(5) that once these patients are inappropriately assigned to our state hospital alcoholism programs (a) they will continue to return, (b) they are inclined to leave before medically discharged or recommended discharge, (c) they tend to interfere with more effective programming for those who are more able to benefit from the programs. OBJECTIVE To establish a cooperative program between the Department of Mental Health, Section on Alcohol Programs, the Illinois Department of Public Aid, and the Cook County Department of Public Aid; To provide emergency psychiatric care of indigent persons in general hospitals for acute intoxication; To short-circuit the general flow of the alcoholic patient away from the state hospital alcoholism programs to the community agency programs. PROGRAM In response to this situation, we have developed a program which provides medical treatment for acutely intoxicated patients in certain acceptable general hospitals. (Appendix VII) Hospitals, where this care can be given, are available. Aside from the money requested by this grant, the cost of this care will be covered by payment from the Department of Public Aid and its county representatives in situations in which patients are eligible for coverage for medical expenses. We believe that some category of assistance will compensate for this service in a majority of cases. In other instances the cost will be paid by the patient's insurance, family, or by the patient himself. However, funds requested in this grant are vital because there will be a significant group of patients unable to pay from personal resources and yet not eligible for payment through any of the categories of assistance available through Public Aid. Funds from this grant request, also, enable us to assure each participating hospital against loss incurred through caring for our indigent patients. This program will include the entire state, depending upon where this programming is indicated and where local arrangements permit its development. The present most pressing situation is in metropolitan Chicago. It is our expectation that this program will be a solution, or a very substantial step toward a solution, of the three conditions which we have long recognized as needing correction. This innovation of service is much more far-reaching in its implications. First, it is a step toward anticipating the tremendous demands, previously mentioned, which these changes will make on our health services. A second significant point is that this program is very much in keeping with the current decentralization of health services in general. We believe that it makes much better sense to treat the alcoholic patient in his own community and in existing health facilities or in those facilities which are being planned than to direct further effort toward establishing special installations for the care of the acutely intoxicated at this time. The providing of medical treatment in general hospitals for acutely intoxicated people is only one phase of our plan. The question of intake is highly relevant. At the outset, patients would be admitted chiefly from the Hospital Referral Serivces and from the admitting service of other to be designated programs, but our chief mission is to pick up patients before they arrive at state hospitals. Since our program includes several general hospitals, we include a "clearing center" which would keep carefully compiled information regarding the movement of patients in and out of beds set aside for acutely intoxicated patients. This clearing center would serve all sources of referral, both in and out. Also, our net work of ancillary programs will be expanded to permit referral for ongoing aftercare. (Appendix VI) At the outset, this program would not be sufficient to deal with all patients seeking hospitalization because of acute intoxication. For example, this program would have to be greatly expanded before it could accommodate the hundreds of intoxicated patients who are now jailed daily until they recover from the acute stages of intoxication. The criteria for admission for medical treatment of the acute intoxicated would involve the following: (1) acute intoxication with or without complications; (2) indications that the patient cannot be restored to a nontoxic state in his home; (3) acceptance of hospitalization on a voluntary basis; (4) behavior compatible with admission to a general hospital. The period of hospitalization would be brief, three to five days, in as many instances as possible. Screening and diagnosis would be done before discharge as much as practicable, but this could be completed at the clearing center. Based on the screening and diagnosis, an aftercare plan will be made on each case with appropriate referral to existing facilities in the area closest to where the patient resides. Referral could be to outpatient clinics, state hospital programs, halfway houses, missions, service centers, vocational rehabilitation, Veterans Administration, employment agencies, and public aid. Emphasis will be on follow-up from the very outset, although this is a very challenging task. We visualize this program as a model for future expansion into both existing and planned medical services. IMPLEMENTATION Tentative plans have been made with three Chicago area general hospitals to initially involve themselves in this project. (Appendix VI) An attempt has been made to determine a per diem cost for each of the participating hospitals based on the latest cost analysis, as published by the