People with mental illness still need care after leaving hospital

By Mike Moran

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The Iowa Mental Health and Disability Services System Redesign Committee issued its report on Dec. 9, 2011 outlining its five-year plan to redesign Iowa's funding and service delivery to people with disabilities.

Preliminary discussion has centered on reducing or eliminating funding for residential care facilitates (RCF) as well as other providers of mental health care. Chatham Oaks Inc., an RCF, is a private non-profit corporation formed by Johnson County in 1988 to provide services to people with mental illness. Our board of directors wants to share how Chatham Oaks fits into the “continuum” of mental health care.

Chatham Oaks, located on several acres of county land along Melrose Avenue, provides services and living arrangements for approximately 75 individuals in the RCF plus 18 separate apartment units next door. Chatham Oaks provides Supported Community Living Services (SCL) in Iowa City and Coralville.

Chatham Oaks is one step on the mental health care service delivery ladder leading to a better and improved quality of life. Often, the first step is psychiatric hospitalization where evaluation is completed and treatment plan determined.

Step two is often a period of time at Chatham Oaks, or a similar setting, to give the person time to stabilize on the treatment plan and make modifications. Along with mental illness, a person may also need treatment for multiple physical health issues and/or substance abuse.

Key to a successful outcome is Chatham Oak's professional full-time nursing staff making sure the individual is doing well on medications. While at Chatham Oaks the person is encouraged to gain skills that will lead to independent living as well as to take part in staffed recreation activities, exercise and participation in community activities.

The third step is for most individuals to move into their own home, with the option of receiving SCL services.

During 2011, there were 171 referrals to Chatham Oaks Inc.; 70 people were admitted and 62 were discharged. The average length of stay for individuals who were both admitted and discharged in 2010 was 71 days. While there are people who have lived at Chatham Oaks for a longer period of time, the primary goal is for the individual to return to independent living as quickly as possible.

Also, 101 people were not admitted because they were considered too ill or too dangerous to themselves and others to be admitted. Where do people too sick for this level of care go? To prison? A homeless shelter? Or, do they die somewhere in a dirty apartment, alley or under a bridge? No detailed research has provided the answer.

Some people, because of the severity of their illness, by choice may reside at a RCF like Chatham Oaks. Any proposal for a mental health care plan should include allowing people with a mental illness a choice in where and in what manner they want to live.

As hospitals may recommend a patient with a broken hip or back surgery stay for a period of time following release in an assisted living facility or home with 24 hour nursing coverage, we believe it also critical the response to treatment by many individuals with mental illness be closely observed for a time following release from the hospital. There is empirical evidence that going from the hospital directly to a home environment without a period of medical oversight frequently leads to relapse.

We urge the Iowa Mental Health and Disability Services System Redesign Committee and legislators to further consider maintaining the present continuum of care, which include RCFs.

Mike Moran, president, Chatham Oaks Board of Directors, on behalf of the board. Comments: mike-

moran@iowa-city.org