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DRAFT RECOMMENDATIONS
(4/7/08)
ASSEMLYMAN GERALD GREEN’S
MENTAL HEALTH SUBCOMMITTEE
The Mental Health Subcommittee wants to prevent/minimize negative impact, associated with the closure of Muhlenberg Regional Medical Center’s (MRMC) Adult Inpatient Psychiatric Unit. We believe that MRMC is and will continue to lose, specialized Mental Health staff as employees seek employment opportunities elsewhere. These staff losses may limit the Hospital’s ability to accept some inpatient mental health patients prior to the closure of acute care services at the Hospital. Thus, we recommend timely action to facilitate the transfer of services to other area providers prior to the closure of MRMC. Within this context, we make the following recommendations:
I. Adult Inpatient Psychiatric Beds + Psychiatric Emergency Services
a. Closed Beds (S.T.C.F.)
Subcommittee recommends that the Division of Mental Health Services/DHS, in conjunction with the Department of Health and Senior Services, redirect Middlesex County involuntary admissions away from Trinitas Hospital to a Middlesex County Inpatient Provider.
Impact — This proposed change would allow Trinitas Hospital to essentially replace 6 of the 8 dedicated involuntary closed psychiatric beds (S.T.C.F.) offered by MRMC in a rapid fashion.
b. Additional Closed Involuntary Psychiatric Beds
Subcommittee recommends that Trinitas Hospital’s C.N. Application for adding 2 adult closed psychiatric beds be awarded ASAP.
Impact — Adding 2 additional closed psychiatric beds at Trinitas Hospital will allow the Hospital to essentially replace all 8 closed adult psychiatric beds (STCF) offered at MRMC. Thus, Plainfield residents who require closed JSTCF level of care will have access to this service.
c. Adult Open Inpatient Psychiatric Beds
MRMC operates 16 voluntary beds and the Subcommittee has determined that generally, local providers (Union, Middlesex and Somerset) reportedly are operating their voluntary beds at high occupancy. No provider has the ability to add voluntary beds without construction which, generally, would be a 9 to 12 month process.
Impact — The loss of 16 licensed adult open acute beds in Plainfield (occupancy approximately 50%) may create immediate access issues for this type of service. The Screening Center must be able to access open beds in the County and from neighboring Middlesex and Somerset County Providers.
DRAFT RECOMMENDATIONS (CONT’D.) - Page 2
(4/7/08)
Recommendation — Subcommittee requests that Solaris not request a de-licensing of these beds. The DOHSS & DHS/DMHS must examine the need for open acute beds in the Plainfield region and take appropriate action to meet that need.
d. Psychiatric Emergency Services (PES)
The subcommittee recommends that Psychiatric Emergency Services function and related contract (PES, site-based and Mobile) be transferred to Trinitas Hospital. This timely transfer will allow Trinitas time to interview existing MRMC staff for positions and to fill any current vacancies. Trinitas will also have time to develop relationships and process with surrounding hospitals operating voluntary inpatient psychiatric units, as well as with providers of outpatient services in the area. The subcommittee further recommends that since the psychiatric crisis service, while based in Plainfield, will largely be delivered in a variety of settings (Medical ERS, Family Health Center, that a phased redesign of the Psychiatric Emergency Service (PES) system is required. A redesigned PES system should include the following components:
Longer Term Recommendations - Adding hospital diversion, respite and increased post emergency follow-up components to Psychiatric ER, as recommended by the Governors Taskforce on Mental Health, would improve local system capability for diversion of people in crisis from inpatient psychiatric services. This could be accomplished through a competitive RFP or RU process. This promises better outcomes for persons served and alleviates some of the burden from a soon to be overstressed local acute care system.
Adding a crisis stabilization unit in front of the ER is an emerging best practice that has proven effective in other states. It could be positioned so that people who present with psychiatric emergencies but no co-occurring medical problems could avoid unnecessary, costly and intrusive medical clearance procedures. Staffing could include persons with personal experience with mental illness, another emerging best practice.
Impact — Transfer of the PES and the related contract allows continuation of critical infrastructure, which is necessary to handle psychiatric crisis’ to operate without interruption.
e. Replacement Inpatient Psychiatric Beds
Trinitas Hospital is stepping up in a crisis situation by volunteering to temporarily release 6 CN approved closed acute beds (STCF) to Middlesex County.
DRAFT RECOMMENDATIONS (CONT’D.) - Page 3
(4/7/08)
Subcommittee recommends that the DOHSS/DHS work with Trinitas to add these 6 closed beds to its existing licensed number (21) and provide the capital to operationalize these beds.
II. Child/Adolescent Mental Health Intensive Outpatient Services (CIOP)
MRMC wishes to discontinue the operation of its CIOP that is operated on-site at the hospital by United Family and Children’s Services. Hospital reimbursement on a cost-basis allows the intensive program to operate. In order to maintain this service with existing reimbursement, which is likely to be revised, effective 1/2009.
Subcommittee recommends that the Departments of DHS/DCF allow the transfer of this program to Trinitas Hospital and that the latter continue to operate the program under an existing subcontract with UF&C until at least 12/31/08.
III. Intoxicated Patients
The subcommittee is very concerned about how intoxicated individuals who formerly were evaluated at the Muhlenberg Medical Emergency Room will be handled given the planned closure of the full service Emergency Department at MRMC.
Recommendation — The subcommittee is aware that the City of Plainfield has a task force focused on the issue of dealing with intoxicated persons in the city. Since the issue will likely be of greater concern after the closure of MRMC, we respectfully suggest that the Task Force accelerate the development and implementation of solutions to address this significant concern.
IV. Transportation
The subcommittee believes that the issue of transportation has various components. In addition, a subcommittee has been organized to identify issues and solutions associated with transportation. The MH subcommittee recommends that the subcommittee for transportation address this concern. The most significant transportation issue we perceive is the ambulance transport to Elizabeth of potentially committable patients. Based upon current data, approximately 350 individuals are committed to MRMC annually. Thus, on average, one trip per day. The subcommittee believes that current process where sending entity facilitates transport will be adequate to respond to this need.
V. Ambulatory Mental Health Services
The anticipated closure of MRMC’s inpatient psychiatric unit may impact on demands for ambulatory MH services.
Subcommittee recommendations that Union County Psychiatric Clinic, the primary provider to this population, assess potential impact and articulate these concerns in the process mentioned below as well as other appropriate existing county and state mental health processes.
VI. Implementation of Recommendations
The exposure of subcommittee members suggest that a team effort is required to guide successful implementation of a potentially redesigned psychiatric acute care system (inpatient, PES/Screening). Thus, the subcommittee recommends that it continue to operate and expand/contact, where appropriate, after the immediate task of developing recommendation is complete.
JL/nfr
Draft Recommendations
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