PROGRAM STATISTICS ON BELLEVUE OUTPATIENT ASSISTED TREATMENT PROGRAM
(Excerpted from 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)
The following statistical summary covers the period from the beginning of the OCP on July 1, 1995 through January 1, 1999.
REFERRAL OUTCOME
As of January 1, 1999, the OCP had received a total of 789 referrals. The outcome is as follows:
206 (26%) initial outpatient commitment order granted
138 (17%) patient was transferred to a state psychiatric center for ongoing inpatient care
115 (15%) treating physician withdrew the referral
66 (8%) randomized into the control group of the PRA study
39 (5%) patient eloped from the hospital (including while on pass for an outpatient interview)
37 (5%) both hospitalizations within the prior 18 months were not involuntary
37 (5%) patient was placed out of New York City
36 (5%) patient was on voluntary status and requested discharge
31 (4%) patient did not have a history of noncompliance prior to both involuntary hospitalizations
26 (3%) patient’s petition to the court for hospital release was granted
17 (2%) CT was unable to verify patient eligibility due to inadequate information
12 (2%) patient had no other psychiatric hospitalization in the prior 18 months
10 (1%) active referral
10 (1%) patient was transferred to another acute psychiatric care facility
6 (<1%) patient was discharged to an acute care medical unit
1 (<1%) hospital’s request for an outpatient commitment order was denied
1 (<1%) patient arrested for assault on the inpatient unit and incarcerated
1 (<1%) patient expired
CHARACTERISTICS OF PATIENTS WITH 9.61 ORDERS
As of January 1, 1999, a total of 198 patients had been court-ordered to comply with categories of outpatient psychiatric care and treatment.
The following describes demographic features of the patients:
126 (64%) male
72 (36%) female
71 (36%) African descent
67 (34%) European descent
46 (23%) Spanish Caribbean and Mexican descent
13 (7%) Asian descent
1 (<1%) Native American
INITIAL COURT ORDERS AND CLINICAL SERVICES
All initial 9.61 orders were granted for a period of 180 days. In all but one case (see below) the court ordered the patient to comply with all categories of services requested by the hospital.
Upon discharge with an initial court order, patients resided in the following settings throughout the five boroughs of New York City:
51 (26%) supervised living arrangements ordered in conjunction with residential placement
48 (24%) with one or more family members
40 (20%) own apartment
38 (19%) supervised living arrangements ordered in conjunction with shelter-based transitional housing
12 (6%) single room occupancy hotel
8 (4%) in apartment with partner or friend
1 (<1%) supervised living arrangements ordered in conjunction with skilled nursing facility
Upon discharge with an initial court order, patients received the following categories of case management ordered by the court:
84 (42%) supportive case management
68 (34%) intensive case management
43 (24%) assertive community treatment (this category also includes psychiatric treatment)
Upon discharge with an initial court order, patients received the following other categories of psychiatric treatment ordered by the court:
65 (33%) day treatment (hospital or community based)
54 (27%) individual treatment
36 (18%) day treatment (on site at transitional shelter)
Orders for medication were granted after May 1, 1996. Outpatient commitment orders were requested for 161 patients after that date. Of those, 101 (63%) had medication as a category of service on the initial order. One initial request for medication was denied by the court.
RENEWAL ORDERS
As of January 1, 1999, the court had granted a total of 276 renewal orders and denied one hospital petition. Three renewals were granted for 90 days; all the rest were granted for 180 days. All categories of services requested by the hospital were granted on all renewal orders except for one case in which day treatment and supervision of living arrangements were ordered but requested medication was not.
As of January 1, 1999, 37 patients had initial outpatient commitment orders and were not yet eligible for renewal. The following describes the renewal history of the 161 patients who have been eligible for renewal of outpatient commitment orders:
53 (33%) No renewals
32 (20%) One renewal
29 (18%) Two renewals
18 (11%) Three renewals
6 (4%) Four renewals
5 (3%) Five renewals
6 (4%) Six renewals
5 (3%) First renewal requested, hearing pending
1 (<1%) Case closed after one renewal; two subsequent initial outpatient commitment orders
2 (1%) Case closed after one renewal; one subsequent initial order and one renewal
1 (<1%) Not renewed at the time of first order; second initial order, renewed three times
1 (<1%) Not renewed at the time of first order; second initial order, renewed twice
1 (<1%) Not renewed at the time of first order; second initial order, renewed once
1 (<1%) Not renewed at the time of first order; second initial order, renewal pending
CHANGES OF SERVICES
The hospital requested material changes of outpatient commitment orders for a total of 38 patients, which represents 19% of patients who received orders.
