Joan B. Beasley, Ph.D., Director for START Services, UNH Institute on Disability/UCED
Throughout the United States, there is a growing trend to improve community services and supports with the provision of emergency or crisis respite beds outside the individual's home. This is an important service and the need should not be underestimated. Many individuals with intellectual disabilities and mental/behavioral health service needs may not require psychiatric inpatient stays but may require short term facility-based support to assist the individual and their caregiver during a time of acute difficulty. In addition, the expected length of stay in psychiatric inpatient facilities may require the use of transitional clinical respite as the next step before the return home. Furthermore, we have learned from experience that temporary removal from the place in which difficulties arise can help to inform caregivers about what is needed to prevent future problems. This is especially true if collaboration with the caregiver and an assessment of the crisis situation take place in the context of the provision of respite.
Historically, policy planners have underestimated the number of individuals and families who would benefit from planned clinical respite in order to avoid emergency situations and to assist families and individuals in need of a brief break. We know that for families of individuals with co-occurring disorders, access to services designed to support families may not be available due to the unique needs of their loved ones. Planned clinical respite is intended to serve individuals who have not been able to use respite in more traditional settings due to their on-going mental health and/or behavioral issues.
Planned clinical respite reduces strain on families, allows for ongoing assessment, caregiver and individual support, and offers a place to go for brief out-of-home stays. Providers of this service should be highly skilled; while providing a positive and recreational atmosphere, they also evaluate the individual's behavioral health and ongoing support needs. Typically, planned respite stays are on average a maximum of three days per visit, but can be as long as one week per visit.
The needs of families are often under-represented in program planning when it comes to planned clinical respite in spite of the fact that providing support to these families is both people-centered and cost effective. For example, the cost of 36 days a year (3 days a month) of planned respite, along with needed clinical and crisis prevention support is approximately $14,000 a year for an individual living with his or her family, while the cost of residential placement for the individual with co-occurring needs is on average $125,000 a year.
Sometimes improved public policy initiatives arise from a need to explore options more carefully during times of financial difficulty. It is my hope that more states will now consider the benefits of planned clinical respite for individuals who reside with their families to avoid unnecessary emergency room visits, hospitalizations that can often result in permanent residential placements during this time of severe fiscal constraint.
Lunsky, Y., Gracey, G., & Gelfand, S. (2008). Emergency psychiatric services for individuals with intellectual disabilities: Perspectives of hospital staff. Intellectual and Developmental Disabilities, 46(6), 446-445.
Weigle, K., Rubin, L., Phillips, J. & Fahs, J. (2006). The TN-START Annual Report . Report submitted to national advisory council of the TN START program. Chattanooga, TN: Team Centers.
Beasley, J.B. (2002)."Trends in coordinated and planned mental health service use by people with dual diagnosis". In J. Jacobson & R. Fletcher (Eds.) Contemporary dual diagnosis: MH/MR service models, Volume II: Partial andsSupportive services (pp. 35-51). Kingston, NY: NADD
For further information, please contact Dr. Beasley at Joan.firstname.lastname@example.org,
The "U.S. Public Policy Update" is an ongoing column in The NADD Bulletin. We welcome your comments and submissions for this column. To learn more or to contribute to this column you may contact Joan Beasley, Editor of the U.S. Public Policy Update at email@example.com.