In all the debate about assisted outpatient treatment, all the statistics thrown around, and all the promises made about what a great thing it is here is something I bet most people dont know. Tennessee already has mandatory outpatient treatment and has had since 1982. I didnt even know until a couple of weeks ago. It is still on the books, still an operating program. The law establishing it reads like something straight out of the Treatment Advocacy Center. So why all the fuss? Why are we trying to pass something that basically already exists? And what does Mandatory Outpatient Treatment (MOT) tell us about what to expect from Assisted Outpatient Treatment (AOT)?
You might recall from an earlier post that AOT in New York is basically a mechanism for discharge planning of people in the hospital. I believe the figure was that this was true 75% of the time. MOT is totally a mechanism for discharge planning. So in effect, it 75% the same in substance as AOT.
So what is the story with MOT?
It is used inconsistently at best and in some parts of the state not used at all. It doesnt really work because of problems built into the law. Like AOT in New York, it is used in higher population areas with more resources. For much of Tennessee it is closer to irrelevant than anything.
Basically the problem is the same as the problem with AOT. It matters what you commit people to. You can “force” people into treatment, but you cant force providers to provide treatment and you cant force insurance companies to pay for it. Let me provide a little context before I explain the point I am trying to make.
In Tennessee if you are in a state hospital you are by definition either uninsured or on TennCare. If you are uninsured you may be on the behavioral health safety net. If that is the case your benefits are $750/yr through special contract with several local mental health centers. Services offered are the barest minimum. If you are on TennCare for the most part the only providers who will serve you are local mental health centers, because private providers feel like the state pays too little and it is not worth their while. If you have private insurance and are a voluntary patient you are eligible for treatment at a private hospital. Many of those have intensive outpatient programs that they try to hook people up with after discharge. They only want voluntary patients though, because they have found from experience that people who dont want to be there are more trouble than anything else and tend to be disruptive of the treatment of those who want to be there. Your commitment to treatment is essential to their program.
The idea of MOT is for the hospital to team with a willing provider to develop a plan of outpatient treatment for someone being discharged. The key phrase is “willing provider.” Providers do not want to accept someone who has TennCare or is on the behavioral health safety net. And so what you find is there is no place to refer people to. You can commit all you want, but unless you increase the state payments or act in some way to coerce providers against their will you do not have a functioning program. Private insurance companies do not regard judicial decisions as binding decisions of medical need. Again you can commit patients, but you cant commit insurance companies unless you change the law.
What those people who come from out of state to herald the coming of Assisted Outpatient Treatment dont understand or dont care to understand is just how bare our cupboard is. Unless they wish to coerce providers (most can find enough willing clients), or they wish to coerce insurance companies (good luck) their is no way to have a program as things are currently set up.
The option is for the state to pay for everything. That is what has happened in New York and in other places. AND if the state is going to pay they must get the money from somewhere and in Tennessee the only place to get it is from the bare core of services provided to people who want help, but are struggling to make it with what they have access to.
If they want to commit people the simplest thing might be to build a system that has services in it to commit people to. But if you did that you might not need to commit people anyway.
I dont think any of this is rocket scientist material. In the end the TAC is only out for the glory of the TAC. They dont understand what the mental health system in Tennessee is about and how it operates and because of that are going to leave Tennessee with a mess and go in glory with the notch of one more state on their gun.
The only answer to a better mental health system is a better mental health system. There are no shortcuts, no magic bullets, no holy crusades, no wonderful medications, no big sticks that will substitute for that. It takes money and vision to do that. The TAC wants to take our money and their vision is only a replica of what we have already tried and found wanting.
In all the debate about assisted outpatient treatment, all the statistics thrown around, and all the promises made about what a great thing it is here is something I bet most people dont know. Tennessee already has mandatory outpatient treatment and has had since 1982. I didnt even know until a couple of weeks ago. It is still on the books, still an operating program. The law establishing it reads like something straight out of the Treatment Advocacy Center. So why all the fuss? Why are we trying to pass something that basically already exists? And what does Mandatory Outpatient Treatment (MOT) tell us about what to expect from Assisted Outpatient Treatment (AOT)?
You might recall from an earlier post that AOT in New York is basically a mechanism for discharge planning of people in the hospital. I believe the figure was that this was true 75% of the time. MOT is totally a mechanism for discharge planning. So in effect, it 75% the same in substance as AOT.
So what is the story with MOT?
It is used inconsistently at best and in some parts of the state not used at all. It doesnt really work because of problems built into the law. Like AOT in New York, it is used in higher population areas with more resources. For much of Tennessee it is closer to irrelevant than anything.
Basically the problem is the same as the problem with AOT. It matters what you commit people to. You can “force” people into treatment, but you cant force providers to provide treatment and you cant force insurance companies to pay for it. Let me provide a little context before I explain the point I am trying to make.
In Tennessee if you are in a state hospital you are by definition either uninsured or on TennCare. If you are uninsured you may be on the behavioral health safety net. If that is the case your benefits are $750/yr through special contract with several local mental health centers. Services offered are the barest minimum. If you are on TennCare for the most part the only providers who will serve you are local mental health centers, because private providers feel like the state pays too little and it is not worth their while. If you have private insurance and are a voluntary patient you are eligible for treatment at a private hospital. Many of those have intensive outpatient programs that they try to hook people up with after discharge. They only want voluntary patients though, because they have found from experience that people who dont want to be there are more trouble than anything else and tend to be disruptive of the treatment of those who want to be there. Your commitment to treatment is essential to their program.
The idea of MOT is for the hospital to team with a willing provider to develop a plan of outpatient treatment for someone being discharged. The key phrase is “willing provider.” Providers do not want to accept someone who has TennCare or is on the behavioral health safety net. And so what you find is there is no place to refer people to. You can commit all you want, but unless you increase the state payments or act in some way to coerce providers against their will you do not have a functioning program. Private insurance companies do not regard judicial decisions as binding decisions of medical need. Again you can commit patients, but you cant commit insurance companies unless you change the law.
What those people who come from out of state to herald the coming of Assisted Outpatient Treatment dont understand or dont care to understand is just how bare our cupboard is. Unless they wish to coerce providers (most can find enough willing clients), or they wish to coerce insurance companies (good luck) their is no way to have a program as things are currently set up.
The option is for the state to pay for everything. That is what has happened in New York and in other places. AND if the state is going to pay they must get the money from somewhere and in Tennessee the only place to get it is from the bare core of services provided to people who want help, but are struggling to make it with what they have access to.
If they want to commit people the simplest thing might be to build a system that has services in it to commit people to. But if you did that you might not need to commit people anyway.
I dont think any of this is rocket scientist material. In the end the TAC is only out for the glory of the TAC. They dont understand what the mental health system in Tennessee is about and how it operates and because of that are going to leave Tennessee with a mess and go in glory with the notch of one more state on their gun.
The only answer to a better mental health system is a better mental health system. There are no shortcuts, no magic bullets, no holy crusades, no wonderful medications, no big sticks that will substitute for that. It takes money and vision to do that. The TAC wants to take our money and their vision is only a replica of what we have already tried and found wanting.