One type of support for individuals transitioning out of the hospital used very successfully in New York State is a Peer Bridger Project in which a trained peer specialist provides one-to-one support to a person ready to be discharged. This relationship begins several months before the discharge date and continues for several months after discharge. This is an excellent way to address the concerns and fears a person who has been in the hospital for months or years may have about being able to make it on the outside. The Genesis Club in Worcester and the Lighthouse Clubhouse in Springfield run Peer Bridger projects under a DMH contract entitled “Peer Support in After Care”. Such programs need to be expanded throughout the state.
As a result of the 1999 Supreme Court’s Olmstead decision the state is compelled to ensure that people with disabilities receive services in the least restrictive setting. In no way can state hospitals be considered the least restrictive setting. One objective listed in Massachusetts’ Community First Olmstead Plan is “to increase the availability and diversity of residential support options”. It is our understanding that over 200 people are currently stuck in DMH facilities. They are ready for discharge but have nowhere to go. Essentially, these folks are being warehoused at several hundred dollars a day.
Currently there is tremendous shortage of safe, decent affordable housing in Massachusetts. This remains a huge barrier to success in living in the community. DMH clients and other low-income people wait many years for subsidized housing. Money saved by closing hospital beds must be diverted to greatly increasing the number of rental vouchers available to people with mental health conditions. Also we need to think creatively—the old way of thinking about “independence” is moving from living in a state hospital to a highly structured group home with other adults not of one’s choosing. Then the view is that people should move to their own apartment with residential supports. One size fits all just doesn’t work. Why does the definition of “independence” always seem to include living alone in an apartment? For many people this can lead to isolation and worsening of one’s mental health condition. Also, who would chose to live in a group setting with people you don’t know and maybe don’t like? The current idea of group homes needs to be revisited. People must have choices as to where they live and with whom. They must be able to choose what type of supports they will receive.
A form of community support that does not exist but would prevent hospitalization is personal care assistance (PCA) for people with mental health conditions. Currently Medicaid regulations stipulate that to be eligible for PCA services, a person must need “hands on care”. This excludes most people with psychiatric disabilities. The few of our members who have PCA services have them because they have a physical disability as well as a mental health condition. One person uses her PCA mainly to support her through difficult periods of anxiety and depression. For her the companionship and support is more important than the help she receives getting in and out of the bathtub or mopping the kitchen floor. The peer support she gets from her PCA has kept her from using emergency services and kept her out of the hospital. Many people with mental health conditions could greatly benefit from having a PCA. Massachusetts needs to act now to obtain a waiver from the federal government so that MassHealth regulations can change to cover people with mental health issues.
A second Medicaid waiver is needed to allow Certified Peer Specialist (CPS) services to be billable to Medicaid. Other states such as Georgia and Arizona have such waivers, and they have been able to greatly expand the number of peer specialists working in the community. We are excited that the new Emergency Service Program (ESP) contracts require ESPs to hire peer specialists, and the new Community Based Flexible Support (CBFS) contracts also require providers to hire peer specialists; however a Medicaid waiver would encourage providers to hire many more peer specialists. The role of a peer in supporting a person cannot be underestimated. Many of us have found peer support to be a central factor in our recovery.
Some people have expressed concerns that the system is blocked—that there are people in acute hospitals that are not ready for discharge and not getting better. Their insurance has run out and the private facilities are footing the bill. These same people argue that this has lead to longer waits in emergency rooms. They say these folks need to be sent to a state hospital. Why can’t we be more creative? What about developing peer-run respites and other healing communities which allow for fresh air and various methods for healing? Why is hospitalization in a state institution have to be the answer?
This Commission has an important responsibility. It is our hope that the Commission recommends the closure of state hospitals and ensures that the money saved goes to expanding community mental health services and support.
It is M-POWER’s belief that the key to recovery and wellness is COMMUNITIES NOT LOCKED WARDS!!