RIGHTS UNDER THE LANTERMAN ACT

Chapter Ten
Services and Supports
for People with Dual Diagnosis

·       What It Means to be Dually Diagnosed

·       Services and Supports for Mental Health Needs

·       Responsibilities of Regional Centers

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Written by: PROTECTION AND ADVOCACY, INC.
Publication #5063.01 – English
Copyright © 1983 by PAI - REVISED EDITION 2006

Protection and Advocacy, Inc. (PAI), is a nonprofit agency that works with people with disabilities. PAI provides a variety of advocacy services, including information and referral, technical assistance, and direct representation. For information or assistance with an immediate problem, call:

PAI

Toll Free: (800) 776-5746
www.pai-ca.org

PAI receives funding from a variety of state and federal programs, providing advocacy services to people with disabilities under seven federal statutes and two state contracts. Any opinions, findings, recommendations or conclusions expressed in this publication are those of the authors and do not necessarily reflect the views of the organizations which fund PAI.

OCRA

Toll Free: (800) 390-7032

The Office of Clients’ Rights Advocacy (OCRA) is a statewide office run by Protection & Advocacy, Inc., through a contract with the California Department of Developmental Services. OCRA employs a Clients’ Rights Advocate (CRA) at each regional center. The CRA is a person trained to help protect the rights of people with developmental disabilities. Appendix Z lists the Clients’ Rights Advocate for each regional center along with their contact information.

TABLE OF CONTENTS

1.     What does “dual diagnosis” mean?  10-1

2.     If I have both a psychiatric disability and a developmental disability, how does the regional center make sure I get the mental health and other services I need?  10-1

3.     What are regional center’s obligations to collaborate with county mental health agencies?  10-2

4.     If my child has a psychiatric disability, what mental health services are available him or her?  10-3

5.     Can a county mental health agency deny me mental health services solely because I have a developmental disability in addition to a psychiatric disability?  10-5

6.     What are my rights if I am denied mental health services because I have a developmental disability or for any other reason?  10-6

7.     What if I have a developmental and a psychiatric disability and both the regional center and mental health agency tell me they do not have the type of placement or services and supports to meet my needs?  10-8

8.     What are the responsibilities of the regional center if I am in the psychiatric unit of a hospital?  10-8

9.     What specialized living arrangements have been developed or are being developed for people with dual diagnoses?  10-9

Appendix Q: State Department of Mental Health: Specialty Mental Health Consolidation Part II (Included and Excluded Diagnoses)

 

CHAPTER TEN

Services and Supports
For People With Dual Diagnosis

·       What It Means to be Dually Diagnosed

·       Services and Supports for Mental Health Needs

·       Responsibilities of Regional Centers

1.             What does “dual diagnosis” mean?

The term “dual diagnosis” as used in this Manual and in the developmental disabilities system refers to people who have (or are labeled as having) both a psychiatric and a developmental disability.[1] Based on DDS data, published on the DDS website as of December, 2005, 10% of people with developmental disabilities also have psychiatric disabilities.

2.             If I have both a psychiatric disability and a developmental disability, how does the regional center make sure I get the mental health and other services I need?

People with dual diagnosis may need services and supports from both the regional center and mental health systems. As with any other service, if you should be getting a mental health service from county mental health agency or from Medi-Cal, the regional center must advocate on your behalf to help you obtain the service. If there is a delay or problem, the regional center should provide the service in the meantime. You should make certain that your need for services from mental health or Medi-Cal is discussed at your Individual Program Plan (IPP) meeting and included in your IPP.

If you agree to it, your IPP team must review your health status, including your mental health needs, at your IPP meetings. The team must discuss the medications you are taking, any side effects, and the date of the last medications review. If there are any concerns, a referral must be made to the regional center clinical staff, your doctor or other qualified professional. Your health status and referrals must be written in your file.

Regional centers also provide certain specialized services for people with dual diagnosis as discussed below.

3.             What are regional center’s obligations to collaborate with county mental health agencies?

In order to make certain that people with a dual diagnosis get needed specialized services and supports, there are several things the regional center must do. Each regional center must have a memorandum of understanding (MOU) with each of the county mental health agencies in its catchment area.[2] This means that both agencies must agree to cooperate to make sure that you receive the mental health services you need. Each MOU must identify the staff at both the regional center and at the county mental health agency responsible for identifying consumers with dual diagnoses, coordinating activities between the two agencies, and resolving problems. The agencies must jointly develop plans and procedures for crisis intervention (including 24 - hour emergency response systems, interagency notification guidelines and crisis follow-up protocols), case conferencing and discharge planning for consumers who are admitted to psychiatric inpatient facilities, and training for service providers. See the memo from DDS and a policy letter from the California Department of Mental Health addressing the required collaborative efforts between regional centers and county mental health agencies at http://www.dmh.cahwnet.gov/DMHDocs/docs/letters04/04-06.pdf and http://www.dmh.cahwnet.gov/DMHDocs/docs/letters04/04-06_Enclosure.pdf.

When the local agencies cannot resolve a disagreement about these services, DDS and the Department of Mental Health must help them resolve it, if both agencies request their assistance. At least once each year, the director of each regional center and the local county mental health agency must meet to review their agencies’ collaboration efforts, address any unresolved issues, and establish the direction and priorities for the two agencies working together. Every year, these agencies must send copies of the MOUs to DDS. You can request a copy of the MOU for your area from your regional center or from DDS.

4.             If my child has a psychiatric disability, what mental health services are available him or her?

Medi-Cal eligible children and youth under the age of twenty-one are entitled to receive a broad range of diagnostic and treatment services as required by the Early and Periodic Screening Diagnostic and Treatment (EPSDT) services provision. This means that the state is required to screen eligible children to determine the existence of certain physical or mental illnesses or conditions and provide services that are medically necessary. Medically necessary EPSDT services are services needed “to correct or ameliorate defects and physical and mental illnesses and conditions discovered by the screening services, whether or not such services are covered under the State [Medicaid] plan.”[3] As a result, children and youth under 21 are eligible for some mental health services that are not available to adults.

A mental health service that is available only to children and youth under EPSDT is therapeutic behavioral services (TBS). TBS is one-to-one limited-term services provided to help you and your child learn new ways of controlling problem behavior and ways of increasing the kinds of behavior that will allow your child to be successful. The TBS staff person and you and your child will work together intensively until your child no longer needs TBS. Your child will have a written TBS Plan that will say when, where and what type of behavioral interventions the TBS aide will use with your child. The TBS staff person can work with your child in most places where he or she is likely to need help with her problem behavior. This includes your child’s home, foster home, group home, school, day treatment program and other areas in the community. Your child is eligible to get TBS where medically necessary if he or she has full scope Medi-Cal, is under 21 years old, has serious emotional problems, is already receiving a mental health service, and either:

·       Lives in a group home for children and young people with very serious emotional problems. [These group homes are sometimes called Rate Classification Level (RCL) 12,13 or 14 group homes]; OR

·       Lives in a nursing facility that specializes in mental health treatment or Mental Health Rehabilitation Center (these places are also called institutions for mental diseases or IMDs); OR

·       Is at risk of having to live in a group home (RCL 12,13 or 14), a psychiatric hospital or IMD; OR

·       Has been hospitalized within the last 2 years for emergency mental health problems.

You can request TBS by having your child’s mental health service provider contact your county mental health agency or by contacting that agency yourself. Y