Adult Mental Health

Rule 79 Case Management:
County agencies provide Rule 79 Mental Health Case Management to consumers of their counties who meet the eligibility criteria as stated in Minnesota Statutes.  Mental Health Case Managers receive referrals from consumers, families and friends of consumers, provider agencies, hospitals, medical clinics,  mental health centers, Intensive Residential Treatment Services (IRTS), community individuals, and law enforcement.  Case managers are advocates for consumers and work to insure that the consumers are able to live their lives as independently as possible.

Consumers in the community may choose to accept or refuse case management services.  Individuals admitted to a Behavioral Health Hospital and committed to the Commissioner of Human Services will receive case management services until the commitment ends which is usually six months after the commitment hearing.  After their legal status changes, they are offered the opportunity to continue with services.

Case managers meet with the consumer whenever they wish either through appointments or through drop-ins.  The consumer and case manager will meet to sign releases, complete a Functional Assessment (FA), and develop an Individual Consumer Support Plan (ICSP) that addresses information regarding the consumer’s strengths and needs.  Goals are developed to assist the consumer to live as independently as possible.  Case managers review assessments and talk with therapists, psychiatrists, and consumers about what they feel their needs are and with what they would like assistance.  Consumers have the right to choose to work on or to choose not to work on any goals.  Case managers make referrals to providers who assist the consumer with their needs.  They have contact with the consumer or collateral at least one time each month.  Quarterly reviews are held with the consumer.  To determine if further services are needed, providers meet together to discuss progress, concerns, or needs of the consumer.  Case managers also are available to work through crisis situations and, if needed, help the consumer find a safe place until the crisis passes.  Case managers meet as a Pre-Petition Screening Team to review commitment information submitted by physicians who are recommending commitment of an individual who is a danger to self or to others.  The Pre-Petition Screening Team makes recommendations to the Court and presents the information to the County Attorney.

Eligibility:
An adult who has a mental illness and meets at least one of the following criteria:

  • The adult has undergone two or more episodes of in patient care for mental illness within the preceding 24 months.
  • The adult has experienced a continuous psychiatric hospitalization or residential treatment exceeding six months’ duration with the preceding twelve months.
  • The adult has been treatment by a crisis team two or more times within the preceding twenty four months.
  • The adult:
    • Has a diagnosis of Schizophrenia, Bi Polar Disorder, Major Depression, or Borderline Personality Disorder;
    • Indicates a significant impairment in functioning; and
    • Has a written opinion from a mental health professional, in the last three years, stating that the adult is reasonably likely to have future episodes requiring in patient or residential treatment or unless on going case management or community support services are provided.
  • The consumer has, in the last three years, been committed as a person who is mentally ill and whose commitment has been stayed or continued.

Available Services

Assertive Community Treatment Teams (ACT):
ACT is an intensive, comprehensive, non-residential, rehabilitative mental health service team model.   Provided by multidisciplinary, qualified staff who have the capacity to provide most mental health services necessary to meet the consumer’s needs. Services are:

  • Directed to consumers with a serious mental illness who require intensive services.
  • Offered on a time unlimited basis and are available to recipients 24 hours per day, 7 days per week, 365 days per year.

Eligibility:

  • Be eligible for Medical Assistance (MA);  Mental Health Consortium has other funds to service non-MA consumers
  • Be adults eighteen years in age or older
  • Have a diagnosis of Severe Mental Illness (SMI), but currently limited to Schizophrenia, Schizoaffective Disorder,  or Bi Polar Disorder
  • Live within the area the ACT team serves

ACT Services:

  • Case management
  • Support and skills training in activities of daily living (self-care, home-making, financial management, transportation, health care)
  • Support and skills training in social, interpersonal relationships, and leisure time activities
  • Illness education and medication management
  • Assist in locating and maintaining safe and affordable housing with an emphasis on recipient’s choice and independent community housing
  • Psychological education to family members
  • Discharge supports are reduced as the consumer demonstrates increasing independence

Intensive Residential Treatment Services (IRTS)
Time limited mental health services provided in a residential setting to recipients in need of more restrictive setting and at risk of significant functional deterioration if they do not receive these services.  90 days stay with possibility of extension if they meet the MA requirements.  Requires extension after 90 days if consumer continues to meet admission criteria with active psychiatric symptoms and with functional limitations and the following:

  • Progress notes indicate that symptoms are reduced, but goals have not been met
  • The goals can be expected to be accomplished within the requested extended time frame
  • Documentation exists that shows attempts have been made unsuccessfully to coordinate care and transition  to other services

IRTS are designed to develop and enhance psychiatric stability, personal and emotional adjustment, self-sufficiency, and skills to live in a more independent setting.

