Ready For Excellence

Laura A. Smith-Creaser, RNState University of New York

Institute of Technology

Are we

in the NYS mental health system ?

“The time has come to fundamentally change the way we think about mental health in New York State…” - Acting Commissioner Kristin M. Woodcock

WHY

MUST CHANGE…

“Approximately 715,000 individuals access care in specialty mental health settings each year. 10,000 of those individuals were served in OMH inpatient hospitals in 2012, which now has a census below 4,000 and once stood at 93,000 in the 1950’s. That leaves more than 700,000 New Yorkers being served in the community.

Despite significant reforms to become more recovery-oriented, OMH remains overly reliant on extended inpatient hospitalization for those with serious mental illness. This reliance comes at a great cost. Over $1.3 billion per year is spent on OMH hospital treatment and care for 10,000 individuals, while $5.3 billion is spent on mental health care in the community for a population of more than 700,000 people. New York’s historical choice to maintain 24 State operated hospitals is no longer sustainable. “ - OMH Regional Centers of Excellence Plan July 2013

What does this “fundamental change” look like ?

NYS OMH established Ten (10) Key Points that serve as the foundation of the changes:

1) The redesign must be good for the children, adults and families served;

2) Promoting resiliency in youth and recovery for adults;3) Early access to care;4) System must seamlessly meet the needs of individuals

and families with high return on investment;5) Improved access to safe and affordable housing for

people with mental illness; 6) State services must be regarded as highly specialized

and focused on most complex and challenging mental illnesses;

7) Offer choice by eliminating catchment areas;8) Staff must accept need for change and evolve to new

models of service provision like Wellness Centers;9) Staff may have to relocate, but State is committed to

opportunities and retraining;10) Accountability and transparency… public

involvement!

State will be divided into Five (5) regions:

1) Western2) Central3) Hudson river4) New york city5) Long IsLAND

Within the five (5) regions will be fifteen (15) regional centers of excellence.

“In the next three years, OMH will establish fifteen (15) Regional Centers of Excellence (RCE) across the State. Each RCE will have a specialized inpatient hospital program located at its center with a network of state-operated community-based services operating throughout their region.”

- NYS Office of Mental Health (2013)

Central New York Region

Sounded Like A Plan… …except that this transition was not shared with the members of the community that serve the mentally ill until it was already in progress… we found out about it with the announcement of the closing of a major inpatient facility in our local area. A major mental health resource and employer was here one day and gone the next (or at least it felt that way.) The actual transition happened within one year’s time frame.

The local impact is being assessed as the transition is happening… in the words of the State, “The past is like an anchor holding us back, we have to let go of who we are to become who we will be…” So, we moved forward in real time and the transition (along with its local impact) is left to be assessed as it is happening. This is what inspired my interest in studying the local impact of these changes as a topic for this project.

The State views the present state of change (we are in year one of the three year plan) favorably, “We can offer far more to New Yorkers with mental illness by breaking down the walls between facilities and communities, and focusing on collaborative and integrated care that utilizes the strengths of our workforce and those of the community provider system…”

So, is our local workforce strong enough? Can we go from serving (generally) a three-county area to the 20-county area that makes up just the Central New York Region?

As one of two hospital-based psychiatric units in the Oneida-Herkimer-Madison county region – Faxton-St. Luke’s Psychiatric Unit was bound to feel some impact from having two major pieces of the Regional Center of Excellence located in our “backyard.”

With the Central NY Psychiatric Center (with the Sex Offender Treatment Facility and the civil confinement of criminals with mental illness) and the loss of a local residential center for adults with mental illness, the transition to a Regional Center of Excellence – and “community-based services” replacing the residential services for adults , it was inevitable that the result would be in increased utilization of hospital-based psychiatric services.

The hospital-based units, however, have not receive increased financial support… or psychiatrists… or medical and support staffing… or other patient-serving resources, so what will be the impact of the transition to a Regional Center of Excellence?

