Psychiatric News August 19, 2005
Volume 40 Number 16
© 2005 American Psychiatric Association
p. 12
Patients Benefit From CMHC, Medical School Partnership
Kate Mulligan
Yale University and Connecticut's Department of Mental Health joined
forces 39 years ago to establish a community mental health center that has
brought multiple benefits to patients, students, researchers, psychiatrists,
and mental health professionals.
Each night outreach workers from the Connecticut Mental Health Center
(CMHC) and collaborating agencies work at New Haven's Town Green encouraging
homeless people to accept help for their mental illness and substance abuse
problems.
By day, at the center itself, Yale Department of Psychiatry faculty members
and other researchers conduct clinical and basic neurobiological research in a
very different kind of effort to mitigate the damage of those disorders.
The range and variety of expertise that the CMHC brings to the alleviation
of mental illness result in large part from its administrative structure.
The CMHC is a state-owned community mental health center that operates
under a memorandum of agreement between Connecticut's Department of Mental
Health and Addiction Services (DMHAS) and Yale University. That arrangement,
which began 39 years ago, poses obvious challenges and offers great
opportunities.
Like other mental health centers, the CMHC serves an economically
disadvantaged population who suffer from serious mental illness, often with a
co-occurring substance abuse disorder.
"We take that responsibility seriously," said CMHC Director
Selby Jacobs, M.D. "This is not an ivory tower. We serve exactly the
same kind of people you find at other community mental health
centers."
With a budget of more than $1 million, the CMHC operates its Outreach and
Engagement Project, bringing treatment and rehabilitative services to people
who traditionally are among the most reluctant to accept them (see article
below).
Staff provide services at three satellite clinics, one of which offers
bilingual and bicultural services to Spanish-speaking people, in addition to
outpatient and hospital treatment at its main facility.
Outreach to the community is enhanced by virtue of the CMHC's role as the
lead agency for the Community Services Network (CSN). Sixteen community-based
organizations work as a consortium to address the needs of people with serious
mental illness and cooccurring substance use disorders.
Tom Styron, Ph.D., CSN's executive director, said CSN provides a
"remarkably diverse, innovative, and comprehensive set of
services." They include vocational and social rehabilitation programs,
crisis and respite services, and opportunities for various kinds of supported
housing.
He pointed to the Park Street Inn as an example of collaboration. Funded by
DMHAS, the facility will provide transitional housing to persons who might
otherwise need to remain in a state psychiatric hospital. Coordinated medical
and rehabilitative services will be offered by four of the CSN member agencies
in an effort to prepare residents for permanent homes in the community.
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Members of the Community Services Network are turning two historic
buildings into the Park Street Inn, to be used to transition patients in a
state psychiatric hospital back into community life. Photo courtesy of
Connecticut Mental Health Center
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Jacobs is a professor of psychiatry and Styron is an associate professor in
the Department of Psychiatry at the Yale University School of Medicine. Those
affiliations are key to some of the CMHC's strengths.
DMHAS Commissioner Thomas Kirk, Ph.D., described the advantages of Yale
University's involvement with the CMHC.
"It's a win-win situation," he said. "Patients benefit
from the improved quality of care that comes from the application of new
research, and faculty members gain the experience of treating people with
challenging forms of mental illness in a well-run facility."
He pointed out that the university affiliation also enhances the state's
capability to benefit from federal research and development grants.
Jacobs said, "DMHAS provides about $3 million in research money to
the CMHC each year. Faculty members leverage that figure about six times
because of their ability to obtain competitive research grants."
He believes that success in translating research into practice is a
defining characteristic of an academic mental health center. The Institute of
Medicine has estimated the time for such translation typically to be 15 or
more years.
Staff have begun a multiphase effort to build on their successful
experience conducting large-scale research projects to bring the results of
that research more quickly to patients.
They reviewed lists of ongoing research projects and interviewed research
program directors to identify projects that lend themselves to translation.
One of the three projects identified will incorporate the results of
neurocognitive research that enhances brain functioning into an existing
program that provides psychosocial supports for people with disabilities who
are preparing for employment.
Greater use of evidence-based medicine and of best practices will also
support the goal of improving the translation of research.
Jacobs also mentioned a collaborative effort between DMHAS and the Yale
Program for Recovery and Community Health (PRCH).
With support from a five-year, $2.3 million grant from the National
Institutes of Health to the DMHAS, PRCH researchers will examine the
effectiveness of various interventions, such as peer-support services and
collaborative treatment planning, that are part of "person-centered
care." (Collaborative efforts between DMHAS and PRCH to implement a
recovery model throughout Connecticut will be described in a later issue.)
Commissioner Kirk cited the CMHC's work in forensic psychiatry as another
important contribution. Staff from the Law and Psychiatry Program consult with
courts and community groups, conduct research, and train psychiatry
residents.
The CMHC's overall budget is approximately $50 million a year for research,
services, and costs attributed to teaching, but the figure fluctuates with the
availability of research funds.
Medicaid funds constitute approximately 2 percent of the budget for
clinical services, considerably less than the percentage at most community
mental health centers.
One result is greater flexibility in terms of services offered and
eligibility for those services. The CMHC also has limited protection from the
kinds of funding cuts that are occurring throughout the country.
Jacobs said, however, that DMHAS funding has been "flat" for
several years, which results in a decrease in resources because of the effect
of inflation.
"We are not claiming to do more with less," he said. "We
are going to maintain quality and balance in the kinds of clinical services we
offer."
Nonetheless, Jacobs is identifying cost-effective ways of providing good
care. A clinic that will offer early intervention at the time of the first
episode of psychosis is one such method. The result, he expects, will be
better quality of life for the patients and lower costs for the mental health
system because of diminished need for repeated hospitalizations and other
kinds of expensive long-term treatment.
He also continues to find ways to sell the value of the CMHC to state
officials and other audiences.
"We are training the future generation of medical directors, doctors,
and psychiatric nurses who will be responsible for the health care of
Connecticut residents," Jacobs said.
He can show that the CMHC secured federal grants that nearly doubled the
amount of money that the DMHAS targeted to the provision of supported-housing
opportunities for people with serious mental illness.
New Haven city officials and DMHAS offered financial support for the CMHC's
outreach program because of its success in addressing problems of homelessness
and substance abuse (see article on facing page).
Jacobs believes strongly in the importance of advocacy at the national
level for adequate funding for public psychiatry. He is chair of APA's
Committee on Public Funding for Psychiatric Services.
"During his presidency, Dr. [Paul] Appelbaum highlighted the problems
associated with the systematic defunding of the mental health system,"
he said. "Data from SAMHSA for 1991-2001 support his view and show a
shift in costs to the public sector. Medicaid has become the most important
single source of funds for mental health services. Now that program is the
target of a government commission established to control and cut costs. Any
cuts will hurt the most needy and vulnerable of psychiatric patients. I
believe that responding to Dr. [Steven] Sharfstein's recent call for increased
advocacy is crucial." Sharfstein is APA's current president.
Information about the Connecticut Mental Health Center is posted at
<www.communityservicesnetwork.org/agencies/cmhc.html>.
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