Department of Public Health. Pending the approval of this grant, we have received a firm agreement with the Martha Washington Hospital (Appendix VII) tentative per diem amounts from Alexian Brothers and Grant Hospitals. As indicated in Appendix VII, the per diem rate for Martha Washington would be $50 and it would appear that the other two hospitals would vary between that amount and $60. The per diem amounts that we are attempting to establish with the participating hospitals include all charges excepting surgical and psychiatric services. Where it can be readily assessed that the patient requires either prolonged or intensive care for conditions other than detoxification, he would not be referred to this program. Realizing that over 3,000 patients were admitted to Chicago area state hospitals in 1967, and that the rate of alcoholism admissions across the state rose 2,000 patients in 1967 over 1966, it would be extremely difficult to immediately meet the obvious needs, rather it is our intent to establish a pilot program with whatever funds are available and to extend the program as additional funds become available from other sources. REQUEST In view of the above, the Section on Alcohol Programs requests your consideration of funds in the amount of $250,000 for the remainder of the present biennium. These funds augmented by funds from the Department of Public Aid and the cost shared by third parties, in behalf of our patients, will enable us to establish a pilot program for the management of the indigent alcoholic patient in the metropolitan Chicago area. Recognizing that the same problems exist in other areas throughout the state, we further recommend consideration of an amount of $100,000 to seed these programs where other funding and programs are not available. ADMINISTERING AGENTS That the Section on Alcohol Programs be responsible for the administration and supervision of the funds requested. APPENDIX I (Following paragraph extrapolated from Department of Mental Health Annual Report-July 1966-June 1967.) The number of persons with a primary diagnosis of alcoholism continue to comprise more than one third of the non-emergency applications processed through this Unit. During the last nine months of the past fiscal year eighteen hundred and thirty (1830) persons were assigned to Department of Mental Health facilities as chronic alcoholics. Many had previous records of hospitalization. This group of patients demand services, and all too often misuse available facilities. Many are in need of medical attention, which is often denied at the only medical resource available to them. Many are undomiciled, estranged from families, and unemployed. They see in Department of Mental Health facilities a temporary room and board situation as well as a place where medical attention is available if needed. It is felt repeated request for readmission may be due to a lack of adequate services for the alcoholic in our facilities, as well as a lack of motivation for change on the part of the patients. This writer is aware of the shortage of staff and space, however, a more concentrated effort to coordinate our present resources may prove definitive in the care and treatment of the alcoholic. APPENDIX II Estimated number of alcoholics in Illinois according to the Jellinek estimating formula, calendar years 1952–66 Year: 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 (plus) Source Department of Mental Health, Division of Planning and Evaluation Services, Statistical Research Section, June 30, 1967. 1954 1955 1956. 1957. 1958. 1959 1960. 1961 1962. 1963 1964 1975. 1966. 1967. APPENDIX III MALE ADMISSIONS TO ILLINOIS STATE HOSPITALS, FISCAL YEARS 1954-66 Source: Department of Mental Health, Division of Planning and Evaluation Services, Statistical Research Section, June 30, 1967. 93-453-68-18 APPENDIX IV Admission of patients to Illinois State hospitals with a diagnosis of alcoholism fiscal year 1953-66 Source: Department of Mental Health, Division of Planning and Evaluation Services, Statistical Research Section, June 30, 1967. APPENDIX V NORTH AMERICAN ASSOCIATION OF ALCOHOLISM PROGRAM, NEWS MEMORANDUM Re: The Administration Alcoholism Bill. To: All members. From: A. H. Hewlett, Executive Secretary. Following through on President Johnson's alcoholism legislative recommendations contained in his recent Crime message to Congress, Representative Harley O. Staggers (Democrat-West Virginia), chairman of the House Committee on Interstate and Foreign Commerce, has introduced the "Alcoholic and Narcotic Addict Rehabilitation Amendments of 1968." This bill (HR-15281) would amend the Community Mental Health Centers Act to include three new titles one for Alcoholic Rehabilitation, the second for Narcotic Addiction, and the third a general title relating to the funding of both. Title I-Alcoholism. The proposal would add "Part C-Alcoholism" to the Community Mental Health Centers Act and would provide: A. Construction grants for facilities for the prevention and treatment of alcoholism. Such grants may be made only to public or nonprofit private agencies or organizations, the applications of which must meet the requirements for approval set forth in clauses 1) through 5) and clause (A) of Section 205(a) of the Community Mental Health Centers Act. Applicants for such grants would be required 1) to show the need "for special facilities for the inpatent or outpatient treatment, or both, of alcoholics"; 2) to show satisfactory assurance that the services would be principally