5. Mental Health Services for Adult

1) Inpatient Services

(1) Acute Hospitalization

Acute inpatient psychiatric treatment is provided in a voluntary or municipal hospital that holds an operating certificate from the New York State Office of Mental Health. Patients are admitted for a minimum period of 24 hours and up to a maximum of thirty (30) days. In New York City there are 2600 certified inpatient psychiatric acute care beds in 43 different facilities. Inpatient services are supported through private insurance, Medicaid or Medicare.

(2) Long-term Hospitalization

Long term inpatient treatment (more than 30 days)is provided in a State operated psychiatric center. In most instances, this occurs when patients are transferred from a local voluntary or municipal hospital after completion of acute phase of treatment, and are deemed to require additional hospitalization. Five (5) adult psychiatric centers are located in New York City. These facilities are funded and operated by the New York State Office of Mental Health.

2) Outpatient Services

Based on need, different consumers require different levels of care. Several distinct program categories have been devised to make available treatment as individualized as possible. All outpatient mental health services in New York City are required to have a valid operating certificate issued by the New York State Office of Mental Health. State Office of Mental Health certification regulations (Part 587) define the service types and specify minimum requirements for various programs, such as the range of available services, consumer-staff ratios, treatment planning/review, range of services, psychopharmacology, space requirements, and discharge planning. The majority of licensed outpatient services is financially supported through a combination of private insurance, Medicaid, Medicare, self-pay and direct funding from the Department.

(1) Clinic Treatment Programs
Clinic programs provide treatment designed to reduce symptoms, to improve functioning, and to provide ongoing support. Services include assessment, health screening and referral, verbal therapy, medication therapy, medication education, symptom management and psychiatric rehabilitation-readiness determination and referral.

(2) Continuing Day Treatment Programs
Continuing day treatment programs provide active treatment designed to maintain or enhance current levels of functioning and skills, maintain community living and to develop self-awareness and self-esteem through the exploration and development of strengths and interest. Eligibility for admission to a continuing day treatment program is based on a designated mental illness diagnosis and a dysfunction due to mental illness. Services include assessment and health screening and referral, medication therapy, medication education, case management, rehabilitation readiness development, psychiatric rehabilitation readiness determination and referral and symptom management.

(3) Partial Hospitalization Programs
Partial hospitalization programs provide active treatment designed to stabilize and ameliorate acute symptoms, to serve as an alternative to inpatient hospitalization, or to reduce the length of a hospital stay within a medically supervised program. Eligibility for admission to a partial hospitalization program is based on a designated mental illness diagnosis which has resulted in dysfunction due to acute symptomatology and requires medically supervised intervention to achieve stabilization and which, but for the availability of a partial hospitalization program, would necessitate admission to or continued stay in an inpatient hospital. Services include assessment, health screening and referral, symptom management, medication therapy, medication education, verbal therapy, case management, psychiatric rehabilitation readiness determination and referral, crisis intervention services, activity therapy and clinical support services.

(4) Intensive Psychiatric Rehabilitation Treatment (IPRT) Programs
IPRTs are time limited programs with active psychiatric rehabilitation designed to assist persons in forming and achieving mutually agreed upon goals in living, learning, working and social environments and to intervene with psychiatric rehabilitation technologies to overcome functional disabilities and to improve environmental supports. Eligibility for admission to an IPRT program is based on a designated mental illness diagnosis, a dysfunction due to mental illness which is likely to continue for a prolonged time, readiness to participate in a designated intensive psychiatric rehabilitation treatment program, and referral by a psychiatrist. Services include psychiatric rehabilitation readiness determination, psychiatric rehabilitation goal setting, psychiatric rehabilitation functional and resource assessment, psychiatric rehabilitation skills and resource development, and psychiatric rehabilitation support services.

3) Residential Services

(1) Adult Home

(2) Community Residence

(3) Supported Housing Program

(4) Family Care

4) Case Management Service

According to the State Office of Mental Health, supportive case management programs are designed to assure that persons with mental illness living in the community have access to the services and supports necessary to improve or maintain their level of functioning. Also, intensive case management is available for individuals who have a serious, persistently mental illness and have experienced difficulty engaging in community mental health services.

(1) Supportive Case Management Programs

The supportive case management model, as described in a 1995 the State Office of Mental Health report, is designed to coordinate services and supports for people diagnosed with mental illness to enable them to live successfully in the community. Clients of supportive case management programs, in general, are enrolled in community mental health programs (e.g., outpatient programs), and have some functional disability that requires support or intervention to live independently. Services are individually tailored to the circumstances, needs and desires of each person and use a rehabilitation-oriented approach. Among the services provided are 1) the facilitation of service delivery, including helping individuals make and keep appointments and escorting individuals to appointments as needed and arranging mental health, medical and psychiatric rehabilitation services; 2) advocating and assisting individuals to gain access to entitlement and other health services (e.g., Medicaid, food stamps, educational services, etc.); 3) assisting people in learning to use fiscal resources; and, 4) providing health promotion services or arranging for medication education that will help the person understand the importance of taking prescribed medication.

(2) Intensive Case Management

Intensive case management programs were developed to assist persons with serious, persistent mental illnesses who have not successfully engaged in community based mental health services. Eligible clients must have a diagnosable mental illness that impairs functions in several essential areas of life, including self care, social functioning, activities of daily living, economic self sufficiency, self direction and concentration. Target groups include (1) high risk/heavy users of inpatient units, emergency and crisis centers, (2) extended care state psychiatric center patients, and (3) individuals with serious, persistent mental illnesses who also are homeless. Other subpopulations include mentally ill chemical abusers, forensic patients and persons with combined mental illness and mental retardation. Services are individually configured and geared to the circumstances, needs and desires of each person. Intensive case management services are delivered in the community, and programs have a low staff to client ratio. Services are not time-limited. Intensive case managers conduct outreach to engage clients; monitor and coordinate the delivery of evaluations and assessments and participate in the development of an individualized, goal-oriented services plan; provide assistance in crisis intervention and stabilization; assist clients through on-going support, training and assistance in the use of personal and community resources; assist in developing a range of community and family supports; advocate for changes in the system. Intensive case management services are available 24 hours a day, 7 days a week, 365 days a year.