Saving Lives, Saving Money: Services that Work
An Advance Directive for health care, also known as a living will, a legal document that allows individuals to provide directions regarding medical care. The Advance Directive is used when a person is unable to make or communicate decisions about medical treatment, and is created before any condition or circumstance occurs that causes a person to be unable to actively make a decision. In the Advance Directive, someone is designated to make decisions on behalf of the individual.
A health care representative is the person appointed in the Advance Directive for the purpose of making health care decisions on your behalf when the individual is unable to do so. A health care representative can accept or refuse any treatment, service or procedure used to diagnose or treat a physical or mental condition, except as otherwise provided by law. A health care representative makes decisions for the individual, as stated in the advance directive.
An Advance Directive allows individuals to state their preferences regarding any specific form of treatment, including electroshock (electroconvulsive therapy or ECT), a particular brand of medication, or any aspect of health care. Sometimes, the law allows a person’s preferences to be overridden—like in emergencies—and, sometimes preferences alone aren’t enough to make something happen.
An Advance Directive may be revoked at any time and in any manner without regard to a person’s mental status, but a health care representative can only be terminated in writing, with the person’s signature and the signature of two witnesses.
Except as authorized by a court, conservators must comply with a ward’s individual health care instructions and other wishes, if any, expressed while the ward had capacity to create an Advance Directive. A conservator may not revoke the ward’s advance health care directive unless authorized by the probate court.
The Connecticut Legal Rights Project has created an Advance Directive for Health Care Toolkit has been created to meet many of the health care needs of people who are receiving mental health services. Although the Toolkit has been created for people receiving mental health services, anyone can use it. To obtain the Toolkit, or ask questions, call toll-free 1- 877-402-2299 (TTY 860-262-5066), or visit www.clrp.org.
A health care representative is the person appointed in the Advance Directive for the purpose of making health care decisions on your behalf when the individual is unable to do so. A health care representative can accept or refuse any treatment, service or procedure used to diagnose or treat a physical or mental condition, except as otherwise provided by law. A health care representative makes decisions for the individual, as stated in the advance directive.
An Advance Directive allows individuals to state their preferences regarding any specific form of treatment, including electroshock (electroconvulsive therapy or ECT), a particular brand of medication, or any aspect of health care. Sometimes, the law allows a person’s preferences to be overridden—like in emergencies—and, sometimes preferences alone aren’t enough to make something happen.
An Advance Directive may be revoked at any time and in any manner without regard to a person’s mental status, but a health care representative can only be terminated in writing, with the person’s signature and the signature of two witnesses.
Except as authorized by a court, conservators must comply with a ward’s individual health care instructions and other wishes, if any, expressed while the ward had capacity to create an Advance Directive. A conservator may not revoke the ward’s advance health care directive unless authorized by the probate court.
The Connecticut Legal Rights Project has created an Advance Directive for Health Care Toolkit has been created to meet many of the health care needs of people who are receiving mental health services. Although the Toolkit has been created for people receiving mental health services, anyone can use it. To obtain the Toolkit, or ask questions, call toll-free 1- 877-402-2299 (TTY 860-262-5066), or visit www.clrp.org.
An evidence based practice, ACT has been extensively researched and evaluated and has proven clinical and cost effectiveness. Aimed at providing comprehensive, multidisciplinary care, ACT includes nurses, psychiatrists, social workers, case managers, occupational therapists, and other trained professionals, and is based on the premise that people receive better care when their mental health providers are working as a team.
ACT teams provide case management, initial and ongoing assessments; psychiatric services; employment and housing assistance; family support and education; substance abuse services; and other services and supports critical to an individual's ability to live successfully in the community. ACT services are available 24 hours per day, 365 days per year. Each client receives individualized support from the entire team in setting and achieving his or her personal goals towards maintaining independence, including improved social relationships, finding and keeping a job, maintaining overall wellness, rebuilding family relationships, and many more.
These wrap-around services are successful in preventing relapse, and heavy reliance on more expensive emergency room use and hospital stays. The success of this model is based on the strong relationships that are built between the team members and the clients, which promote respect, trust, and mutual understanding.
Other strengths of the ACT Team model include:
ACT teams provide case management, initial and ongoing assessments; psychiatric services; employment and housing assistance; family support and education; substance abuse services; and other services and supports critical to an individual's ability to live successfully in the community. ACT services are available 24 hours per day, 365 days per year. Each client receives individualized support from the entire team in setting and achieving his or her personal goals towards maintaining independence, including improved social relationships, finding and keeping a job, maintaining overall wellness, rebuilding family relationships, and many more.
These wrap-around services are successful in preventing relapse, and heavy reliance on more expensive emergency room use and hospital stays. The success of this model is based on the strong relationships that are built between the team members and the clients, which promote respect, trust, and mutual understanding.
Other strengths of the ACT Team model include:
- Consumers receive ACT services in their homes, where they work, and in other settings in the community where problems occur or where support is needed.
- ACT teams offer whatever services and supports are needed for as long as people need them
- Several ACT team members work regularly with each consumer.
- ACT teams fit their schedules around the needs of consumers.
- ACT teams provide an array of services to help meet consumer needs. With ACT, consumers benefit most because they are hospitalized less often and have more stable housing.
- ACT services are available 24 hours a day, 7 days a week. Someone is always available to handle emergencies.
