Delaware’s mental health system improves, but struggles with acute care increases

Four years ago, it wasn’t uncommon for someone with a mental illness in Delaware to have been institutionalized for decades.

The Department of Justice stepped in, and in 2011 the First state agreed in a settlement to build community services and pull patients out of unnecessary long-term care and a federal monitor says there’s progress.

The court monitor assigned to oversee the Delaware’s system overhaul, Robert Bernstein, said the state has come a long way. There are new walk-in crisis centers, supportive housing and employment programs, and a mobile response unit that responds to anyone in need in an hour or less. Many patients who had been locked up at the Delaware Psychiatric Center for years are now living in apartments.

“Rather than sitting in a day room all day, they’re doing what ordinary people do,” Bernstein said.

But in his latest progress report, Bernstein also highlighted a troubling trend. The time patients spend in short-term mental health care is going up, not down. Delaware had agreed to decrease the number of acute stay bed days by 30 percent in the 2014 fiscal year, and by 50 percent by this coming July. Last January, with five months remaining in the fiscal year, the state had already exceeded the mandated 30 percent reduction level. By June, the number of bed days had shot up to 30 percent more than when the settlement agreement began.

Jim Lafferty, the executive director of the mental health association in Delaware, said the state has done a laudable job retooling its services, but the acute care spike raises important questions.

“Is it that the services are not sufficient? Is it that the quality of care is not where it ought to be? I’d say really, nobody knows,” he said.

Bernstein is calling for the state to dig deeper into its data to find out what’s driving the surge so that it can come up with a solution. He suspects substance abuse is a huge factor.

Michael Barbieri, director of substance abuse and mental health services for the state, said while he’d like to see short-term psychiatric hospital stays drop, focusing too much on one indicator is misleading.

“It’s a good benchmark but it isn’t a sole driver of quality of care,” he said.

“I think what we’re seeing,” he added, “is an increased utilization of services because we have been promoting more aggressively mental illness as an issue and trying to do more outreach to get people in care.”

If patients need to be hospitalized, Barbieri said, they need to be hospitalized, and the state doesn’t want to jeopardize treatment.