A total of 29 patients changed one or more providers on the OCP treatment plan without modifying the court order; this represents 15% of patients who received orders.
ACTIVE ORDERS
As of January 1, 1999, there were 114 patients with active outpatient commitment orders. Their status is as follows:
33 (29%) supervised living arrangements ordered in conjunction with residential placement
31 (27%) with one or more family members
22 (19%) own apartment
9 (8%) supervised living arrangements ordered in conjunction with shelter-based transitional housing
8 (7 %) hospitalized
4 (4%) single room occupancy hotel
4 (4 %) missing
1 (<1%) in apartment with partner or friend
1 (<1%) supervised living arrangements ordered in conjunction with skilled nursing facility
1 (<1%) incarcerated
The 114 patients receive the following categories of case management ordered by the court:
30 (26%) supportive case management
47 (41%) intensive case management
28 (25%) assertive community treatment (this category also includes psychiatric treatment)
The 114 patients receive the following other categories of psychiatric treatment ordered by the court:
38 (33%) day treatment (hospital or community based)
29 (25%) individual treatment
6 (5%) day treatment (on site at transitional shelter)
CLOSED CASES
As of January 1, 1999, the CT had closed a total of 84 outpatient commitment cases for the following reasons:
25 (30%) patient doing well and renewal not requested by treating psychiatrist
19 (23%) hospitalized and no plan for discharge to the community
13 (15%) missing
11 (13%) refusing services, not eligible/appropriate for OCP
5 (6%) moved out of New York City
5 (6%) incarcerated
3 (4%) medically ill, inpatient care required
2 (2%) deceased
1 (1%) hospital’s renewal request denied
CONTROLS
Patients in the control group of the PRA study were followed by the CT for a period of one year from the date of discharge from the referring hospitalization. PRA was unable to follow two of the 66 patients who were randomized into the control group. The CT followed a total of 65 patients who were randomized into the control group.
The following describes demographic features of these 65 patients:
41 (63%) male
24 (37%) female
28 (43%) European descent
25 (38%) African descent
9 (14%) Spanish Caribbean and Mexican descent
3 (5%) Asian descent
Upon initial discharge into the control group patients resided in the following settings throughout the five boroughs of New York City:
26 (40%) shelter-based transitional housing
14 (22%) residential placement
11 (17%) own apartment
10 (15%) with one or more family members
4 (6%) single room occupancy hotel
Upon initial discharge into the control group patients received the following case management services:
38 (58%) supportive case management
15 (23%) intensive case management
12 (18%) assertive community treatment (this category also includes psychiatric treatment)
On initial discharge into the control group patients received the following other kinds of psychiatric treatment:
14 (22%) day treatment (hospital or community based)
14 (22%) individual treatment
25 (38%) day treatment (on site at transitional shelter)
As of January 1, 1999, 60 control patients’ OCP cases have been closed. The status of these patients at the time their cases were closed was as follows:
14 (23%) missing
10 (17%) residential placement
8 (13%) own apartment
7 (12%) hospitalized
7 (12%) with one or more family members
6 (10%) shelter-based transitional housing
3 (5%) refusing services
2 (3%) single room occupancy hotel
2 (3%) moved out of New York City
1 (2%) deceased
These patients received the following case management services at the time of discharge from the OCP:
17 (28%) supportive case management
13 (22%) intensive case management
14 (23%) assertive community treatment (this category also includes psychiatric treatment)
These patients received the following other kinds of psychiatric treatment at the time of discharge from the OCP:
6 (10%) day treatment (hospital or community based)
13 (22%) individual treatment
5 (8%) day treatment (on site at transitional shelter)
As of January 1, 1999, five patients in the control group were still being followed by the CT. Their status as of that date was as follows:
1 living with a family members, being referred from treatment
1 at a state operated community residence
1 moved out of New York City
1 refusing services
1 missing
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