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Two innovative mental health programs were honored with APA's prestigious Gold Achievement Award at the Institute on Psychiatric Services, which was held in Los Angeles last month.
Two additional programs were recognized with APA's Significant Achievement Awards
The Gold Achievement Award winner of the category for small community-based programs was the Mental Health Center of Greater Manchester, N.H. The winner of the category for large academic institutionally sponsored programs was the McMaster Regional Mood Disorders Program of Hamilton Psychiatric Hospital in Hamilton, Ontario.
The Gold Achievement Award recognizes outstanding programs for persons with mental illness and developmental disabilities and includes a $5,000 prize made possible by a grant from Pfizer Inc., U.S. Pharmaceutical Group.
Daniel Potenza, M.D., clinical director of the Greater Manchester Mental Health Center's community support program, told Psychiatric News in a later interview, "The award is both a tribute to our staff who have learned dialectical behavioral therapy (DBT) and integrated it into clinical programs and tools and to the courage of our clients who have tried them."
Since 1994 the program has used DBT with potentially suicidal patients who have borderline personality disorder and are high users of care. The result has been a dramatic reduction in service use and costs, according to the October issue of the APA journal Psychiatric Services.
Potenza commented, "The key to DBT is balancing acceptance and change. By constant acceptance, patients can become observant and change the things they are unhappy with."
The program is based on group skills training, and participants must agree to participate for a year and sign a contract to that effect. The group is led by two therapists and meets for two and a half hours each week. Group members use workbooks to complete four training modules, each focusing on a different set of skills: "core mindfulness," which involves paying attention to one's experience by observing, describing what is perceived, and focusing on one thing at a time; emotional regulation of painful emotions; distress tolerance and interpersonal effectiveness, which is the ability to initiate desired changes and maintain relationships and self-respect, according to the journal article.
Program participants also meet for one hour a week with a therapist or case manager, who is also available for telephone consultation.
Typical and atypical neuroleptics are used to alleviate mood disruption, and SSRIs seem to lessen impulsivity, states the article.
Potenza noted that 22 patients have completed the 12-month program since the pilot project began in late 1994. Research on the first 14 participants showed a dramatic reduction in the use of services after completion compared with the year prior to program participation.
There was a 77 percent decrease in hospital days, a 76 percent decrease in partial hospital days, and a 56 percent decrease in crisis bed days. Visits to the emergency room were cut by 80 percent, notes the article.
Although the number of outpatient visits tripled and the total visit costs rose from $49,000 to $141,000, patients' hospital costs declined from $453,000 to $83,000. Total costs were cut by more than half, from $645,000 in the year prior to program entry to $273,000 at the completion of the 12-month program, according to the article.
Potenza commented, "The patients' quality of life also improved; they were less symptomatic, and eight were employed during the program."
A one-year transition group was added last year to reinforce the skills that patients learned during training and refine their application. They can also continue in individual therapy, noted Potenza.
"A less structured version of the program called DBT Lite has been implemented for patients who display aspects of borderline personality-disordered functioning without meeting the criteria for full-blown diagnoses," said Potenza.
A shorter version (16 weeks) of the program has been added to target adolescents with traits consistent with borderline personality disorder. Preliminary results have been similar to the adult group participants, added Potenza.
He noted that the expanded program was funded in Fiscal 1996-97 at about $520,000. About two-thirds came from third-party payers such as Medicaid and private insurance, and the state provided about $85,000. Another $60,000 came from program contracts with managed care companies, said Potenza.
More information about the community support program at the Mental Health Center of Greater Manchester is available by contacting Potenza by e-mail at potenzad@mhcgm.org or by telephone at (603) 668-4111, ext.5280.