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What Consumers and Families Expect From Treatment Systems for Persons with Severe Mental Illness



Accountability Domains

Some Possible Metrics at System Level

Some Possible Metrics at Consumer Level

Some Possible Metrics at Clinical Level

1. Nondiscrimination: People with serious brain disorders and their families are treated fairly and equitably in health care, employment, housing, and all areas of life.

  • Does the state require full parity in private health insurance?
  • Does a health plan have a different and lower standard of allowable care for comparable chronic illnesses—such as heart disease v. bipolar disorder?
  • Survey of consumers asks about the experience of job or housing discrimination: Were you refused a job or lease because of mental illness treatment?
  • Clinicians report housing and employment status

2. Access to and Continuity of Care: People with serious brain disorders have access to information and emergency hot lines, available 24 hours a day, 7 days a week, including response in the languages prevalent within the system of services and an appropriate level of care in a seamless system.

  • Does state, local mental health authority, and health plan have such emergency hot lines?
  • Does a state, local mental health authority, and inpatient facility have mandated discharge plans with specifically assigned care coordinators?
  • Does state, local mental health authority, and health plan have available crisis support programs when hospitalization is not necessary?
  • Survey of consumers asks about the responsiveness, sensitivity, and attitudes of emergency hot line workers.
  • Survey of consumers asks about disruptions to their care.
  • Appropriate and geographically convenient clinical staff are available 24 hours a day, 7 days a week.
  • Complete physical examination within 24 hours of admission into any inpatient facility.
  • Treatment integration of all medically recognized conditions
  • Does review of clinical charts and data show that there is a continuity of care interventions within appropriate time frames?
  • Discharge from inpatient facilities only when clinically indicated.
3. Evidence-based treatment and services: People with serious brain disorders and their families have access to necessary treatment, services and supports shown to be effective.
  • Does a state, local mental health authority, or health plan have ACT programs sufficient to need?
  • Does a state, local mental health authority, or health plan have a policy of access to appropriate, safe, and effective medications, determined by science to render the best outcome?
  • Does a state, local mental health authority, or health plan provide for family education? Does it support NAMI’s Family-to-Family program?
  • Does a state mental health department or health plan have an interagency agreement with vocational rehabilitation service providers?
  • When medications were prescribed, were they accompanied by education concerning side effects?
  • Does review of clinical charts and data show that appropriate medication at the appropriate dosage were given?
  • Does review of clinical charts and data show that family education was "prescribed" and given?
  • Does review of clinical charts and data show that appropriate psychotherapy was "prescribed" and given?
  • Does review of clinical charts and data show that supported employment was made available when appropriate?
  • Does review of clinical charts and data show that supportive housing, if required by the individual, was made available?
4. Consumer and Family Involvement Consumers and family members are involved in all aspects of the treatment system serving them, from oversight, monitoring and evaluation, to partnering in their own treatment decision-making.
  • Does the state include more than a token number of consumers and family members on their mental health system advisory councils?
  • Does the state or health plan require that consumers, and, when appropriate, care-giving family members have input into and sign-off on treatment plans?
  • Does the state or hospital system have consumer and family monitoring teams?
  • Does the state, local mental health authority, or health plans have independent consumer satisfaction teams?
  • Survey of consumers and family members about their view of their involvement in their own treatment. (Sample questions are: Do you believe that you had adequate input into determining your course of treatment? Does your physician ask about and/or listen to you and/or take you seriously when you raise questions and concerns about medication side-effects?)
  • Does review of clinical charts/data show that consumers, and when appropriate, family members have signed off on a course of treatment?
  • How did consumer and family monitoring team rate service providers?
  • How did consumer satisfaction teams rate service providers?
  • Are consumer run/peer support groups part of health plan networks?
5. Recovery-Oriented: Treatment, services, and systems provide care in such a way so as to promote the best quality of life desired and possible for a consumer.
