HCFA Investigation Into Illinois’ Placement of Mental Patients Leads Health Policy Report’s Mental Health Round Up

Expanding a probe that stated after two mentally ill patients were charged with murder, the federal government will examine whether Illinois is "improperly warehousing mental patients in geriatric nursing homes," the Chicago Tribune reports. According to the Tribune, murder charges have been filed against two mentally ill patients from Hillcrest Healthcare Center -- an Illinois facility that is classified as a nursing home -- who checked themselves out of the facility on March 22 and allegedly killed a man later that day. Following this incident, HCFA is questioning why the state of Illinois originally approved placing the two men, who had criminal backgrounds and diagnoses of serious mental illness, in the Hillcrest nursing home (Heinzmann, Chicago Tribune, 4/30). "A facility has to be able to provide the care that's necessary and that may be jeopardized in situations where (traditional patients) are commingled with mentally ill patients," Charles Bennett, Illinois branch manager for HCFA's Division of Survey and Certification, said. Further, a federal official said that Hillcrest "appears to be misclassified as a nursing home," as nearly 80% of its patients are being treated for mental illness (Heinzmann, Chicago Tribune, 5/1). Under federal law, any facility where more than 50% of patients are being treated "primarily" for mental illness must be designated as a mental institution (Heinzmann, Chicago Tribune, 5/1). The Tribune reports that there are "probably more than two dozen facilities across the state similarly misclassified." Because of the March incident, HCFA will sanction Hillcrest and "likely" levy fines against the facility and could suspend Medicaid funding for new patients (Chicago Tribune, 5/1).

Rhode Island Sees Rise in Mentally Ill Patients
A Superior Court judge on April 28 ordered Rhode Island's Eleanor Slater Hospital to "resume accepting emergency psychiatric patients," after the state-run facility "shut its doors" to such patients last week, the Providence Journal reports. Eleanor Slater Hospital, which accepts mentally ill patients "in crisis" when other hospitals reach capacity, closed its doors to such patients when it became "suddenly ... overwhelmed by emergency patients it was ill-equipped to treat, jeopardizing its ability to care for its usual clientele of long-term, chronically ill people," according to hospital officials. Since January, the state hospital has accepted 28 "emergency holds," which have "totally outstripped our resources and really negatively impacted the integrity of [the] program," according to Eleanor Slater CEO Richard Freeman. After the weekend of April 21-23, when 10 emergency psychiatric patients were admitted, each requiring one-on-one attention, hospital officials decided to close their doors to emergency admissions, turning away two patients on April 26 night. In response, H. Reed Cooper, Rhode Island's mental health advocate, sought an "emergency reversal of the decision," saying that state law mandates Eleanor Slater to accept emergency psychiatric patients. The Providence Journal reports that the hospital's quandary is indicative of a "deeper problem" -- the number of Rhode Island adults seeking hospitalization for mental illness has "soared" over the past four months. Dr. Gabor Kietner, director of adult psychiatric care at Rhode Island Hospital, said the trend has occurred in part because efforts to reduce hospital lengths of stay "may have gone too far, so that patient are leaving the hospital before they are ready, and more likely to return." In addition, Kietner said the "emphasis on medication -- fueled in many cases by insurance companies seeking to control costs -- is giving short shrift to patients' complex social and psychological needs"; fewer therapists are available for outpatient care; and more psychiatrists "only do 15-minute 'medication visits.'" State Department of Mental Health Director A. Kathryn Power said she plans to meet this week with community mental-health center officials to "begin examining the underlying problem and seeking a solution" (Freyer, Providence Journal, 5/1).

Mass. to Fund Housing Program
Speaking before hundreds of mental health patients and advocates, Massachusetts Department of Mental Health Commissioner Marylou Sudders on April 30 announced a pilot program in which $250,000 in new block grant funds would be allocated for "clubhouse" housing programs, "one of the cornerstones of the state's support system for people with mental illness," the Worcester Telegram & Gazette reports. The program would provide assistance in locating apartments, providing "peer outreach" and paying security deposits for people with mental illness. At the hearing, Ruth Kaufman, program director for Genesis Club, one of the state's 28 "psychosocial clubhouses," called on legislators to support "all human services providers" through budget initiatives, including a $12.8 million boost in state funding for additional community residence and case management services. Kaufman also called for a 3% increase for all human services employees who earn less than $39,000 per year; minimum entry level pay to be set at $12 per hour for full-time employees and private human services provider contracts to receive 3.67% increases (Hammel, Worcester Telegram & Gazette, 5/1).