Mental Health Services - Ralph H. Johnson VA Medical Center

Mental Health ServicesInformation GuideRevised 02/04/2016Primary Care/Mental HealthIntegration (PC/MHI):General OutpatientMental Health The in-between step for Primary Careand Mental Health Services.Provide education and support toPrimary Care providers in their treatmentof mental health symptoms.Brief medication management, psychotherapy,and care management to Veteranswhen primary care isn’t enough.Services include open access to providers, suchas walk-ins, warm handoffs, and self-referrals.Primary goals are to either: 1) successfullytreat Veterans and return them to the care oftheir primary care providers, or 2) successfullytransition Veterans to appropriate mental healthservices for continued, longer-term care.Of note, Veterans with severe mental illness willcompletely bypass PC/MHI services straightinto mental health due to symptom severity. Provides assessments & management of carefor patients with Schizophrenia, Schizoaffectivedisorder, Bipolar affective disorder, Depression,Anxiety, as well as mental health screenings fortransplant candidates, and homeless program.Case management to assess patient needs, refers totreatment modalities within mental health specificto the patient’s issues, and speaks with patientsabout achieving and maintaining overall wellness.Open access providing immediate carewhen needed and guaranteeing thatpatients are seen in a timely manner.Electroconvulsive therapy for severelydepressed patients that have failed otherforms of medication management.Nursing support such as blood pressurechecks, flu shots, ppd placement, andreviewing reminders for complete care.Making referrals to various groups that areoffered, neuropsychology testing, compensatedwork therapy, VA supported housing, cognitivebehavioral therapy, and marital therapy.VARalph H. Johnson VA Medical Center

PRRC/VEC: Pyscho-SocialRehabilitation and Recovery (PRRC)Substance AbuseTreatment Center (SATC)VETERANS ENRICHMENT CENTER (VEC)The Substance Abuse Treatment Clinic (SATC)is a multi-disciplinary treatment team. Ourteam of psychiatrists, psychologists, nurses,social workers, and a peer support specialistprovide individual and group psychotherapy,medication management services (includingoutpatient detox), and aftercare offerings.The VEC is a transitional learning center that teachesskills, offers supports, and promotes communityopportunities essential for a Veteran to develop anactive and meaningful life in their home community. Veterans living with a diagnosis of Schizophrenia,Schizo-affective Disorder, Bipolar, MajorDepressive Disorder, and/or Severe PTSD.Daily functional life is seriously limitedas results of the illness.We are eager to work with Veterans on theirpersonalized recovery goals of abstinenceand harm reduction as well as self-sufficiencyand improving overall quality of life.REQUIREMENTS FOR REFERRAL Our Intensive Outpatient Program runs 5days/week and involves attendance at dailygroup therapy sessions and regular meetingswith case managers for individualized work.Veteran must have a diagnosis of a SevereMental Illness noted above, and;Major functional impairment in daily life fromthe SMI that would equal a GAF score of 50Veteran is interested in participationas a student at the PRRCVeteran is independent, managing owntransportation and self-careParticipation is voluntary and flexibleThe SATC also offers Opioid ReplacementTherapy via the COAST team (CharlestonOpioid Assessment and Substitution Therapy).Health Care for Homeless Veterans (HCHV) ProgramThe mission of the HCHV program is to end homelessness among Veterans and Veteranswith families through outreach efforts and Veteran and community partnerships. Veterans are engaged in treatmentand rehabilitation programs.HCHV Eligibility: Homeless Male andFemale Veterans with and withoutfamilies that meet program criteria.The Homeless Program has a full continuumof care in offering housing case managementservices to Veterans and includes: Grant and Per Diem/Contracttransitional treatment beds HUD-VASH permanent community placement,a joint partnership between the VA and HUDto provide eligible Veterans and Veteranswith families HUD Housing Choice Vouchersand VA supportive treatment services.Services are individualized, personcentered, strength-based, and promotehope, responsibility, and respect.2 Ralph H. Johnson VA Medical CenterSERVICES INCLUDE Case ManagementHCHV OutreachHealth Care (HPACT)Residential Treatment for male and female Veteransand male or female Veterans with childrenConsultationHCHV Walk-In ClinicGPD Dental ProgramHUD-VASH-(VA Supported PermanentCommunity Housing): HCHV Telehealth ClinicNational Call Center for Homeless VeteranIneligible Veterans ServicesPeer SupportSSVF ReferralsCommunity Resource and Referral Center

