The Guardian Model

Persons with severe and persistent mental illnesses rarely fit neatly within the Consumer profile of any one state or local agency. Instead, most individuals find themselves receiving services from many agencies and, quite often, the services or eligibility requirement of one may preclude services from another. Now, more than ever, the mental health system is in need of non-traditional approaches in order to effectively deliver services to persons with mental illnesses who live in our communities.

In 2001, a steering committee was formed consisting of representatives from Connecticut's Probate Court Administration, Department of Mental Health, the Chief Forensic Psychiatrist's Office, Yale University, and the legal profession to develop a plan for the efficient delivery of services to persons with severe and persistent mental illnesses living in the community. This was a collaborative effort to stop the "revolving door" affecting this most at need population. The GUARDIAN MODEL evolved there from and provides cohesion element among all of the agencies influencing the lives of this population and ensures comprehensive treatment for its Consumers including meaningful community involvement, stable housing, adherence to medical and clinical prescriptions, and avoidance of the criminal justice system including technical parole and/or probation violations.

The Guardian Model was developed specifically for Connecticut's Department of Mental Health and Addiction Services and its Probate Court Administration. The model is designed as an independent, interagency oversight program which bridges the gap between disparate service providers all of whom are mandated to provide services for a given Consumer. *As such, the applicability of the principals of the Model are easily adaptable by any public or private sector service agency*.

Studies show that the use of this model results in:

1. reduction in utilization of the emergency room


2. reduction in the number of days admitted to private hospitals


3. reduction in number of days admitted to state hospitals


4. reduction in arrests


5. reduction in incarceration days


6. reduction in involuntary commitments to local and state psychiatric hospitals


7. reduction in incidents of acute crisis


8. Increases in Consumer satisfaction relative to issues of recovery and involvement in treatment planning

Melissa's Project

Melissa’s Project acts as a liaison between individuals with severe and persistent mental illnesses and the various systems in which the individual is involved (i.e. the court system, mental health service providers, community supports, hospitals, and more.) It is the mission of the Melissa’s Project to monitor, coordinate, and navigate our clients through the complex systems of care in which they are involved in order to ensure that individuals within the mental health system have access to quality healthcare and services available to them in the community.

This Project focuses on preventative approaches and the development of appropriate interventions to promote positive change and growth. By improving the quality of care and treatment that individuals receive, we are creating an atmosphere where realistic and individualized goals can be accomplished.

Melissa’s Project, allows the fiduciary to feel at ease that their loved one is receiving the services that they are entitled to and that they are safe in the community. We follow through and act as a buffer between you and the bombardment of requests, telephone calls and the infinite number of issues that inevitably arise when servicing persons in need.

Family Members/Fiduciary

The family member and/or fiduciary of the consumer benefits greatly from our services. He/she is afforded an ally who can assist them in understanding the intricacies of the myriad systems in which the loved one is involved. We provide comprehensive understanding of the complexities of each particular case, a sounding board for their frustrations and an effective voice for promoting the position of the family member or fiduciary as it pertains to their loved one or client.

Additionally, we remove the burdensome task of caring for their loved one and the micro-management of the individuals daily needs.

The family member can go on with their own lives understanding that there is a responsive, caring group who is watching over their loved one and assuring that his/her needs are met. We respond to the various issues which inevitably arise with overwhelming regularity.

From Melissa’s Project, you can feel at ease that their loved one is receiving the services that they are entitled to and that they are safe in the community. We follow through and act as a buffer between you and the bombardment of requests, telephone calls and the infinite number of issues that inevitably arise when servicing persons in need.

Probate Court

By providing a service to the fiduciary as described above, we serve as an invaluable component of the courts overall ability to serve difficult populations. The attorneys who frequently practice in these courts are aware of the services we offer so that they are willing to act as fiduciary with the knowledge that their fiduciary responsibilities will be made less burdensome with our assistance. Thus, the numbers of those who are willing to act as fiduciary has increased.

By providing the court with access to a larger pool of responsible, qualified individuals who are willing to act as fiduciary, we greatly increase the courts efficiency in hearing these matters and moving them forward to a positive resolution. Likewise, through our oversight, we have demonstrated that the court is less likely to be burdened with the high utilizer who frequently passes through the revolving door of the court on his/her way to successive involuntary commitments.

