By Michael R. Ranney, MS, CRC

The Assisted Outpatient Treatment Program, associated with Kendra’s Law, continues to provide enhanced services and monitoring to individuals who are at high risk and in high need of mental health services. Frequent hospitalizations, incarcerations, homelessness, as well as injurious behaviors toward self or others are the risk factors identified at referral. Enhanced services are in the form of care coordination teams where each staff has a limited case-load. These professionals work directly with the consumer and jointly assess needs, coordinate care, develop service plans and monitor the individual on an ongoing basis. In Erie County, strong efforts are made to engage consumers in services and avoid the court-ordered aspect. The utilization of the Diversion Program is to minimize legal constraints and maximize positive interventions. A concern raised in a recent article was that of disclosure of legal rights. An individual referred is provided with an explanation of the referral, description of the program and most importantly, is given information about legal rights and contacts if he so chooses. This is reinforced during various points of involvement. Legal representatives have accompanied consumers to meetings.

Recently the Consumer Advisory Council completed a Consumer Satisfaction Survey. Over 82% of recipients surveyed responded that they felt they received adequate explanation of the program, their rights, choices and responsibilities. Responses in general were very positive. For example, over 96% felt that the program has treated them with respect, over 88% indicated that they trust the program and/or their provider, while 87% believe that the program was on their side and trying to help. Consumers are well aware of both the court-ordered side as well as the diversion side of Assisted Outpatient Treatment. While a coercive element exists, consumers enrolled would not otherwise engage in services as proven by their history. In the interest of their functioning and safety issues, services are offered as a means to maintain stability and be least restrictive. Flexibility and negotiation are higher on the diversion cases, while services are imposed when court-ordered. Currently, 173 cases are enrolled in Diversion, with 13 cases under active court order. The county has processed 365 referrals, with only 24 being petitioned. Of the total cases referred, 45% have been closed. Reasons include other alternatives considered, disenrollment at review, criteria not met, moving out of the area or extended hospital stays.

Initiatives underway in Erie County include the development of a Single Point of Entry for care coordination. The Transition Management Program is also being developed. This program will assist individuals in their return to the community from the hospital or correctional setting. We believe that as these new resources become available for the high risk/high need consumer, the use of the Assisted Outpatient Treatment Program may shift and possibly decrease. The Department of Mental Health is also beginning to study outcomes by way of formal research. The findings will be shared with Mental Health World as they become available.

As previously stated, the goals and commitment of the Department of Mental Health in Erie County are to maximize functioning and maintain stability for the consumer as well as be responsive to community safety. We welcome input from the community on the operation of this very important initiative.