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SALT LAKE CITY — Salt Lake County plans to launch a "hospital without walls" to to better serve the needs of clients with severe, persistent mental illnesses.
The Assertive Community Treatment Team will serve an average of 50 mental health consumers who receive government-funded health care.
The team, made up of a physician or another prescriber, a licensed clinical social worker, a case manager and a certified peer support specialist, visits clients in their homes to provide primary mental health services and refer them to other community resources.
At least one of the team members will be available 24/7, 365 days a year. The program is scheduled to begin July 1.
"We’re talking about our most seriously mentally ill. They’re chronically homeless. They’re chronically in and out of the hospital," said Tim Whalen, Salt Lake County's director of mental health.
"The hospital reimbursement rate is an average of $1,000 a day of Medicaid dollars," he said. "So if we can keep a consumer from going in and out of the hospital, the potential for savings is very, very large.”
The addition of an ACT team to the other county-funded mental health services provided is expected to cost $650,000 to $700,000 in Medicaid dollars, Whalen said.
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About 22.4 percent of the adult population in Utah experienced a mental disorder in the past year and out of those people, 5.14 percent had a severe mental disorder that interfered with their daily activities.The ACT team is a new addition to the county's behavioral health plan approved earlier this week by the Salt Lake County Council.
If the team's staffing and practices are implemented "to fidelity to the evidence-based model prescribed by (the federal Substance Abuse and Mental Health Services Administration), you can expect the folks participating in that service to decrease hospital spending by as much as 40 percent," Whalen said.
Under the current system, some clients diagnosed with schizophrenia or bipolar 1 disorder have required multiple hospital stays each year at an average cost of $1,000 a day, he said. Hospital stays generally last a week to 10 days but can be longer.
"You can see how expensive that gets — fast," Whalen said.
It's hard to go from an impatient stay and then transition back to your home, your family, your friends, and if you're still employed, your employment.
–Tim Whalen, Salt Lake County's director of mental health
Beyond the costs, hospitalizations are disruptive to clients' lives, says Julie Hardle, manager of recovery and resiliency for Optum Salt Lake County and a mental health services consumer.
"It's hard to go from an impatient stay and then transition back to your home, your family, your friends, and if you're still employed, your employment," she said.
Hardle has been hospitalized more than 10 times since 1995 for treatment of bipolar disorder with psychosis, general anxiety disorder and a co-occurring substance abuse disorder, she said.
"For me, in the early days, the trauma around an in-patient stay had a lot to do with the stigma associated with just being identified as someone who was seriously mentally ill," Hardle said.
ACT teams embrace a recovery model that encourages patients to resume their education, find regular employment and come up with ways to become involved in their community — pursuits that provide structure and build self-esteem.
"When you see the results of these programs, people can actually improve the quality of their lives. That's what we're working toward when we talk about recovery," Hardle said.
Today she has a thriving career and strong relationships with friends and family. In recent years, she's lost 150 pounds and takes part in running, biking and swimming races, which she says are all part of her recovery.
While hospitalizations are part of the continuum of care for people with mental illness, "there are many other ways that situations can be handled that are less traumatic than going in-patient," Hardle said.
ACT teams can guide consumers to resources in the community, she said.
"You want them to be able to stabilize in the community. You can't live life in-patient, or live much of a life," Hardle said.
Sherri Wittwer, network director for OptumHealth and former executive director of NAMI Utah, said ACT teams have a proven track record in several states.
Oklahoma experienced a 73 percent decrease in hospital days and a 64 percent drop in days in jail a year after implementing its ACT program, according to a NAMI fact sheet.
Both Virginia and Georgia reported sharp reduction in utilization of their state hospitals.
"This is a model that has been around for a long time and something consumers and families have wanted to see happen in Utah for a long time," Wittwer said.
Teams will interact with clients as much as they need, which may mean "outreach once a week or outreach once a day," said Rick Elorreaga, executive director of OptumHealth Behavioral Solutions.
While the ACT team will be available for an average of 50 clients, initially the goal is to increase that number to 100, Wittwer said.
"These are people who have not been able to be maintained through traditional services so we need to change the way we've been doing things," she said.
