2016 DMHAS Psychiatric Services Study Report Contents Introduction ............................................................................................................................................................. 4 Background and National Trends in Mental Health Service Delivery ................................................................... 5 Trends Influencing Connecticut’s Mental Health System ...................................................................................... 6 Overview of the Connecticut’s Mental Health Service System .............................................................................. 9 DSS and Medicaid and Affordable Care Act in CT ............................................................................................. 11 Financing of Mental Health Services in Connecticut ........................................................................................... 11 State-Operated Inpatient Services in New England .............................................................................................. 12 Overview of Connecticut’s Inpatient Services ..................................................................................................... 14 State-Operated Inpatient Services ......................................................................................................................... 14 State-Operated and Funded Bed Capacity ............................................................................................................ 16 State-Operated Inpatient Utilization and Admission and Discharge Data............................................................ 19 Private Inpatient Services ..................................................................................................................................... 21 Private Inpatient Patient Days and Bed Capacity ................................................................................................. 22 Private Hospital Utilization Rates ......................................................................................................................... 24 Private Hospital Charges by Payor Type .............................................................................................................. 25 DMHAS Wait List Data........................................................................................................................................ 27 Discharge Length of Stay for Wait List Clients.................................................................................................... 31 Community Services ............................................................................................................................................. 31 Outpatient and High Intensity Case Management Services .................................................................................. 32 Residential Services .............................................................................................................................................. 35 Diversionary Services ........................................................................................................................................... 38 Discretionary Discharge Data ............................................................................................................................... 40 Discussion and Findings for Inpatient Services .................................................................................................... 41 Discussion and Findings for Community Services ............................................................................................... 44 Recommendations ................................................................................................................................................. 47 The Department of Children and Families (DCF) Psychiatric Services Study Report......................................... 49 Introduction ........................................................................................................................................................... 49 Emergency Department and Inpatient Services for Children ............................................................................... 51 DCF State Operated Inpatient Services for Children ............................................................................................ 55 Bed Capacity and Utilization for Solnit ................................................................................................................ 56 Community-Based and Diversionary Services for Children and Families ........................................................... 58 Increase in EMPS-Mobile Crisis Intervention Services for Children ................................................................... 60 Increase in Evidence Based Programs .................................................................................................................. 62 1 DCF Recommendations ........................................................................................................................................ 63 Tables Table 1: New England State Operated/Funded Beds ............................................................................................ 13 Table 2: Bed Capacity and Utilization for MH Inpatient Programs in SFY16 ..................................................... 19 Table 3: Number of MH Inpatient Admissions by SFY ....................................................................................... 20 Table 4: Number of MH Inpatient Discharges by SFY ........................................................................................ 20 Table 5: Acute Care General Hospital Psychiatric Patient Days, Discharges and Beds, FFY 2015 .................... 22 Table 6: Acute Care General Hospital Psychiatric Patient Days, Beds, and Utilization Rates, FFY 2015 .......... 24 Table 7: Mental Disorders Inpatient Discharges by Primary Payor, FY 2011-2015 ............................................ 26 Table 8: State Hospital Wait Time Data ............................................................................................................... 28 Table 9: Length of Stay in State Facility Beds ..................................................................................................... 31 Table 10: Outpatient and High Intensity Case Management Services, FY16 ...................................................... 32 Table 11: Bed Capacity and Utilization for MH Residential Programs in SFY16 ............................................... 35 Table 12: Number of MH Residential Admissions by SFY ................................................................................. 36 Table 13: Number of MH Residential Discharges by SFY .................................................................................. 36 Table 14: Number of MH Residential Unduplicated Clients by SFY .................................................................. 37 Table 15: Client Counts in SFY16 for Respite Programs ..................................................................................... 40 Table 16: Solnit South Hospital Bed Capacity and Utilization, FY14-16 ............................................................ 56 Table 17: Solnit South PRTF Bed Capacity and Utilization, FY14-16 ................................................................ 56 Table 18: 2011 Pediatric Psychiatric Inpatient Bed Capacity .............................................................................. 56 Table 19: 2016 Pediatric Psychiatric Inpatient Bed Capacity .............................................................................. 57 Figures Figure 1: State Operated Inpatient Beds By Facility, 1997-2016 ......................................................................... 16 Figure 2: Acute & Intermediate Beds Including Private ...................................................................................... 17 Figure 3: Total CVH Beds .................................................................................................................................... 18 Figure 4: State Operated Beds: Forensic and General Psych ............................................................................... 19 Figure 5: DMHAS Contracted Private Acute & Intermediate Beds ..................................................................... 27 Figure 6: # of Wait List Clients with State Facility Disposition........................................................................... 29 Figure 7: Total Number of Clients on Wait List ................................................................................................... 29 Figure 8: % of List with State Facility Disposition .............................................................................................. 30 Figure 9: Average Days on Wait List ................................................................................................................... 30 Figure 10: Locations of ACT/CSP Programs ....................................................................................................... 34 Figure 11: Locations of Residential Programs...................................................................................................... 37 Figure 12: Locations of Respite and Mobile Crisis Programs .............................................................................. 39 Figure 13: CT Children's Behavioral Health System of