LMHA

It was initially anticipated that we would receive the greatest amount of resistance from the LMHA we were asked to “assist”. This however has proven to be far from true. Case workers see in us a valuable ally who has access to administrative personnel who otherwise may not get involved in their client’s case. We have repeatedly demonstrated our ability to move past typical beurocratic road blocks in order to effectuate positive change for the benefit of the client.

Perhaps more significantly, LMHA caseworkers have noted that we are an integral piece in facilitating open lines of communication between themselves, their sub-contracted service providers and the fiduciary caring for their consumer. We obtain releases in a timely manner, we assist in passing along vital information regarding the consumers and we maintain records which are easily accessible pertaining to the his/her treatment history, successes and failures.

Hospitals

In addition to acting as an accessible representative of the consumer who is able to facilitate communication never-before available to hospital staff and personnel, we are a source of vital information. Due to the fact that Melissa’s Project follows a client across all agencies and through all systems in the community, we provide the hospital with documented evidence of a clients treatment history, medications, compliance and overall condition in the community. Unavailable prior to our involvement, we can provide a comprehensive picture of the totality of circumstances which effect a clients healthcare.

Further, due to our intimate knowledge of the client, his/her needs, and successes in the community, we act a s a link to the LMHA and assist in developing new, comprehensive and realistic discharge plans.

We are not an organization which puts much stock in the needs of hospitals to prematurely discharge clients based upon financial considerations alone. The clinicians, social workers and staff who truly strive for their clients growth recognize us as a partner when it is obvious that further treatment is warranted and discharge would be potentially dangerous or a set back to the overall treatment plan.

DMHAS

Unfortunately financial considerations are a part of today’s world. Resources are carefully distributed amongst various service agencies and they do what they can to work within extremely tight, inflexible budgets. We have shown that we are a valuable asset to DMHAS in that we greatly reduce the amount of man hours previously needed to treat their most difficult clients. Through our collaborative efforts we have distributed responsibility for action amongst sub-contracted service agencies who, prior to our involvement, may have been somewhat disinclined to treat in a manner prescribed by their treatment plan and under their contract with the Department.

By reducing the number of bed days both in private as well as state hospitals we have saved the Department valuable dollars which can be re-allocated for the benefit of other clients in need and/or for the development of programs to reduce the over-utilization of services.

In many cases we ask for the input of other agencies and departments who have assisted us in developing courses of treatment in order to obtain needed services across the fictitious boundaries of disparate state entities. In other words, we have asked other agencies, better suited for addressing particular needs of a client, to assume the financial burden of some, if not all, of the costs of delivering the needed responses. Again, this makes available assets and man-power to more effectively address the services that the Department could and should be asked to handle.

DOC, AAGs, Criminal Justice, Prosecutors and Public Defenders

DOC is the final “stop gap” in our mental health system. It, and the criminal justice continuum, is necessary components of the mental health system. However, they are clearly being misused primarily due to a general lack of understanding of the needs of the mentally ill, acceptance of the chronicity of mental illness, and for failure to distinguish criminality from the manifestation of an illness.

Approximately 16% of the clients in DOC are mentally ill. A great majority of these should not be in jail and will not benefit from, indeed, cannot understand the causal link between their actions and the punishment of incarceration. DOC spends tens of thousands of dollars pharmacologically in order to treat their wards. Upon discharge, a comprehensive plan does not exist, homelessness becomes pervasive which leads to criminal behavior and lands the client back within the criminal justice system.

As the one true constant in the lives of our clients, we work across systems and with various agencies at effectively working with our clients to provide them with real Alternatives to Incarceration. The alternatives that we have employed are not boiler plate options available to court entities. We develop, along with court personnel and service providers, extremely detailed alternatives and, most significantly, means of monitoring and reporting on them in order to prevent their violation. These plans are developed with the client and necessarily take into account the realistic limitation that he/she exhibits relative to compliance therewith.

By avoiding incarceration we avoid the taxation on the criminal justice system. By acting as an information resource we greatly influence the efficiency of the criminal justice system’s ability to handle this unique population.

Anywhere that the client may fall within the criminal justice continuum can benefit from the consistency and knowledge that Melissa’s Project offers. We assist police in understanding the clients behaviors prior to or directly after arrest. We assist Jail Diversion or AIC in developing strategies that may have never been tried and to avoid duplicating those which have previously failed. We ensure CSSD that jail re-interview can effectively assist the courts in identifying criminality versus illness. Upon discharge from jail or prison we act as the ongoing provider to the client who will follow his progress through all aspects of community life in order to decrease recidivism or to better understand the reasons it may exist.