Background: Funding for public mental health services in Maryland is incrementally shifting from state inpatient facilities to community fee for service providers. In 1987, as inpatient facilities downsized, Maryland’s Mental Hygiene Administration (MHA) fostered an initiative to transition older adults with stable but severe and persistent mental disorders into the community. An advanced practice nurse was hired to provide consultation and technical assistance to the staff of long term care facilities. Over next 13 years 700 older adults were placed in the community with a recidivism rate of 6%. In FY 2000 a grant from MHA provided the opportunity to develop additional similar positions. As cost shifting continues to occur, resources for this clientele must now emanate from a partnership of aging services and community adult mental health programs.
Method: The advanced practice nurse works through the administrative level of the Core Service Agencies (CSA), the MHA designated agency to monitor, plan, and manage local public mental health services. Through four avenues: education, consultation, technical assistance, and interagency collaboration/coordination between aging and mental health services, the nurse can oversee resources, ensure appropriateness and quality of care, increase the community’s capacity to meet the needs of older adults with mental disabilities, decrease recidivism, facilitate access to services, decrease stigma, and develop programs unique to older adults with mental illness.
Results: In FY 2000, 2 geropsychiatric nurse consultants were hired to provide consultation and technical assistance to 3 counties representing rural, suburban and urban settings. In 2 years, 100 clients have been transitioned from state inpatient facilities with a recidivism rate of 2%. 10 clients experienced short-term hospital stays for medication adjustment, but were returned to the community. 145 training opportunities were made available to providers and direct care staff in community and long term care settings regarding management of behavioral disorders, mental health, and aging topics. No evidence of trainings through coordination of mental health and long term care services prior to grant positions could be found.
Conclusion: This is an effective model using the existing hierarchical structure of the Public Mental Health system, in combination with the expertise of an advanced practice nurse specializing in geriatrics and mental health. The results of the original initiative and the grant positions indicate that this model is successful in transitioning older institutionalized adults with severe persistent mental disorders into the community.
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