Le Lets t talk a abou out ho how w we e talk abo bout ut - PowerPoint PPT Presentation

Le Let’s t talk a abou out… ho how w we e talk abo bout ut men ental hea health. h.

ROADMAP FOR TODAY - How Illinois Outpatient Laws Can (and Should) Break Our Inpatient Cycles - Incorporating Advance Directives Into Everyday Practice - Decriminalizing Mental Illness

WHAT’S SO IMPORTANT ABOUT COMPREHENSIVE AND COLLABORATIVE CARE? INPATIENT ADMISSION CRISIS POOR DISCHARGE PLANNING & INCONSISTENT COMMUNITY CARE

D ISCHARGE P LANNING • When do we “start” discharge planning? • Successful outpatient matters are not orchestrated the day before discharge. What are some current “gaps” in discharge planning?

Inpatient à Outpatient: Current Gaps in IL Community Treatment Immediate Problems & Issues: • Housing, Housing, Housing • Engagement by Client (With or Without Family) • Involvement and Clear Communication With Family By Treatment Team and Consenting Individual • Was there a prior admission? If so, what did the discharge plan do right and what did it get wrong? • Medications provided at discharge? For how long? Where is prescription being sent?

Gaps Continued: Back in the Community • Insurance, Benefits, Affordable Medications • Appointments and the Space Between Appointments • Ongoing Assessment of Level of Care Administered • ERs, CSUs, CIT Officers, and Living Rooms • Community Residential Placements

OK…But How Are Our Laws Implicated/Involved? Outpatient! • “At any time before the conclusion of the hearing and the entry of the court's findings, a respondent may enter into an agreement to be subject to an order for admission on an outpatient basis.”405 ILCS 5/3-801.5 • The court advises the respondent of the conditions of the proposed order in open court and is satisfied that the respondent understands and agrees to the conditions of the proposed order for admission on an outpatient basis. 405 ILCS 5/3-801.5(a)(2)

Ou Outpatient B By A Agreement v. v. In Involuntary y Outpatien ent There are differences… • What does Illinois “AOT” currently look like? • What are the benefits of “agreed” outpatient? • What is the “black robe effect”? • What are some limitations (academic and practical) if outpatient is sought involuntarily??

Ti Time out! Let’s review!

Now we’re cooki king! Let’s look k at the RE RECIPE IPE fo for a Successful Ou Outpatient Agr Agreem eemen ent:

Ingredients: • Client • Doctor (Provide Written Report, Certification, and about 5-10 minutes of testimony at any Agreed Hearing). • Community Provider (Identify what agency or service can offer medication refills, therapy, and the appropriate level of care: ACT, CST, etc.). • Custodian • Court

Pu Put it all to together: • Involvement and “buy-in” by the: treatment team, respondent, family, and court. • Adequate infrastructure in the community to deliver services required (ACT, CST, Peer Counseling, Crisis Lines, Warm Lines, etc.) • Housing, Housing, Housing. • Ongoing medication management between respondent and community psychiatrist. • An ongoing conversation with respondent about advance directives. • Education of family/community re: services available in the area. • By statute, renewals of AOT Orders are permitted. See 405 ILCS 5/3- 801.5(g)

No Noncomp mpliance ce W With Cou Court rt Ordered Outpatient • Common issues post-discharge. • An order entered under this Section shall not constitute a finding that the respondent is subject to involuntary admission on an inpatient or outpatient basis. 405 ILCS 5/3-801.5 • An agreed order of care and custody entered may grant the custodian the authority to admit a respondent to a hospital if the respondent fails to comply with the conditions of the agreed order. If necessary in order to obtain the hospitalization of the respondent, the custodian may apply to the court for an order authorizing an officer of the peace to take the respondent into custody and transport the respondent to the hospital specified in the agreed order. 405 ILCS 5/3-801.5 (b) • A person admitted to a hospital pursuant to powers granted under an agreed order for care and custody shall be treated as a voluntary recipient pursuant to Article IV of this Chapter and shall be advised immediately of his or her right to request a discharge pursuant to Section 3-403 of this Code.405 ILCS 5/3-801.5 • Notwithstanding any other provision of Illinois law, no respondent may be cited for contempt for violating the terms and conditions of his or her agreed order of care and custody. 405 ILCS 5/3- 801.5(f)

A note about “Success”…

Advance Directives COMPARING AND CONTRASTING: Power of Attorney for Health Care & Declaration for Mental Health Treatment But first…

Th The Purpose of Advance Directives What are the benefits of an Advance Directive? -YOUR voice, YOUR input, YOUR decisions. -Expedite care with specificity. -Preserve autonomy and decrease likelihood of court involvement

PO POWE WER OF OF A ATTOR ORNE NEY Y FO FOR HE HEAL ALTH H CA CARE • SCOPE AND LIMITATIONS • HOW TO REVOKE • DESIGNATE AN “AGENT” • DURATION OF THIS DIRECTIVE?

Dec eclarati tion n for Men ental Hea Health th Trea eatm tmen ent • SCOPE AND LIMITATIONS • HOW TO REVOKE • DESIGNATE AN “AGENT” • DURATION OF THIS DIRECTIVE?

LET’S SAY THAT AGAIN: POWER OF ATTORNEY DECLARATION FOR MENTAL HEALTH TREATMENT - DURATION? - DURATION? - SCOPE? - SCOPE? - REVOCATION? - REVOCATION? - AGENT? - AGENT?

Le Let’s Sh Shift G Gears!

Incarceration Numbers (2016) Local Jails: 740,700 Prisons: 1,505,400 “The United States locks up more of its citizens than any other country on earth. There are more people behind bars in the [U.S.] than the incarcerated populations in India and China combined .” Greg Berman and Julian Adler, “Start Here: A road map to reducing mass incarceration”, pg. 21.

Substance Use Disorders and Incarceration Substance Use Disorder Rate (2010): - 65.2% in state prison. - 65.8% in local jail. - 54.8% in federal prison. “ Substance Abuse and America’s Prison Population 2010. ” – Joseph A. Califano

Mental Health & Incarceration I NDIVIDUALS INCARCERATED WITH SYMPTOMS OF A MENTAL ILLNESS OR RECENT HISTORY : State Prisons: 56% Federal Prisons: 54% Local Jails: 64% Source : State and Federal prisoners in 2004 and local jail inmates in 2002, Bureau of Justice Statistics, Mental Health Problems of Prison and Jail Inmates, September, 2006, NJC 213600

90% of female inmates meet the criteria for a lifetime diagnose of serious mental illness, PTSD, or substance abuse disorder. - Irina Alexandrovna Komarovskaya et al., “Exploring Gender Differences in Trauma Exposure and the Emergence of Symptoms PTSD Among Incarcerated Men and Women,” Journal of Forensic Psychiatry & Psychology 22 (2011)

Pathways for Diversion • What are some ways to mitigate against over- incarceration of individuals with mental illness? • Identifying points of contact w/ criminal justice system. • Current diversion projects. • The “Miami Model”

The Story of George • We’ve looked at: • Outpatient • Advance Directives • Criminal Justice System Now, let’s look at the overlap of all three categories and put it all together.