Montefiore's game plan to fill mental healthcare gaps

New York City-based Montefiore Health System is using new funding from the state to fill gaps in behavioral care in the community. 

In January, the system announced it received $7 million in funding from New York's State Office of Behavioral Health and was designated a center of excellence for behavioral health by the state. 

The award was also backed by three Medicaid managed care plans in the state, Fidelis Care, Healthfirst and MetroPlusHealth. 

Behavioral health leaders at Montefiore sat down with Becker's to explain more about the system's plans for the future and their approach to behavioral health. 

Jonathan Alpert, MD, PhD, the Dorothy and Marty Silverman Chair of the department of psychiatry and behavioral sciences at Montefiore and Albert Einstein College of Medicine, told Becker's the system focused on improving three different domains of care — increasing inpatient capacity, partial hospitalization and outpatient options. 

With the center of excellence funding, Montefiore, which is located in the Bronx, is planning to add beds to its inpatient psychiatric observation unit, open a new partial hospitalization program for adults and add a new children's outpatient psychiatry clinic. 

Salimah Velji, unified executive administrator of the department of psychiatry and behavioral sciences at Montefiore and Albert Einstein College of Medicine, told Becker's the system prioritized what to add based on where the system could make the biggest impact.

"We really relied on the clinical leaders and the frontline staff to help us understand the gap they saw every day," Ms. Velji said. "We tried to take that list and think about what would bring the biggest impact to our communities. And where do we have our strengths and capabilities to make the biggest impact?"

The partial hospitalization program the hospital is planning has two aims, Dr. Alpert said. The first is to avert hospitalization for those who do not need inpatient care, and the second is to serve as a step-down unit for individuals ready to be discharged from the program but who need more intensive care than weekly outpatient visits. 

"It's a high-risk period for people falling through the gaps, not being able to follow-up on outpatient appointments," Dr. Alpert said. 

The program will typically consist of up to six weeks of active treatment for at least four hours a day, Dr. Alpert said. 

"For people ready to be discharged from an inpatient psychiatry unit, but we're concerned to make sure their outpatient treatment is firmly established …  we'll refer them to the partial hospitalization program as a step down as a sort of gradual step back into the community, and back toward what we hope will be healthier and fulfilling lives," Dr. Alpert said. 

In addition to the new planned youth outpatient clinic, the system also recently established a youth intensive outpatient treatment program, Dr. Alpert said, one of three licensed in New York state that accept public insurance. 

"We understand that by intervening as early as possible to youth who are beginning to develop behavioral or mental health problems, or experienced significant trauma early in their lives, we have an opportunity to make a very profound difference on the trajectory of their lives," Dr. Alpert said. 

Making access easier 

Montefiore is focused on helping patients navigate the complex barriers to finding mental healthcare. 

"We're focused on trying to streamline the process by which people can get access to services for mental illness and addiction by reducing the steps they need to take and having a single-access point of entry," Dr. Alpert said. 

Some of the ways to do this include adding urgent care options to reduce wait times, increasing walk-in services, and having clinicians able to speak multiple languages, Dr. Alpert said. 

The system also employs reverse integration of physical and mental health services, Ms. Velji said — integrating physical care services into primarily behavioral spaces.  

"They may be coming to us for a mental health issue, to maintain that connection and to make sure they're well, for example, in our addiction clinic, we also have primary care that's able to partner with our mental health clinician to support the care for other conditions those patients are facing."

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