REPORT OF THE BELLEVUE HOSPITAL CENTER OUTPATIENT COMMITMENT PILOT PROGRAM

prepared by:

Howard Telson, M.D, Richard Glickstein, Esq., Manuel Trujillo, M.D.

MARCH 1, 1999

Bellevue Hospital Center, Department of Psychiatry 462 First Avenue, New York, NY 10016

TABLE OF CONTENTS.............. .........2

ACKNOWLEDGMENTS.......... ...........  3

PREFACE............................................ 4

I. BACKGROUND ............................  5

II. PROGRAM DESCRIPTION ... ................................. 12

III. PROGRAM DEVELOPMENT AND FINDINGS ................... 20

IV. PROGRAM STATISTICS ........................................... 38

V. OBSERVATIONS REGARDING THE POLICY RESEARCH ASSOCIATES REPORT.......47

VI. CONCLUSIONS ..................................................... 61

SELECTED BIBLIOGRAPHY.............. ... ...............66

APPENDIX A. MEDICATION GUIDELINES (Not included)

APPENDIX B. PARTICIPATING PROVIDERS

APPENDIX C. SUMMARY OF STATE ELIGIBILITY CRITERIA

APPENDIX D. SUMMARY OF STATE COMPLIANCE MECHANISMS

ACKNOWLEDGMENTS

The Bellevue Hospital Center Department of Psychiatry has had the privilege of implementing and administering the New York State Outpatient Commitment Pilot Program. The development of the program would not have been possible without the support and cooperation of the New York City Health and Hospitals Corporation, the New York City Department of Mental Health, Mental Retardation and Alcoholism Services, and the New York State Office of Mental Health. The model of ongoing oversight, dialogue, and assistance that existed for this project from the early planning phase enabled such a complex and highly scrutinized enterprise to proceed as smoothly as it did.

The Bellevue Outpatient Commitment Program represents the collective work of scores of Bellevue clinicians in the Inpatient, Outpatient and Emergency divisions of the Department of Psychiatry. Guidance and assistance have been provided by Michael Garrett, M.D., Irene Freedberg, C.S.W., Ken Koval, M.A., Arleen Van Brunt, R.N., Joel Wallack, M.D. and Stuart Rosenblatt, Ph.D. The Bellevue Outpatient Commitment Coordinating Team has been extremely effective thanks to the efforts of Rachel Steiner, C.S.W., Elizabeth Baldwin, C.S.W., Jennifer Leeds, C.S.W., Quintin John Clough, C.S.W. and Merna Whitaker.

Many other individuals contributed to the pilot’s successful implementation. Barbara Jones, Esq., and the staff of the Mental Hygiene Legal Service at Bellevue insured that patients received appropriate advocacy and representation. Providers from over 80 mental health organizations and agencies throughout the NewYorkCity metropolitan area offered services in conjunction with the Bellevue Outpatient Commitment Program. And patients and their families participated in ways that kept the program focused on providing quality clinical care to seriously and persistently mentally ill individuals in the least restrictive setting.

PREFACE

 In 1993 the New York State Legislature conducted hearings which found that some individuals who require mental health treatment and services to survive safely in the community “frequently reject the care and treatment offered to them on a voluntary basis and decompensate to the point of requiring repeated psychiatric hospitalizations.” The Legislature found that a number of other jurisdictions permit outpatient civil commitment to address this problem.

In 1994 NewYork State added Section 9.61 to its Mental Hygiene Law. MHL Section 9.61 calls for one of the New York City Health and Hospitals Corporation (HHC) facilities to operate a pilot program in “Involuntary Outpatient Treatment of Mentally Ill Persons.” Shortly thereafter, the New York City Department of Mental Health, Mental Retardation and Alcoholism Services (DMH) contracted with Bellevue Hospital Center (Bellevue) to operate the pilot program.

MHL Section 9.61 also requires that an independent research study be done to determine the program’s effectiveness in preventing rehospitalization and improving quality of life and to assess participant satisfaction in the pilot. In the spring of 1995, DMH contracted with Policy Research Associates (PRA) to conduct the research study. The PRA Final Report on the pilot was published on December 4, 1998.

This report represents the experience of the Bellevue Department of Psychiatry in implementing and administering the New York State Outpatient Commitment Pilot Program. It begins with a historical review of psychiatric treatment and civil commitment, and places New York’s outpatient commitment pilot in the larger context. It also contains a description of the program, a discussion of Bellevue’s observations and findings, and a statistical summary covering the first three and one half years. The report then describes Bellevue’s response to the PRA report. Finally, it contains Bellevue’s conclusions regarding the project.

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