Patient ID Physician Adm Date Disc Date LOS (days) County Insurance ADM Status Status Chg

GS 3116805 Westm 11/1/2012 11/5/2012 4 Oneida Fidelis 9.39 Ext 11/3

RM 3117431 Sinha 11/1/2012 11/5/2012 4 Oneida M&M 9.39 Con > Vol

MM 3117445 Westm 11/2/2012 11/5/2013 3 Oneida Self Pay 9.39 Ext 11/3

DH 3117456 Westm 11/2/2012 11/3/2012 1 Oneida None 9.39 N/A

JL 3117469 Sinha 11/2/2012 11/5/2012 3 Oneida M&M 9.39 Con > Vol

DA 3117754 Sinha 11/2/2012 11/4/2012 2 Oneida RC Emp 9.39 N/A

That is the focus of my research project… to attempt to find out…

The psychiatric unit admissions/discharge data will be analyzed from November 2012 – October 2013 in an attempt to discover if there are more admissions from outside the original two or three county catchment; if the patients symptoms require a longer stay on the unit; and if other aspects of the patient load demonstrate any noticeable / measureable change.

There is no precedent for the changes that are occurring in the NYS mental health delivery system – this regional approach represents the first major system revision in the 175 year history of NYS’s mental health system.

References

NYS Office of Mental Health (2013). NYS OMH Regional Centers of Excellence: Today begins a new era in New York’s behavioral health system. July 11, 2013. Retrieved October 1, 2013 from http:// www.omh.ny.gov/ohmweb/excellence/rce/docs/rceplan.pdf

Source: NYS Office of Mental Health (2013)

RESEARCH QUESTION:What will be the impact of this on community-based services?

Population: Central NY Region patients with mental illnesses.

Interest / Impact: Increasing numbers of patients and increasing severity of symptoms with reduction of availability of inpatient services.

Comparison: Examine current changes in patient statistics / service needs from those of several months ago.

Outcome: Are we delivering the "excellence" that is the goal of the regional plan? Is our ability to deliver services better or worse?

Time: Review unit-produced statistics covering over a calendar year’s period of time (November 2012 – October 2013). NOTE: Final Paper will include results to October. 2013

A July 10th, 2013 press release from the NYS Office of Mental Health stated that "The NYS Office of Mental Health today released a three-year plan to transform the public mental health system. Under the Plan, OMH will shift the emphasis of its resources from costly long-term inpatient treatment provided at over 24 hospitals to a state-of-the-art network of 15 Regional Centers of Excellence.“

My proposed project topic is to examine if the Central NY region is ready for "excellence" by examining the changing dynamics / statistics of the patient population at the Faxton-St. Luke's Psychiatric Unit level of care and the direct impact of the changing emphasis on daily service delivery.

With the closure of a local adult inpatient facility, the psychiatric unit now receives a significantly expanded population of patients with mental illness and the unit staffing has remained unchanged. My project proposes to explore the initial impact of this regional model on service delivery and patients. The Central NY region, under the regional centers of excellence plan, includes 20 counties (Oneida, Madison, Herkimer, Fulton, Montgomery, Oswego, Onondaga, Cayuga, Chenango, Delaware, Broome, Otsego, Hamilton, Clinton, Essex, St. Lawrence, Jefferson and Lewis).

Why must the NYS behavioral healthcare system change?

New York has a significantly disproportionate number of state-operated psychiatric hospitals when compared to some other states.

“New York presently operates twenty-four (24) state psychiatric hospitals while California (with over twice the population) only operates five. Texas only operates eight and also serves a much larger population than New York.

New York has more state operated psychiatric hospitals (24) on its own than the four other states represented combined (a total of twenty 20).”

“In 2010, NY spent $1.3 billion per year on OMH hospital treatment and care for 10,000 individuals while $5.3 billion is spent on mental health care for over 700,000 in the community. Today, in 2013, the inpatient census is below 4,000 (and they still have 24 state hospitals running.)