for persons residing in or near the particular community or communities in which the facility is to be located and that the facility services will provide at least those essential elements of comprehensive mental health services, and services for the prevention and treatment of alcoholism, including post institutional aftercare and rehabilitation that are prescribed by the Secretary of HEW; 3) to assure that the application has been approval and recommended by the single State agency designated by the State as being the agency primarily responsible for care and treatment of alcoholics in the State, and, in case this agency is different from the agency designated as the Mental Health authority, assurance must be shown that the application has also been approved and recommended by the Mental Health authority; 4) to show that the project is entitled to priority over other projects for treatment of alcoholism; 5) to show that adequate provision has been made for furnishing needed services for persons unable to pay in accordance with regulations of the Secretary under Section 203 (4) and for compliance with State standards for operation and maintenance; 6) the amount of any such grant may not be in excess of 66% percent, as the Secretary may determine. B. Staffing, Operation and Maintenance Grants under Section 261 of the Community Mental Health Centers Act may be made to any public or nonprofit private agencies and organizations for new facilities or for new services in existing facilities for prevention and treatment of alcoholism. Grants under this section would be made only on applications meeting requirements under part B of the Mental Health Centers Act. In making such grants, the Secretary would consider relative need for services, population of the area to be served and financial need. Federal matching funds would be available over a 10 year period, the first year of which the Federal percentage would not be more than 90%, 80% for the second year, 70% for the third, 60% for the fourth and 50% for the next 6 years. C. Specialized Facilities. Grants from appropriations under Section 261 of the Mental Health Centers Act would also be made for projects for construction, operation, staffing and maintenance of specialized residential and other facilities, such as halfway houses, day care centers and hostels, for the treatment of homeless alcoholics. Such grants would be made only for facilities which 1) are affiliated with a community mental health center meeting the essential elements of comprehensive community mental health services prescribed by the Secretary, or 2) are not so affiliated but with respect to which satisfactory provision (as determined by the Secretary) has been made for appropriate utilization of existing community resources needed for an adequate program of prevention and treatment of alcoholism. D. Short Title. This part (everything outlined above) is to be cited as the "Alcoholic Rehabilitation Act of 1968." Title II-Narcotic Addiction. HR-15281 would further amend the Community Mental Health Centers Act to include "Part D-Narcotic Addict Rehabilitation" which would provide: A. Grants under Section 261 to assist in projects for constructing, operating, staffing and maintaining treatment centers and facilities (including post hospitalization treatment centers and facilities) for narcotic addicts within the states. This grant program, as it deals with the kinds of activities authorized by parts A and B of the Mental Health Centers Act will be carried out consistently with the grant programs under that Act except to the extent that in the Secretary's judgment, special consideration would make differences appropriate. B. Grants may be made beginning July 1, 1968 through June 30, 1970 to public or nonprofit private agencies and organizations to cover part or all of the cost in 1) developing specialized training programs or materials or in-service training or short-term or refresher courses with respect to the prevention and treatment of narcotic addiction; 2) training personnel to operate, supervise and administer such services; and 3) conducting surveys and field trials to evaluate the adequacy of the programs for prevention and treatment of narcotic addiction. Title III-General. HR-15281 would authoribe appropriations for both parts above to begin July 1, 1968 through June 30, 1970, to provide such sums as may be necessary (to be determined by Congress) for project grants for construction, operation, staffing and maintenance of facilities described above. Further, appropriations beginning with the years July 1, 1970 through the next eight years would be authorized to be made for continuance of those projects begun prior to June 30, 1970. This title would further amend Part B of the Community Mental Health Centers Act to add a new section (Sec. 225) for "Facilities Relating to Rehabilitation of Alcoholics or Narcotic Addicts." This new section would specify that alcoholism or narcotic addiction projects undertaken by community mental health centers would come under the requirements and provisions set forth in the new titles proposed for alcoholism and narcotic addiction outlined above. Cost of Administration. This bill would also amend the Mental Retardation Facilities and Community Mental Health Centers Construction Act of 1963 to provide up to one half of the administration expenses annually except that not more than 2 percent of the total allotments for any one year, or $50,000, whichever is less, shall be available. |