The State of Delaware and the U.S. Department of Justice have agreed on a settlement that closes the book on a federal probe of issues at the Delaware Psychiatric Center (DPC). The investigation has been ongoing since November 2007. The settlement outlines steps the state will take to overhaul how it handles patients with mental illness, moving Delaware away from what the federal government argued was unnecessary institutionalization of patients, to a system of community-based solutions.
"At DPC, in 2007, we were failing our neighbors and our friends. The facility needed to improve and it had to come fast," said Governor Jack Markell, “And DPC has come a long way.” Markell continued, “But today's announcement is not just about conditions at DPC. That's part of it, but it's bigger than that. We are charting a course that has the capacity to transform the provision of mental health care in the state."
The settlement agreement calls for Delaware to complete a number of initiatives between January 2012 and July 2016. Those initiatives include:
- Creation of a statewide crisis system that includes a hotline, mobile teams, walk-in centers, crisis stabilization services and dedicated apartments.
- Development of a more intensive case management system that aims to deliver comprehensive, individualized and flexible support, service and rehabilitation to individuals in their homes an communities.
- Expansion of vouchers and subsidies for housing, along with additional employment and rehabilitation service and peer and family support services.
The settlement will be enforced by a monitor agreed on by the State of Delaware and the U.S. Department of Justice.
Assistant U.S. Attorney General Thomas Perez called the announcement of the settlement "Independence Day here in Delaware for so many people with mental illness."
"It enables people with disabilities to move into the sunshine of independence, into the sunshine of community-based alternatives, and it allows them to do something that they want to do, which is to become tax payers because this system will enable, with the various supports that are in place, so many people to hold a job, become a taxpayer, and become a vibrant member of our community," said Perez.
Last November, Perez authored a report that concluded that Delaware's current system of dealing with patients with mental illness violates the Americans with Disabilities Act and that a large majority of current patients could be living in community settings. It criticized the excessive use of restraints and seclusion in response to aggressive behavior and advocated cutting to average length of stay at the Delaware Psychiatric Center from three years to six month. It also linked deficiencies in care with three patient deaths in 2009 - two suicides and a case where a patient who collapsed was ignored by staff.
Delaware's Department of Health and Social Services secretary Rita Landgraf says the plan laid out in the settlement will assist some 3,000 Delawareans who may have otherwise faced institutionalization and help cut the number of patients at the Delaware Psychiatric Center from around 160 to about 125.
"I believe that this agreement reflects where we want to take our state. We want to make this state a leader in mental health services. And the U.S. Department of Justice shares in that vision," said Landgraf. "To the U.S. Department of Justice this is about fulfilling commitments under the Americans with Disabilities Act, but to us it is about providing service to us, our neighbors, our family members and our friends, who have persistent mental health issues, but who can with the right support be very valuable members of the community."
Landgraf estimates implementing the changes will cost the state approximately four million dollars, but Perez stated there will be long term economic benefits for the state by transitioning to what he says is a more cost-effective community based approach.
"According to current estimates, it costs approximately $220,000 a year to treat a person at the Delaware Psychiatric Center, and the state foots 100 percent of that bill," noted Perez. "Under the new paradigm that this agreement fosters, that same person can be treated in the community for less than $50,000."
But Markell believes the state will ultimately be judged not by the economics of the settlement, but by the results of care provided.
"How well we do once a person is institutionalized is one thing. But making sure they are not institutionalized in the first place is a loftier goal and one we commit to today." said Markell.