Patient ID Physician Adm Date Disc Date LOS (days) County Insurance ADM Status Status Chg

GS 3116805 Westm 11/1/2012 11/5/2012 4 Oneida Fidelis 9.39 Ext 11/3

RM 3117431 Sinha 11/1/2012 11/5/2012 4 Oneida M&M 9.39 Con > Vol

MM 3117445 Westm 11/2/2012 11/5/2013 3 Oneida Self Pay 9.39 Ext 11/3

DH 3117456 Westm 11/2/2012 11/3/2012 1 Oneida None 9.39 N/A

JL 3117469 Sinha 11/2/2012 11/5/2012 3 Oneida M&M 9.39 Con > Vol

DA 3117754 Sinha 11/2/2012 11/4/2012 2 Oneida RC Emp 9.39 N/A

WB 3118381 Sinha 11/2/2012 11/8/2012 6 Oneida None 9.39 Ext 11/4

VE 3118774 Westm 11/3/2012 12/5/2013 32 Oneida Medicaid 9.39 Ext 11/5

KB 3118838 Westm 11/4/2012 11/8/2012 4 Oneida Fidelis 9.39 Ext 11/6

AT 3118921 Sinha 11/4/2012 11/7/2012 3 Oneida None 9.39 Con > Vol

LF 3118895 Westm 11/4/2012 11/5/2012 1 Oneida HMO Md 9.39 N/A

JJ 3118933 Sinha 11/4/2012 11//6/2012 2 Albany Medicare 9.39 Ext 11/6

DK 3119013 Rayancha 11/4/2012 11/30/2012 26 Oneida Medicare 9.39 Ext 11/5

AR 3119025 Westm 11/4/2012 11/7/2012 3 Herkimer Medicaid 9.39 Ext 11/6

RM 3119028 Westm 11/5/2012 11/6/2012 1 Oneida Medicaid 9.39 N/A

SB 311/9791 Westm 11/5/2012 11/8/2012 3 Oneida None 9.39 Ext 11/6

RB 3120217 Sinha 11/6/2012 11/7/2012 1 Herkimer Pomco 9.39 N/A

SM 3120967 Westm 11/6/2012 11/9/2012 3 Oneida None 9.39 Ext 11/7

JC 3121050 Rayancha 11/6/2012 11/8/2012 2 Oneida M&M 9.39 N/A

DATA COLLECTED FROM 11/1/12 - 10/18/13 AND HAND-ENTERED AND PIVOTED FOR PROJECT USE. SOME DATA COLLECTED FOR UNIT USE AFTER PROJECT.

With the projected demand for community-based services expected to increase as a result of the RCE plan, and with this area being the home to the main activity centers of the RCE, and the stated requirement for accountability and transparency, my objective in this research project was to gather and analyze:

1) admission / discharge statistics;2) home county of patients being served; and3) length of stay and other data (if relevant).

The Goal:

To assess any potential impact on psychiatric service utilization at the Faxton-St. Luke’s Psychiatric Unit.

BOTTOM LINE:

While Oneida County admissions continue to remain highest, there

is preliminary evidence of increasing admissions from

other counties within the newly define “Central Region”.

Data still being assembled for July – October 2013.

Albany 1 0.14%

Chenango 2 0.30%

Clinton 1 0.14%

Delaware 1 0.14%

Franklin 1 0.14%

Herkimer 86 12.74%

Jefferson 4 0.60%

Lewis 3 0.40%

Madison 27 4.00%

Montgom 1 0.14%

Oneida 516 76.30%

Onondaga 18 2.70%

Oswego 3 0.40%

Otsego 6 1.00%

Rensselaer 1 0.14%

Schnect 1 0.14%

Schnectad 1 0.14%

Schohar 1 0.14%

St Lawren 2 0.30%

Grand Total 676 100.00%

11/1/2012 – 6/30/13 Cumulative