By Ron Honberg, J.D., National Director of Policy and Legal Affairs, NAMI
In the 2006 New Yorker article “Million Dollar Murray,1” Malcolm Gladwell describes how small numbers of individuals living with serious mental illness and substance abuse incur extremely high costs for communities. These costs frequently can be linked to hospitals, jails and emergency health and mental health services.
Gladwell effectively illustrates that the failure to spend public resources wisely often leads to higher costs. The individuals described are frequently arrested or hospitalized but receive few, if any, services in between these arrests or hospitalizations. Sadly, this scenario plays out in community after community across the country.
An innovative new program started by a partnership led by NAMI Georgia called Opening Doors to Recovery (ODR) is trying to show that there is a better way. Georgia has struggled for many years to provide effective services to its citizens living with serious mental illness and co-occurring disorders.
The ODR program was established in Region 5 of Georgia, which includes Savannah and other communities in the southeastern part of the state. It is a private/ public funding partnership in the best sense of the term. The three major funders are Bristol-Myers Squibb Foundation, which provided $2 million in funding, CSX Railroad Corp. and the Georgia Department of Behavioral Health and Developmental Disabilities (DBHDD).
The goal of ODR is to provide intensive community supports to individuals living with serious mental illness in Southeast Georgia with “an established history of recurring homelessness, incarcerations or hospitalizations.” Although the program is initially limited to 100 participants, the goal is to expand the program more broadly, perhaps even statewide, if the goal of reducing hospitalizations, incarceration and homelessness is achieved.
Georgia’s mental health system has experienced significant problems in recent years both in the provision of inpatient and community-based services. The state operates under a consent decree with the U.S. Department of Justice in which it has committed to meeting certain numerical targets in implementing programs such as Assertive Community Treatment (ACT), supportive housing, crisis-stabilization programs, peer supports and supported employment.
“I wish everyone else could see me in the way you see me. I don’t even know how you see me, but whatever it is, I want to feel this way forever. I feel like how normal people must feel. But if it doesn’t last forever, I’ll remember this period in time that I was respected and heard and appreciated for the rest of my life. Opening Doors to Recovery has good people in it helping me.” –ODR participant
Michael Compton, M.D., heads up a team of researchers evaluating the impact of ODR on the individuals being served. In a recent Psychiatric Services article, Dr. Compton explains that the ODR model was stimulated by two previously successful collaborations in the state: the statewide Crisis Intervention Team (CIT) program and Georgia’s peer support specialist initiative (which has served as a model for many other states). The success of these two programs was very much predicated by collaboration between key stakeholders and systems involved in the provision of services to people living with serious mental illness.
Like CIT and the peer support specialist model, ODR is predicated on collaboration at local levels. In Region 5, a strong partnership has been established among individuals, family members, local providers, hospitals, law enforcement, emergency departments, clergy and others who touch the lives of people living with serious mental illness. These partnerships extend beyond the conceptual level—they translate into actual practice.
For example, after informed consent is provided, the names of ODR participants are placed in the state’s computerized criminal justice database, and police officers who have contact with participants receive automated notices informing them of the individual’s participation in the program and providing them with a number to call. ODR also includes a pilot project involving a comprehensive electronic recovery record, including health and mental health information, psychiatric advance directives, consent forms and other vital information.
On its face, ODR looks like a traditional intensive casemanagement model. However, a closer look reveals some unique features. For example, ODR utilizes a team approach to helping its clients navigate the network of mental health, health and social services. Teams of community navigators comprised of individuals in recovery (peers), family members and licensed mental health professionals receive extensive training to work cooperatively to provide services to each individual served by the program. Each of these three individuals brings different perspectives to the shared goals of recovery and reducing recidivism.
Unlike traditional mental health services, ODR has a comprehensive focus. Participants receive assistance in accessing treatment, finding stable housing, developing and improving relationships and achieving meaning and purpose in their lives. In accordance with this approach, participants receive help in accessing mental health and health care services, but also receive help with housing, employment, peer supports, accessing benefits and in addressing other important needs and desires. Grant support from CSX provides access to transportation, a particularly important component of recovery in rural regions. ODR has also established a partnership with the Georgia Department of Labor to facilitate increased employment opportunities for participants.
The data collection and evaluation component of ODR is still in its early stages, so it is too early to provide comprehensive information. However, there are already some illustrations of how the program is helping individual participants. Profiles compiled by the research team show positive short-term impacts, including adherence to treatment, maintaining sobriety and participating in meaningful daytime activities including employment and reductions in arrests, incarceration and hospitalizations. These benefits have not gone unnoticed. The ODR project was recently endorsed by former First Lady Rosalynn Carter (see page 12).
As states and communities continue to look for ways to achieve greater efficiencies in the provision of integrated, coordinated services for people living with serious mental illness and other chronic disabilities, the ODR program is a promising model that bears close observation. While the initial investment of resources in serving people with a pattern of chronic recidivism may be high, the eventual benefits in terms of saving money and saving lives cannot be overstated. People living with mental illness and substance abuse deserve a chance to achieve true recovery.
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1 Malcolm Gladwell, “Million Dollar Murray,” The New Yorker, February 13, 2006, http://www.gladwell.com/2006/2006_ 02_13_a_murray.html.