People suffering from mental illness and/or drug or alcohol addiction are among the most vulnerable in society. Despite the increasing prevalence of patients suffering both mental illness and substance abuse, the health care system has often separated these services, resulting in patients being pushed from one service to another with little coordination or continuity of care. This fragmented approach often denies patients access to follow up treatment and early intervention services, causing them to re-enter the system only when requiring emergency psychiatric care. This is not only traumatic for the patient and their family, but also imposes additional cost and stress on the health care system.
As far back as 1986, the Behavioral Health System (BHS) agency in Philadelphia, Pennsylvania, started exploring the feasibility of developing a unified system for mental health services. The approach of the BHS was to coordinate both mental health services and the various federal, state, and local government funding streams. After negotiations with federal officials, the BHS was permitted to consolidate all mental health funding into one pool.
Consolidation of funds enabled case managers to design health care plans to suit the needs of patients rather than attempting to match services with particular lines of funding. Thus, patients could receive the services they needed rather than what bureaucratic rules dictated. In real terms, this resulted in patients spending fewer days as inpatients and more time in residential and community care facilities and outpatient clinics. Furthermore, the BHS could now be held fully accountable for the expenditure of mental health funds and delivery of services. These arrangements significantly enhanced the accountability of the agency to all stakeholders.
BHS reinvested the savings generated through this consolidated funding into the health system resulting in a range of new initiatives being implemented. These included universal access to mental health services for all adults and children in Philadelphia, employment of new outreach and case manager workers, additional mental health beds, and provision of rental subsidies and housing assistance. This latter initiative is particularly important given that 90 percent of the estimated 400 to 500 homeless people in Philadelphia are suffering a mental illness and/or substance addiction.
Another major initiative of the BHS has been the establishment of the Crisis Response Centers (CRC). Previously, patients requiring acute psychiatric care would present themselves at the emergency room of one of seven hospitals. Frequently these patients would be required to wait for many hours before being examined and, following discharge, there was usually little follow up or monitoring of patients. To address these problems, the BHS created five CRCs to deal with psychiatric emergencies. Strict performance criteria apply to the operation of these centers. For example, all people who arrive at a CRC must be triaged within 15 minutes and treated within two hours. Further, a case manager is assigned to each patient to coordinate a health care plan. Case managers must follow up with each patient within 24 hours and five days of being discharged. This approach recognized that better care of patients when outside of a hospital results in less emergency interventions.
Another important feature of the BHS model is the involvement of stakeholders in the planning and implementation of health care services. Patients, family members, advocates, and health care staff have provided input into new program development and oversight, thus building commitment within the broader community for the BHS.
BHS is a landmark in the delivery of health services by a government agency. It has proven that government can deliver high quality, effective mental health services for less than was previously provided by private insurers. Further, the expansion of coverage to provide universal access ensures that these vulnerable members of the community do not miss out on the health services that they require.