Gone are the days when being admitted to a state mental hospital meant being confined there for months or even years. That wasn't uncommon in the 1960s, when the facility that houses the Memphis Mental Health Institute (MMHI) was constructed.
Even though MMHI didn't move to its current Medical District home until 2007, the facility was set up with 75 beds. But since modern-day treatment for many mental and behavioral health problems allows some patients to be discharged in a matter of days, MMHI was able to close an underused 25-bed unit this year.
"We looked at the data to see what we were using. When we realized that we were staffing for 75 patients but only seeing 50 to 55 on an average basis, we wondered if there was a way to use that money in a more beneficial way," said Lisa Daniels, executive director of MMHI.
The $2.5 million saved by the unit's closing is being redirected to develop new programs and enhance existing community-based behavioral health services.
"There's been a pattern for about 40 years now, where we used to have really large state psychiatric hospitals. At one point, we had more than 6,500 people in state hospitals [in Tennessee], and now we're down to about 500 on any given day," said Douglas Varney, commissioner of the Tennessee Department of Mental Health and Substance Abuse Services. "What has allowed that is that we have gotten better medicine to help people with major mental illnesses, and we have better community support programs."
The community programs Varney is referring to include better crisis triage units, which screen patients before they're admitted to state hospitals and, often, refer those patients to outpatient rather than inpatient services. By closing the 25-bed unit at MMHI in January, the state mental health department was able to give space to the local community-run Crisis Services unit, so the triage team is now located inside MMHI.
"They were going to lose their old facility [on Pauline], and it wasn't ideally situated geographically," Varney said. "Being right next to the Med and [MMHI] makes the operation more efficient."
They've also expanded the Medically Monitored Crisis Detox program, which provides beds for indigent patients who need to detox from illegal drugs, by providing additional bed space. And MMHI has now contracted with Case Management Inc. to help people transferring out of long-term state mental care to find affordable housing and medical services.
"This allows us to help those people who are ready to be discharged find a place to go. It would be wrong to discharge them if they don't have a safe, clean, affordable place to live. They would just stop taking their medicine and relapse and be sent back to MMHI," Varney said. "We're trying to break that cycle by helping them if there are benefits they qualify for, such as TennCare or disability."
About a month ago, MMHI added a new position for a transitional facilitator, also through a partnership with Case Management Inc., who follows up with discharged patients who have been identified as having frequent readmissions to the state mental hospital. The facilitator accompanies those patients to mental health appointments, helps them access funding for medication co-pays, and helps them secure stable housing.
Other changes made with the $2.5 million include adding two liaisons to assist inmates with mental health and substance abuse problems at the Shelby County Jail and expanding MMHI's safety net program, which provides indigent people with medication, outpatient therapy, and other services they wouldn't be able to afford on their own.
Varney estimates that in fiscal year 2014, MMHI will be assisting 1,262 additional patients through these changes.