A strong family and caregiver support system is important to the continued treatment of mental health patients after they leave the hospital. In fact, it is critical in assisting with medication adherence to ensure consumers appear for their appointments with service providers, particularly during transition between inpatient and outpatient settings. However, when discussing family support systems, some physicians contest that less than half of consumers have an “adequate” social support system to meet their daily needs.

Because a strong family support system cannot be “manufactured” or bought through funding, it is important to focus on other controllable issues that can create a positive impact on the continuity of care for mental illness patients. A recent mental health study identified three factors that positively influence the efficiency of the transition process between inpatient facility discharge and intake with a community-based program.

These include:

* when communication occurs “within system”
* when computer systems/consumer records are shared
* when an ACT (or similar) team is involved

Of course, in addition to having a strong family and care support, there are other issues involved. Public policy and government funding are two particularly impactful issues. From a mental healthcare systems perspective, matters involving policy and financing issues impacting continuity of care can be conceptualized along two broad approaches:

1.) Building service coordination into the payment rates and expectations for certain services.

This approach is conceptually similar to what is referred to as Primary Care Case Management in some disease management or chronic care programs.

2.) Defining certain consultation and care coordination services as covered benefits.

Under the first approach, consultation and care coordination would be a defined benefit with its own billing codes and defined coverage limits, eligible providers, allowed situations, and limitations and exclusions. For example, situations where this might be applicable include: hospital discharge planning and short-term transition support; developmental transitions (e.g. child to adult); coordination between primary care and mental health providers; consultation with primary care; consultation with other professionals to implement treatment plans (e.g. schools, residential programs); clinical coordination among multi-disciplinary teams, especially home-based services.

Under the second approach, coordination of care is built into “programs of mental healthcare” or episodes of care. This concept is seen in current disease management models and chronic care models and can include: assertive community treatment, multi-systemic therapy, and Dialectical Behavioral Therapy (DBT). Hospital payment methods assume linkage with step-down, aftercare, and outpatient services, similar conceptually to Medicare Part A that covers hospital stays and 100 days of nursing home or home health rehabilitation as follow-up, when necessary.

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