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DMH releases 268 patients; Case managers in short supply.

Byline: Lee Hammel

The state Department of Mental Health has cleared its hospitals of the 268 patients that it identified three years ago as not needing to be there.

But meeting that goal has compounded another problem: DMH only has enough case managers for 10,650 of the 20,400 adults eligible for them.

It also has enough case managers for 2,000 of the 3,600 children and adolescents eligible, although that age group was not among the 268 patients identified in 2004.

The adult patients were in the expensive state psychiatric hospitals - average annual cost of $175,000 per patient - because the state did not have adequate resources in the community to take care of them. By Feb. 1 the last of the adult patients who did not need to be in the state hospitals and inpatient community mental health centers in 2004 were discharged, with about half going into group homes around the state, according to DMH chief of staff Patricia Mackin.

The other half have gone into supported housing, which are apartments where DMH supplies services to its clients as needed, she said. That has enabled the state to reduce the number of adult continuing care beds in its hospitals from 900 to 850 - on the way to reaching the DMH goal of having an inpatient system with 740 beds.

There was fear among some patient advocates that the 58 patients discharged from Worcester State Hospital and 41 from Westboro State Hospital would usurp services from DMH clients already in the community. But two members of the Central Massachusetts Chapter of the National Alliance for the Mentally Ill said they have not heard of that happening.

The daughter of Elizabeth Taylor of Webster had been in a group home and was moved about two years ago to supported housing in Worcester's Main South section. With the increased freedom that comes from leaving a group home, "My daughter is quite happy in her own apartment with a roommate," Ms. Taylor said.

But Ms. Taylor said she does not feel her daughter is getting the services DMH promised. Her daughter has a DMH case manager on paper, but neither she nor her daughter has ever met the case manager or knows who it is, she said.

Ms. Taylor also wishes that the private, nonprofit agency that provides her daughter with supported housing under contract with DMH also would supply a registered nurse to drop in every 6 or 8 weeks. With psychiatric medications often causing weight gain and high blood sugar and cholesterol in psychiatric patients who might not be taking good care of themselves, in-home visits from a nurse and a case manager independent of the housing contractor would be better than just the annual checks from a clinic at Family Health and Social Services, Ms. Taylor said.

She and James E. McDonald of Shrewsbury, another member of Central Massachusetts NAMI, both pointed to the DMH-sponsored family forum in Worcester in October in which four workshops came to the independent conclusion that DMH needs more caseworkers. A caseworker serves as quality control for DMH's independent contractor system, Ms. Taylor said.

Ms. Mackin acknowledged "everyone should have case management services. Right now we just don't have the resources to provide a case manager for every client."

Mr. McDonald said the employees of the social services agencies don't have the same qualifications as DMH to provide case management or even to provide twice-daily medication visits to DMH clients. Ms. Mackin agreed the 360 DMH case managers for adults and 80 serving children, who average $43,000 per year, are better paid than the vendor employees, resulting in more turnover and less well-trained workers among the vendors.

While aware of the families' desire for more DMH caseworkers, Ms. Mackin said, DMH is "evaluating the entire community system." That system includes 6,480 beds in group homes and apartments, and rehabilitation services such as day treatment, employment services and clubhouses.

It's a process DMH Commissioner Elizabeth Childs began when she joined the department 3-1/2 years ago and probably will not finish until next fall or the following spring, the chief of staff said.

The unified behavior health initiative, which includes other agencies and family advisory committees, is looking at what services the department should offer, and in what balance, she said.

In the meantime, Ms. Mackin said, "No DMH clients were displaced or lost services as a result of the 268 discharges" from the hospitals.

"The goal of the DMH community system is to support individuals to live in the community in the least restrictive, appropriate setting," she said.

"We have programs that are staffed 24/7 as well as programs that have support services ... offered for people that live more independently," she said.

"Individuals who occupied existing capacity, that were now clinically appropriate for a less intense service, were `graduated' through the system as appropriate and available," Ms. Mackin said.
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Title Annotation:LOCAL NEWS
Publication:Telegram & Gazette (Worcester, MA)
Date:Mar 11, 2007
Words:821
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