Perspective on Assisted Outpatient Treatment

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Michael F. Hogan, Ph.D., was confirmed in March 2007 as Commissioner of Mental Health in New York State. The NYS Office of Mental Health operates 25 accredited psychiatric hospitals, and oversees New …

Michael F. Hogan, Ph.D., was confirmed in March 2007 as Commissioner of Mental Health in New York State. The NYS Office of Mental Health operates 25 accredited psychiatric hospitals, and oversees New York’s $5B public mental health system that serves 650,000 individuals annually. Dr. Hogan previously served as Director of the Ohio Department of Mental Health and Commissioner of the Connecticut DMH. He chaired the President’s New Freedom Commission on Mental Health in 2002-2003, and was appointed as the first behavioral health representative on the board of The Joint Commission in 2007. He has also served on NIMH’s National Advisory Mental Health Council, as President of the National Association of State Mental Health Program Directors and Board President of NASMHPD’s Research Institute. He has received leadership awards from the National Governor’s Association, the National Alliance on Mental Illness, the Campaign for Mental Health Reform, the American College of Mental Health Administration and the American Psychiatric Association.

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  • 1. AOT: What’s the Conversation We Should Have? Berger Symposium November, 2009 Dr. Mike Hogan, Commissioner, OMH
  • 2. A Conceptual Model for Discussing AOT
  • 3. The Context: Where Are the Gaps in Care?
    • “ Mental illness” has high incidence and prevalence, is the leading illness related cause of disability
    • It is complex and variable in etiology, course, personal experience, impact, response to treatment
    • Getting good care is akin to running the steeplechase…long, hard, lots of hurdles:
        • Recognizing that a problem exists
        • Recognizing that treatment is available
        • Overcoming stigma, inertia to seek care
        • Finding the right caregiver
        • Arranging payment for care
        • Achieving relief through—or without—treatment
    • What is the contribution of AOT in this context?
  • 4. Model: What Facilitates Treatment Engagement? Accessible, Acceptable, Competent Care A Navigable, User-Friendly System Special Enhancements for Engagement Use of Leverage Applies to Few Applies to Many More Intrusive Less Intrusive
  • 5. A Navigable, User-Friendly System? “ Shambles” “ Opaque” “ Is there no place on earth for me?” “ Who’s the bastard out there?” Mega-city complexity Continuity of Caregivers? NYS “System” Resists Order—Change Here is Hard
  • 6. Accessible, Acceptable, Competent Care: Much Can be Done by Every Provider
    • Dimensions of Good Care
      • Good access: geographic, temporal, cultural
      • Affordability
      • “ Welcoming”
      • Person-centered care
      • Family is welcome
      • Competency: clinical, interpersonal, cultural
      • Treatment effective
      • Convenience high/side effects are low
    Trends: MH Service Utilization
  • 7. Special Enhancements for Engagement: Our Priority
    • Earlier intervention, especially in normative settings e.g. PCP’s
    • Steps to overcome general stigma, fear, uncertainty
      • E.g. Outreach and Engagement enhances clinic care
    • To overcome “learned” stigma, fear, uncertainty
      • Affirmative employment with supports; Peers on staff, Peer conducted outreach
      • Peer operated alternatives; “recovery centers”
      • WRAP plans, Advance Directives/crisis plans
    • Intensive Outreach, ACT
    • Care Monitoring Project to re-connect people to care
    • What families do, that we should support:
      • Care giving, monitoring, advocacy
      • “ Interventions”
      • Family leverage
      • Use of courts
      • Representative Payee arrangements
  • 8. Use of Leverage by Mental Health Professionals, Agencies, System
    • Court-related arrangements
    • Housing contingencies
    • Representative payee arrangements
    • Involuntary commitment
      • Inpatient
      • Outpatient
      • Both/either
  • 9. Concluding thoughts
    • Do the most good
    • Do the least harm
    • Thank you