Consumers' Rights When Applying to License Mental Health Housing: Part Two
(Column: Ask the Housing Experts)
All supportive housing programs that serve people with mental illness operate under rules and regulations. Different sets of regulations apply to different models of housing, depending on who licenses or funds the program. Part 595 of the New York State Mental Hygiene Law establishes the regulations that apply to all housing programs licensed by the New York State Office of Mental Health (OMH). Of the different types of supportive housing here in New York City, five are required to follow the 595 regulations (595's): the Supervised Community Residence, the MICA Community Residence, Apartment Treatment programs, the Community Residence/Single Room Occupancy (CR/SRO), and the Residential Care Center for Adults (RCCA). The 595's establish the rules by which a mental health residential program must operate, and they define both the rights of applicants to the program and the rights of residents in these programs. This article is the second in a two part series about the 595 regulations; in this part, we will be focusing on an individual's rights when they are discharged from one of the above mentioned models of supportive housing.
According to the regulations, residents should have input in identifying the next level of housing that they want and need, and this process should be a collaborative effort between the resident and program staff. If the goal is to move to a more independent level of housing, the resident's service plan should include teaching those skills the resident needs to have to be successful in their move to more independent housing.
According to the 595's, each program should begin the discharge planning process for each resident from the day they are admitted to the program, and continue throughout their stay in the residential program. The discharge planning process includes the following:
The resident, the program staff, other community service providers, and collateral contacts should be involved in the process as needed and as agreed to by the resident;
There should be a clinical assessment of the resident's psychiatric level of functioning, including an evaluation of the resident's rehabilitation, physical, social, and residential needs and goals. This is done by trained, experienced qualified clinical staff;
The resident should be offered appropriate residential and necessary service options;
Completed referrals to appropriate community-based residential and service providers;
Appointments should be arranged, with the agreement of the resident, to community-based residential and service providers.
According to the 595's, any resident who is discharge-ready may be discharged. Residents may also request to be discharged at any time. A resident is ready for discharge only when all of the aforementioned discharge planning activities have been fully followed; appropriate alternative residential settings have been identified, and the resident is willing to move to such settings.
If a resident is not discharge-ready, they can be discharged if discharge planning activities have been followed as much as possible under the given circumstances, and at least one of the following conditions applies:
1. The resident has permanently vacated the residence. To discharge a resident using this condition, the program must determine that the resident has voluntarily left the residence with no apparent intent to return. The program must hold the bed for the resident, but for no more than 30 days.
2. The resident's medical status, psychiatric status, and/or capacity for self-preservation, according to the 595's, requires a level of care other than what the residential program can provide. Qualified clinical staff must conduct a clinical assessment of the resident. Additionally, the needed services or supports must not be available under the Americans with Disabilities Act. The resident must be notified in writing of the decision to discharge and the need to locate alternative housing, and can participate in the creation of a mutually agreed discharge plan. If an agreement cannot be reached, the program must give the resident a written 30-day notice of their intent to terminate residency providing the reason(s) for termination, indications as to what the resident can do to correct the situation and alternative residential and service options. If the situation is not corrected within the first 30-day period, the provider shall give the resident a written final notice of their intent to terminate residency within the next 30 days, listing the reasons for termination and alternative residential and service options.
3. The resident fails to meet one or more responsibilities for residency as described in the 595 regulations, such as violating the terms of the residency agreement (i.e., not paying program fees, violating rules regarding visitors, etc.), failing to respect the quiet enjoyment of other residents, acting in ways that adversely impact other residents and/or creating health or safety hazards in the residential setting. Programs should follow the same protocols as indicated in the above paragraph.
4. The resident's behavior poses an immediate and substantial threat to the health, safety and well being of themselves or others, or the resident creates a serious and ongoing disruption of the therapeutic environment of the residential program. There must be documentation of the behavior in the case record. The service provider may immediately arrange for the removal of the resident to an appropriate location (given the resident's current status, needs, and conduct) that can provide reasonable safety for the resident. Removal can be conducted by a mental health crisis team, where available or, a police officer or, if necessary, a sheriff's department. In such cases, a clinical assessment by clinical staff should determine if the resident can re-enter the program or if discharge from the program is recommended. If discharge is recommended, the service provider may give the resident a written final notice of the intent to terminate residency within 30 days, indicating the reasons for termination, and offer alternative residential and service options.
If a resident is hospitalized, providers should contact the hospital inpatient staff, the resident, and other collateral contacts to plan for the return of the resident upon discharge. The provider must hold the resident's bed for at least 45 days of such hospitalization, unless the provider and the resident agree that the resident will not return to the program. The provider should hold the resident's bed for up to 90 days if the provider determines that the resident will return within that period of time. Former residents of the residential program who do not meet the above 45 or 90 day bed hold criteria shall be given priority consideration for readmission.