1. Fixing Not Forcing Services: Outpatient Commitment as System Failure
IBHI Criminal Justice - Behavioral Health Conference:
Partnerships Promoting Integrated Healthcare
January 2017
Harvey Rosenthal NYAPRS

2. New York Association of Psychiatric Rehabilitation Services (NYAPRS)
A 35 year old statewide coalition that has brought together New Yorkers with psychiatric disabilities and community recovery providers to advance policies, programs and social conditions that advance recovery, rehabilitation, rights and community inclusion for all through:
State and national advocacy
Training and technical assistance programs
Creating models of peer support

3. New York Association of Psychiatric Rehabilitation Services (NYAPRS)
NYAPRS E-News

4. AOT as System Failure
“AOT is a tool to use within a well-functioning mental health system” Swartz 2013

5. AOT as a Tool to Compensate for System Inadequacy
“AOT is largely used as a transition plan to improve the effectiveness of treatment following a hospitalization” 2009 NYS Duke Study
Getting to the front of the line: “Limited service slots and housing availability are also influential in the decision to use this model as court-ordered individuals are given priority for these scarce resources.”

6. Comparing AOT with Voluntary Approaches
NYS Legislature’s mandate for a study to “compare the outcomes for (those) who receive enhanced outpatient services and for those who are mandated into outpatient treatment”
2009 Duke study offered “a limited assessment of whether voluntary agreements are effective alternatives to initiating or continuing AOT.”
Since 1999: 14,348 court orders; 13,591 enhanced voluntary services

7. AOT Myths
Claim: Recovery services exclude those with the most extensive conditions
Fact: Thousands of us might otherwise return to past conditions of being homeless, incarcerated and subject to frequent relapses, were it not for these recovery services.
Claim: AOT would avert tragic episodes
Response: “People who understand what outpatient commitment is would never say this is a violence prevention strategy” Swanson 2013

8. Fixing Not Forcing: Raising The Bar
Higher expectations, greater accountability and coordination (goals of NYS Medicaid Redesign)
More engaging and evidence-based services
Out of the office, out of the closet
Better transitional services from mental health and substance use inpatient and from criminal justice facilities
Workforce: Caseloads; Capability, Cultural competence
Putting the application of privacy rights and the right to refuse in perspective

9. Recovery Services Helping Individuals with Serious Mental Health Conditions
Housing First programs help 85% of otherwise homeless or incarcerated individuals to stay in housing and treatment (Pathways to Housing)
Assertive Community Treatment teams: helped reduce readmissions by one-third and the number of inpatient days by 50%; improved family and social support, increased self-reliance and independence, and improved daily living skills (Psych. Services)

10. Recovery Services Helping Individuals with Serious Mental Health Conditions
Peer crisis respite programs reduce recidivism by over 90% (PEOPle, Inc)
Peer run Supported Housing Programs reduced readmissions by 90% (Housing Options Made Easy)
Mental Health Peer Connection: saved $71 million by helping individuals leave or avoid institutionalization through practicing the principles of education, empowerment and equality for persons with disabilities

11. Recovery Services Helping Individuals with Serious Mental Health Conditions
Westchester County Care Coordination pilot with peer support and wrap around dollars helped reduce:
incarceration by over half
state hospital use by over 2/3
homelessness by 54 to 24 average days
increased participation in SU and peer support programs by over 50%
Peer bridger programs help thousands to reduce relapses & readmissions by 70% for those in state hospitals and by almost 50% for those in the community and on the streets…..and to engage with essential community supports and services! (NYAPRS)

12. Intensive and Sustained Engagement and Treatment pilot

13. Sustained Intervention
Immediate
Intensive
Flexible
Sustained Intervention
Care Coordinator
PT Nurse practitioner

14. INSET REFERRAL SOURCES
Forensic System
Family,
Friends
Performing Provider System
Community
INSET
REFERRAL SOURCES
Health Home
ACT
Emergency Services
Health Plan
Medical Providers
Behavioral Health Providers

15. INSET PROGRAM Certified Peer Consulting Nurse Practitioner Specialist
Care Coordinator
For individuals who have not responded to other interventions
Immediate and Sustained
Intensive intervention emphasizing natural supports
Peer outreach and engagement
Crisis Stabilization
(crisis respite, emergency housing, medication)
Sustained Support
Harm Reduction Model
Facilitate transition to ongoing services and supports