  • 24 hour coverage in the delivery of rehabilitative services
  • Staff available to safely supervise and direct activities
  • Capacity to promptly and appropriately respond to emergent needs and may adjustment to staff to assure health and safety of recipients

Admission Criteria:

  • Have a mental illness based on a diagnostic assessment
  • Have functional limitations and inability to care for self in assessed areas
  • Is reasonably expected to commence or resume illness recovery skills and participate in active treatment
  • Is not responsive to treatment in a less restrictive setting
  • Needs the restrictive setting and is at risk of functional deterioration if IRT services are not received
  • Has one or more of the following:
    • History of two or more in-patient hospitalizations in the past year
    • Significant independent living instability
    • Homelessness
    • Increased abuse of alcohol and or drug use
    • Frequent use of mental health and related services with poor outcomes

Discharge Criteria:

  • Has met treatment plan goals and objectives
  • Shows evidence of decreased impairment of thought, mood, behavior, or perceptions and less restrictive community based alternatives exist and are appropriate
  • Has symptoms and needs that permit lesser level of service and adequate supports and services are in place
  • Is voluntarily involved in the Individual Treatment Plan (ITP) and no longer agrees to participate in IRTS
  • Has medical or physical health needs that exceed what can be done in a residential treatment setting
  • Does not participate in treatment
  • Does not make progress towards treatment goals and no expectation that progress will be made
  • Leaves against medical advice

Covered Services:

  • Supervision and direction
  • Individualized assessment and treatment planning
  • Crisis assistance
  • Nursing services
  • Interagency case coordination
  • Transition and discharge planning
  • Living skills development, including:
    •  Budgeting and shopping
    •  Cooking and nutrition
    •  Healthy living
    •  Household management
    •  Medication self administration
    •  Using transportation
  • Employment related skills
  • Integrated dual diagnosis treatment (mental health and chemical dependency)
  • Illness management recovery education about mental illness and relapse education
  • Family education about mental illness and treatment.

Partial hospitalization:
A time limited structured program of multiple and intensive psychotherapy and other therapeutic services provided by a multidisciplinary team and provided in an outpatient hospital facility.  The goal of partial hospitalization is to resolve or stabilize an acute episode of mental illness.

Eligibility:

  • Eligible for MA, General Assistance Medical Care (GAMC), or Minnesota Care
  • Be experiencing an acute episode of mental illness that meets the criteria for an in patient hospital admission
  • Have family or community resources needed to support and enable the consumer to benefit from less than 24 hour care
  • Be referred for a program by a physician

Adult Rehabilitation Mental Health Services (ARMHS):
This service is rehabilitative and is meant to enable the consumer to develop and enhance mental health stability, social competencies, personal and emotional adjustment, and independent living and community skills.  ARMHS instruct, assist, and support consumers with regaining or starting skills to live independently.

Eligibility:

  • Eligible for MA
  • 18 years or older diagnosed with a medical condition such as Mental Illness or Traumatic Brain Injury (TBI)
  • Has substantial disability and functional impairment in three or more life areas, has had a diagnostic assessment, and has had documentation that the consumer needs that level of service

Community Support Program (CSP):
A program to help people manage their mental health symptoms, participate in their community, learn medication management, and develop daily living skills.  Funding is from a County grant through individual service arrangements with the provider to work with consumers of the County.

Eligibility:

  • Diagnosed with a Severe Mental Illness (SMI) and residing in the County of service
  • Does not require MA eligibility
  • Willingness to accept the service