Crisis Intervention Teams are a partnership program between the local police and the community provider network that provides training to law enforcement personnel and provides for a joint response to crisis in the community involving persons with behavioral health disorders. The goal of CIT is to reduce the need for arrest in favor of referrals to appropriate treatment resources. CIT provides trained clinicians in Hartford, New Haven, Norwich, Stamford, Bridgeport, and Waterbury to work collaboratively with CIT trained officers, providing Mental Health evaluation and recommendations when responding to crisis calls.
Jail Diversion/Court Liaison programs provide court-based services to persons with psychiatric and co-occurring (mental illness and substance abuse) disorders who are arrested on minor offenses. The primary function of the program is to facilitate access to appropriate treatment services by providing assessment, referral, and linkage to community mental health services. Diversion staffs work to maintain individuals in community treatment services, inform court personnel of treatment compliance, and facilitate access to mental health services through contacts within the Department of Correction when an individual is incarcerated. Diversion programs:
- Reduce recidivism of persons with mental illness by providing access to appropriate treatment
- Reduce incarceration of persons with mental illness charged with low-level offenses by providing alternative programs
- Enhance public safety by freeing up jail beds for violent offenders
- Provide humane and confidential care for persons with serious mental illness who are involved in the criminal justice system
- Provide judges with additional sentencing options
- Increase cost-effectiveness of the court, DOC, and DMHAS through access to appropriate services for persons with psychiatric disabilities A program in Massachusetts which served 200 mentally ill people had an initial cost of $400,000 and saved $1.3 million in emergency health services and jail costs.
People with co-occurring mental health and substance use disorders have higher rates of recovery and sustained wellness when they participate in this service model, an evidence-based practice that is proven to support dual recovery and reduce the costs. Individuals are able to address both disorders at the same time, in the same service organization, and with the same team of treatment providers.
Using a stages-of-change approach to treatment and an individualized approach to treatment, IDDT is a multidisciplinary model that combines pharmacological (medication), psychological, educational, and social interventions to address the needs of the individuals served and their family members.
Using a stages-of-change approach to treatment and an individualized approach to treatment, IDDT is a multidisciplinary model that combines pharmacological (medication), psychological, educational, and social interventions to address the needs of the individuals served and their family members.
Specialized supports to individuals receiving behavioral health services offered by someone with lived experience of a mental illness can offer a unique brand of hope and guidance that is just as valuable as the services offered by certified behavioral health professionals. In Connecticut, certified recovery specialists are current or former recipients of mental health services who provide direct services to consumers on community support teams, assertive community treatment teams, and emergency, outpatient or inpatient settings. They are certified through a 60-hour DMHAS-approved training, and perform a range of tasks designed to assist the people they serve in regaining control over their own lives. Recovery specialists model competence and the possibility of recovery. They assist consumers in developing the perspective and skills that facilitate recovery.
Meaningful employment has been shown to promote recovery from psychiatric and addiction disorders, in ways that range from aiding in symptom relief to ensuring successful community integration. Investment in evidence-based supported employment programs, a model embraced by the publicly funded behavioral health service system in Connecticut, helps to reduce unemployment, promotes social integration, and offers the state huge savings in public assistance costs. At the same time, communities become more productive and gain a broader tax base, while individuals gain self-esteem, independence, and the ability to contribute to the broader community.
Supported employment programs, in coordination with mental health services, effectively help individuals with behavioral health conditions to achieve competitive employment by building work readiness, supporting the job search process, and offering ongoing supports to ensure a successful employment experience.
Currently, DMHAS funds 34 agencies across Connecticut to provide a broad menu of employment and education services. While employment strategies must be tailored to meet individual needs, agencies generally offer a range of services including career planning, job search assistance, job placement, on- and off-the-job coaching, and career advancement services. Over 4000 persons per year are assisted in finding and keeping employment through the DMHAS system.
Supported employment programs, in coordination with mental health services, effectively help individuals with behavioral health conditions to achieve competitive employment by building work readiness, supporting the job search process, and offering ongoing supports to ensure a successful employment experience.
Currently, DMHAS funds 34 agencies across Connecticut to provide a broad menu of employment and education services. While employment strategies must be tailored to meet individual needs, agencies generally offer a range of services including career planning, job search assistance, job placement, on- and off-the-job coaching, and career advancement services. Over 4000 persons per year are assisted in finding and keeping employment through the DMHAS system.
Only a small percent of homeless people with mental illness require institutionalization; the large majority of individuals with mental health challenges are able to live in the community, given the proper combination of supports. Connecticut leads the nation in creating supportive housing opportunities, with more than 4,700 units of permanent supportive housing in over half its communities, but much more is needed to end our homelessness crisis.
Supportive housing, a combination of affordable housing and mental health services, has been shown to significantly reduce more expensive services like emergency room visits, hospitalizations, detoxification services, incarceration, and mental health residential program facilities. The most successful approach, “housing first,” offers permanent housing up front (no more than 30% of a person’s income), followed by voluntary supportive services. Because building trusting, mutually respectful relationships is fundamental to this model, it is highly effective in promoting residential stability and community integration.
Supportive housing, a combination of affordable housing and mental health services, has been shown to significantly reduce more expensive services like emergency room visits, hospitalizations, detoxification services, incarceration, and mental health residential program facilities. The most successful approach, “housing first,” offers permanent housing up front (no more than 30% of a person’s income), followed by voluntary supportive services. Because building trusting, mutually respectful relationships is fundamental to this model, it is highly effective in promoting residential stability and community integration.