  • Does the state, local mental health authority, or health plan provide for peer support and clubhouses?
  • Does the state or local mental health authority assure appropriate safe, continuous, decent housing with needed supports in the least restrictive setting possible for all individuals with severe mental illnesses for which it is responsible? (Conversely, one may ask about problems with homelessness—as insufficient treatment/housing resulting in homelessness is definitely not recovery-oriented.)
  • Does the state have appropriate work incentive policies?
  • Survey of consumers about their view of whether the treatment system they are involved in promotes recovery, is satisfying to them, etc.
  • Service providers report on (and state/plan collect and disseminate) outcome measures including treatment system satisfaction, homelessness and employment status, or for children, school attendance status.
6. Right to Safety/Consumer Protection:
  1. Consumers have a right to safety.
  2. Consumers have a right to be protected from abuse and have meaningful access to due process.
  • Does hospital system (or state, etc.) have appropriate seclusion and restraint policies?
  • Does the state/local mental health authority/plan track the number of and investigate incidents of deaths/serious injuries resulting from seclusion/restraint?
  • Does the state/local mental health authority/ plan/CMHC have ombudsman, patient advocates, and family advocates? An adequate and adequately disseminated policy for filing a grievance or appeal (including use of an independent 3rd party external clinical review mechanism)?
  • Does health plan have adequate confidentiality policies?
  • Number, type, and outcome of grievances and appeals.
  • Consumer/family monitoring teams monitor and report on seclusion and restraint use as observed in unannounced visits to a facility.
7. Decriminalization: Severe mental illness is treated as an illness and disability rather than as a crime.
  • State/local mental health authority has low numbers of individuals with severe mental illnesses in jails and prisons.
  • State/local mental health authority has jail diversion programs, including mental health courts to divert psychiatrically disabled persons out of the Judicial System and into the Specialty Mental Health System of Care.
  • Effective state and local councils on offenders with mental impairments.
  • Survey of consumers asks about the responsiveness, sensitivity, and attitudes of their treating professionals.
  • Appropriate and clinical staff are available 24 hours a day, 7 days a week.
  • Complete physical examination within 24 hours of admission into any inpatient facility
  • Treatment integration of all medically recognized conditions
  • Does review of clinical charts and data show that there is a continuity of care interventions within appropriate time frames?
8. Adequate Investment: Adequate resources are invested into treatment, services and supports for individuals with severe mental illnesses.
  • State tracks number of individuals with severe mental illnesses treated in a given time frame and that reflects a reasonable estimate of the number of individuals expected to live in the catchment area.
  • States/local mental health authorities/plans have adequate capitation rates for individuals with severe mental illnesses.
  • States/local mental health authorities have adequate budget for treatment/services for individuals with severe mental illnesses.
  • States, local mental health authorities, plans provide an unduplicated count of persons served by diagnosis and volume and type of services.
  • Survey of consumers asks about experience in locating and obtaining timely appointment with appropriate professional disciplines and specialists.
  • Appropriate professional disciplines and specialists are available to each health plan enrollee.
9. Cultural Competency: Individuals with mental illness are treated within systems of care that demonstrate knowledge and sensitivity to cultural differences including ethnicity, race, gender, religion/spirituality, sexual orientation and other factors.
  • Does the agency value and adapt to local cultural diversity?
  • Does the agency utilize representatives of diverse local groups in planning and assessing the cultural appropriateness of services?
  • Does the agency provide training and experience in instituting service adaptations to better serve ethnic minorities?
  • Does the agency provide a treatment staff whose members represent the variations of the local cultural groups?
  • Does the agency provide education literature, signage and ambiance adapted to the variations in the local cultural groups languages and values?
  • Survey of consumers asks about whether they were able to choose a treating professional who was from the same, or who was bale to understand the racial and ethnic issues involved in their therapy.
  • Survey of consumers asks about whether the agency conveyed treatment information to them in the language that they understood the best.
  • Culturally sensitive professional disciplines and specialists are available to each and every plan enrollee.

 


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