Couples & Family ClinicRespond to any Consult or directreferral with an initial (usuallyby phone) contact to confirmthat each partner or familymember signs on to evaluationand therapy. Appointments aretypically scheduled with cotherapy teams within 2 weeks.Evidence-based couple and familytherapies that are sophisticatedand focus feelings, thoughts, andbehaviors in relationships (EFT, IBCT,CBCT for PTSD, BCT for SubstanceUse Disorders, PICT, etc.).Typically 3 evaluation sessions (jointinterview, individual relationshipassessment interviews, and thefeedback session leading topatient-centered collaborativegoal and objective setting.Therapy sessions usually goes for6 to 12 sessions, the couple orfamily drive both the number ofsessions and frequency of sessions.We not only obtain a base-linequestionnaire data assessment (largequestionnaire packet) but also trackoutcome progress using a 2 pageweekly questionnaire filled out atthe beginning of each session.About one-third to one-half of ourcouples and families are seen viaCBOC or Home-based Telehealth.We see couples pre-marriage, duringmarriage, and post-marriage. We seefamilies with young, teenage, or adultchildren – also multigenerationalfamilies. We see all couples andfamilies with major or minor comorbidities (e.g., PTSD, mood andanxiety disorders, pain, substanceuse, medical problems unless theco-morbidity is severe (we thenmay refer for individual therapywith or without couples therapy).Overall, our effectiveness oroutcomes match the rate of the beststudies out there --- i.e., about 50% ofcouples or families make statisticallysignificant positive change ANDclinically significant change (movingfrom the clinically distressed stateto the non-distressed state).3A Inpatient Recovery UnitThe 3A inpatient unit treats veteranswith mental disorders that aresevere enough to significantlyimpair functioning or make them animminent danger to self or others.Average length of stay is 9-12 days.Common disorders treated on theinpatient unit include depression,bipolar disorder, schizophrenia,substance use disorders, anxietydisorders and dementia.Patients are treated using a recoverymodel of care that ensures everypatient has the opportunityto recover on some level.Patients work with nursing, socialwork, MDs, pharmacy on treatmentplanning. Patients are offereddaily group programming.There are 2 attending physicians onthe unit (Dr. Christine Pelic and Dr.Paul Everman). There will be a 3rdattending soon with unit expansion.All patients have discharge followup in 7 days. High risk patients needfollow up weekly for 4 weeks.Compensated Work Therapy (CWT)CWT provides vocational rehabilitation services toVeterans currently receiving mental health treatment.Referrals are made by consult from the mental healthprovider and include the following programs:SUPPORTED EMPLOYMENTTRANSITIONAL WORK COMMUNITY BASED EMPLOYMENT SERVICES Veterans with diagnoses of PTSD, MajorDepression, Bipolar Disorder, substance abuse,other anxiety disorder, or homelessnessVeterans who are not ready to seek immediatecompetitive employment and have Identifiedspecific goals for treatment that will providethem with the knowledge, skills, and abilitiesto be able to obtain competitive employmentfollowing successful completion of the programVeterans assigned participate in atemporary paid work experiences Veterans referred with a primary diagnosisof psychosis, bipolar disorder, schizophrenia,or schizoaffective disorderVETERANS WHO BECAUSE OF THE SEVERITY OFTHEIR MENTAL ILLNESS WOULD NOT BE ABLE TOFUNCTION INDEPENDENTLY IN EMPLOYMENTWITHOUT INTENSIVE ONGOING SUPPORTVeterans who are homeless or currentlyreceiving mental health care that are ready forcompetitive employment and need short termassistance with job search in the community.www.charleston.va.gov 3

Homeless Patient Aligned Care (H-PACT)HPACT is designed to ensure timely andeffective treatment for homeless Veteransthrough two components: Mon-Fri walkin hours and scheduled appointments.Provides comprehensive health care and psychosocialservices to promote, maintain, and restore healthfor the homeless Veteran. The aim is to providepreventative care as well as minimize the effects ofillness and disability and to improve quality of life.ELIGIBILITY CRITERIAHomeless Veterans must be without a fixed, stableaddress of residence, or in a transitional housingsituation, at the time of their initial visit. As homelessVeterans frequently cycle in and out of homelessness, aVeteran may continue to attend clinic once housed tomaintain continuity of care. The Veteran may changeto a traditional primary care provider per request and/or if deemed appropriate by the (HPACT) team.REFERRAL PROCESSHomeless Veterans may be referred through directtelephone contact to the HPACT, from outpatientclinics, homeless programs, ED, inpatient services,CBOC’s in VAMC catchment area, or through selfreferral. CPRS consult is available as well for nonurgent referrals (primarily from traditional PACT whenVeteran seems appropriate for HPACT services).The Philosophy is that the homeless Veteranshould be afforded the same high level ofprimary care and preventative healthcare servicesavailable to non-homeless Veterans with thegoal of achievement of optimum wellness.HPACT, through comprehensive assessment, treatment,education, and referral will provide a venue of care thatis accessible, timely, and customized to meet the uniqueneeds of the homeless Veteran. The expected outcomesare decreased emergency room visits, decreasedinpatient hospitalizations, improved quality of life,housing placement, and improved patient satisfaction.HOURS OF OPERATIONHPACT is open 8:00 am to 4:30 pm, Monday throughFriday, to see patients by scheduled and unscheduledappointments. Unscheduled patients are Triaged.H-PACT SCOPE OF SERVICES EXIT CRITERIATransfer out of HPACT will occur if they aredeceased, move out of the area, become stablyhoused for at least 1 year, have not been seen for 24 months or if the Veteran requests transfer.4 Ralph H. Johnson VA Medical Center Evaluation and assessment of the patientProvision of medical and mental health careInclusion of the patient in the planning of carePreventive health care and educationReferral to specialty clinicsKnowledge of available resourcesPlan for follow-up to hospitalizations when requiredIntegration with Homeless programs (HCHV, GPD,HUD-VASH, VJO, HVSEP, SATC) to facilitate referrals totransitional housing, emergency shelters, substanceabuse and mental health programs, employmentassistance, and other community resources.Limited transportation assistance – 1 day bus passand meal assistance (typically one each per Veteran)Immunizations, vital signs and screenings,orders for radiology, lab, prosthetics or otherspecialists as indicated, ordering of nonnarcotic prescription medications.