Mentors on Discharge Repeated psychiatric hospitalizations are costly, impede recovery and are demoralizing to individuals, families, and clinicians. Between 40 to 50 percent of patients with a history of repeated psychiatric hospitalizations are readmitted within 12 months. At San Francisco General Hospital, the average length of stay on an inpatient service is approximately 7.8 days and costs roughly $1,300 per day-- or $10,140 per hospital stay
Following Discharge from Inpatient Psychiatry For best outcomes patients should see an outpatient psychiatric or behavioral health specialist within 7-10 calendar days of discharge after hospitalization for mental illness Proper follow-up care is associated with lower rates of re-hospitalization and with an increased likelihood that gains made during hospitalization are retained The period immediately following discharge from inpatient care is recognized as a time of increased vulnerability Ensuring continuity of care by increasing compliance to outpatient follow-up care helps detect early post-hospitalization medication problems and provides continuing support that improves treatment outcomes and reduces healthcare costs
A Peer-Based Approach Using peers to provide support to consumers at this stage of their recovery seems highly effective as an adjunct to mainstream mental health services. Findings from multiple studies suggest that use of peer mentors is a promising intervention for reducing recurrent psychiatric hospitalizations for patients at risk of readmission.
Preliminary Findings In 2013, John George Psychiatric Hospital (JGPH) was awarded an MHSA innovations grant for $238,000. In collaboration with NAMI Alameda South they launched the Mentor on Discharge (MOD) program. Patients who opted into the program were matched with a peer mentor prior to discharge. Mentors would meet weekly (for 6 months) with the goal of supporting transition to the community. At the end of the 18-month grant JGPH experienced the following results: # of participants in program report (cohort): 60 # of hospitalizations 12 mos prior to MoD: 173 # of hospitalizations 12 mos after MoD: 48 Avg days between hospitalizations before MoD: 62 Avg days between hospitalizations after MoD: 159 Total Grant $ = $238,000 Hospital admissions avoided: 125 Avg hospital admission costs at JGPH: $8,500 Total gross systems savings (Cost Avoidence): $1,062,500 Less grant dollars: -$238,000 Total return on investment: $824,500
225! 180! 135! 173! 159! 90! 45! 48! 62! 0! # of Hospitalizations! Avg days between hospitalizations!
CRITERIA Criteria to be in program 2 hospitalizations in inpatient psychiatry within the preceding 18 months Patient must volunteer to accept a mentor and request hospital visit Criteria to be a mentor Person with lived experience Willingness to undergo a 40-hour training Must meet with participant prior to discharge Agree to meet weekly for 1 hour and assist the participant with their wellness and recovery journey. The mentor will NOT act as counselor, case manager or therapist; but facilitate Participant own choices for wellness and recovery
MOD Program Design weekly NAMI presentation on the unit In Our Own Voice is a 60 min. peer presentation about hope and recovery Patient is offered Mentor on Discharge Patient must have had 2 hospitalizations in the past 18 months Once enrolled, an electronic request for a mentor is made. MOD Coordinator matches on gender, language, and age. Mentor comes to the unit to meet with the patient (within 48 hours of request) Discharge
Discharge Mentor meets with the individual (within 48 hours post discharge) Weekly meetings with NAMI coordinator Mentor Commitments and Activities (6 months) One in person meeting per week Two phone calls per week Mentor will assist in establishing connection with outpatient mental health facility, primary care, and community supports MFT provides additional support to mentors MFT phones participants as a quality assurance measure *To put one person through the Mentors on Discharge program in San Francisco for 6 months costs $2,506 per participant
CHALLENGES AHEAD Funding the program (grants, Medicaid reimbursement) Recruiting and retaining participants How to best determine and measure readmission rates
THANK YOU Bailey Wendzel Program Director NAMI San Francisco Bailey@namisf.org Joe Rose President NAMI Alameda County South Gifford Boyce-Smith, MD President NAMI San Francisco