program for which a premium is charged.
• Part C - alternative to receiving traditional Medicare (Parts A and B).  Beneficiaries enroll in a Medicare Advantage health plan, typically an HMO or PPO, instead of participating in the other parts of Medicare.  Part C coverage may be greater and premiums lower than Parts A and B and gap coverage combined, but the provider network will be more limited.  Part C is voluntary.
• Part D - Prescription drug coverage program.Part D is also voluntary and has a premium.    Part D is also voluntary and has a premium.  If you do not choose to get Part D coverage when you first become eligible (or did not enroll in a Medicare Advantage plan that includes prescriptions) there is a financial penalty for joining at a later date.   

In addition to Medicare, some people choose to get a “gap plan” offered by private insurers.  This is supplemental insurance to fill in the gaps in Medicare Parts A and B. (Do not confuse Plan C supplemental insurance with Part C above.)

Additional information is available at www.medicare.gov, and www.medicarerights.org.

Dual eligibility.  Some people with disabilities are dually eligible for both Medicare and Medicaid because they have very low incomes and few other resources.  As a general rule, Medicare payment levels for providers are higher than Medicaid payments.  On the other hand, Medicaid often covers services that Medicare does not cover.  Therefore, for many people with disabilities, the ideal arrangement is to be dually eligible for both Medicare and Medicaid which enables them to access the benefits of both programs. 

Community Mental Health Services
The way to obtain care through Community Mental Health Services depends on whether you have private health insurance, Medicare, or Medicaid.  If you have private insurance or Medicare and want to use Community Mental Health Services, call the appropriate number below to be referred to the core provider (formerly called Base Service Unit or BSU) closest to your residence. 

Chester County             610.344.6265 or 800.692.1100 x6265
Delaware County           610.713.2365
Montgomery County       610.278.3642
Philadelphia County       215.685.6440

If you have Medicaid, you will probably be referred to the appropriate core provider by the behavioral health vendor for your county (see top of page 2).  Initially, you should call the core provider for an intake appointment, at which point a psychiatrist and case manager will be assigned.  The doctor will oversee psychiatric care and prescribe medications.  The case manager can assist in planning for daily needs, setting goals toward recovery, arranging day treatment services, group or individual therapy, vocational and employment services, housing or whatever is needed for rehabilitation.  (There may be a long wait to get into a supervised group home or Community Residential Rehabilitation (CRR).)

Sometimes a case manager will go with a consumer to appointments and other services s/he needs.  Otherwise, it is a good idea for a family member to help in getting services.  Family members can help the consumer write a list of questions before phoning or meeting with a service provider and can be of enormous help if they go with the consumer to apply for needed services.   Encourage service providers to write down needed information and instructions for the consumer.  Encourage the consumer to do the same, and have everyone reconfirm what is said. 

Additional Helpful Resources

• Mental Health Association of Southeastern Pennsylvania (MHASP) – 215.751.1800 – provides support to consumers living in the community (e.g. housing, case management) and family education through their Training and Education Center (x232) which offers a very helpful information packet and workshops about specific mental illnesses and problem-solving strategies.
• PLAN of PA (Planned Lifetime Assistance Network) - 610.687.4036 - provides fee-for-service case management, representative payee service, personal care planning for the future, special needs trust services.
• PA Health Law Project - 215.625.3663 - gives free help to people when their Medicaid and Medicare services are not working well for them; their website (www.phlp.org) provides helpful information on accessing mental health treatment in getting help with prescription medications).
• PA Institutional Law Project - 215.925.2966 - gives legal assistance to consumers in hospitals, prisons, and other institutions.
• NAMI affiliates offer information, support, speaker meetings, support groups, Family-to-Family (a very helpful, free 12-week course for family members), advocacy opportunities, and social events.

NAMI PA, Chester County                     610.293.1422
NAMI PA, Delaware County                    610.623.0071
NAMI PA, Main Line                                267.251.6240
NAMI PA, Montgomery County                215.886.0350
NAMI PA, North Central Philadelphia       215.228.7214
NAMI PA, Northeast Philadelphia          215.342.9553
NAMI PA, Northwest Philadelphia         215.224.6307

For additional NAMI affiliates, in other areas, see www.NAMI.org or call

NAMI PA (state)                       800.223.0500
NAMI (national)                        800.950.6264                    

Many additional resources in southeastern Pennsylvania, including drop-in centers, social groups, support groups, volunteer opportunities, and behavioral health-care providers, are described in the Resource Guide available at www.nami.org/sites/NAMIPAMainLine.

Helpful information for consumers and family members to have immediately accessible (maybe in your wallet)

• Names, phone numbers and addresses of all the people and agencies serving the person, including psychiatrist, case manager, emergency phone numbers, Social Security contact person, Public Assistance case worker, housing contact, etc.
• Phone number of and a “working relationship” with the person’s pharmacist where prescriptions are filled.  Always read the information on all prescriptions to be sure you have the correct medication and instructions for taking it.

Related Files

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