Article about DDMI Wing
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Psychiatric Hospitalization Services of
Developmentally Disabled in California
Developmentally Disabled in California
DEVELOPMENTAL DISABILITY PSYCHIATRIC HOSPITALIZATIONS IN LOS
ANGELES USING TREATMENT AND PREVENTION MODELS
Journal: National Association of Dually Diagnosed, NADD; September/ October 2008
Volume 11 Number 5
Stephen Mouton, Psy.D.
Clinical Psychologist
San Gabriel Pomona Regional Center for
Developmental Disabilities Pomona, California
ABSTRACT
Los Angeles County developed its own network of specialized resources, liaisons and
protocols to increase the probability of successful mental health treatment and
meaningful psychiatric hospitalizations through collaborative efforts and unique
service provisions. Detailed discussion of the population, statistics and models are
presented.
Background:
California ’s population with a developmental disability and mental illness diagnosis
are served separately by the State Department of Mental Health (DMH) and the 21 non-
profit Regional Centers for Developmental Disabilities (Regional Centers) located
throughout California and created by California ’s Lanterman Act. According to the
Department of Developmental Services website, the 2006 -2006 California budget for
Regional Centers was $3,194,268,000
The Los Angeles County Department of Mental Health (DMH) serves approximately
one-quarter of a million residents each year, making it the largest mental health
service system in the nation (www.dmh.lacounty.gov).
Los Angeles County is one of the nation’s largest counties, with over 4,000 square
miles, 88 different cities, and over 130 unincorporated communities, containing over 10
million residents.
In May of 2007, California Health and Human Services Agency, Department of Mental
Health released the FY 2004-2005 involuntary detention statistics. California assessed
142, 737 adults who were placed on a 72-hour involuntary hold (W.I.C. 5150) in
California psychiatric hospitals. Los Angeles County had 48, 473 adults (34% of the
California detention total.) California Psychiatric hospitals also detained 20,284
children on 72-hour involuntary holds. Los Angeles County detained 6,058 children
(30% of the state detention total). California and Los Angeles County have difficulty
serving individuals with developmental disability and mental illness needs because of
issues about funding from state budgets, separation of service delivery protocols and a
lack of educated and experienced professionals available at service delivery sites who
understand the special needs of individuals with a dual diagnosis (developmental
disability and mental illness.)
In June 2007, California had over 225,000 individuals who qualified for regional center
services because of a diagnosis defined in the Lanterman Act. 55,807 regional center
clients reside in Los Angeles County
.Julie Jackson, Acting Deputy Director of D.D.S., presented data at the national
Association of State Developmental Disability Directors Bi-Annual Meeting in June,
2005 indicating over 33,713 regional center clients receive medications for behaviors
(approximately 16% , 14,785 clients have severe behavior problems (approximately
7%) and 20,106 had been identified with a dual diagnosis (approximately 10%) using
the statewide statistical data maintained by individual regional centers.
Using state percentiles of 16% for medications for behaviors, Los Angeles County ’s
regional center population would have approximately 8,929 clients with behavioral
needs, 7% with severe behavior problems (3,906) and 10% (5,580) with an established
dual diagnosis.
Factors leading to Psychiatric Hospitalization:
Los Angeles County has a memorandum of understanding (MOU) with DMH and the
7 Los Angeles County Regional Centers to provide services for commonly served
clients. Los Angeles County DMH and Regional Centers meet every two months to
discuss improvements in service delivery, share resources and discuss policy to better
serve the mutually served clients. The California Mental Health Task Force, which
meets Quarterly in Sacramento, conducted surveys with regional centers and
psychiatric hospitals in 2005-2006 and identified the factors of physical aggression
(towards others / self) and property damage as the two most common factors involved
with involuntary psychiatric hospitalization of clients with a dual diagnosis of mental
illness and a developmental disability.
Additionally, multiple psychiatric hospitalizations have other factors which facilitate
the learned aggressive behaviors and property damage including: inappropriate
medication, overmedication, residential issues, inappropriate staffing levels,
personality dynamics, lack of therapeutic follow up and day program issues which may
not be resolved upon discharge from the hospital.
Traditional involuntary hospitalization involves transportation to a psychiatric hospital
following an assessment by law enforcement or a psychiatric evaluation team (PET).
Services for developmentally disable clients with a mental illness usually consist of
heavy medication (to reduce symptoms) and group therapy, followed by discharge
within 72 hours. Low functioning individuals, individuals with a diagnosis of autism
and individuals with sensory impairments receive a band aid approach to the
symptoms due to the ineffectiveness, and often inability to participate in “talk” therapy
as a primary non-medication intervention and are discharged back to the community
with a few days supply of freshly dispensed psychiatric medication, which often masks
the underlying symptoms which resulted in hospitalization.
In response to the lack of appropriate psychiatric hospital resources, California
Regional Centers have developed a psychiatric wing (DDMI wing) at College Hospital
in Cerritos, California http://www.DDMIWing.com to provide exclusive services for
individuals with a dual diagnosis using non-verbal therapies, a team of consulting
Psychiatrists and using a behavior modification approach to therapeutic intervention.
Hospitalizations are paid exclusively by the regional center and do not have a time
limitation for therapeutic intervention and treatment.
Additionally, Regional Centers have developed hospitalization reduction models which
include: contracting with specialized Psychiatrists to provide short-term out-patient
treatment to dually diagnosed individuals with special medication needs.
San Gabriel Pomona Regional Center uses a Bio-Behavioral Team which includes a
specialized Psychiatrist, Behavioral Psychologist and Pharmacologist to review
medications, behavior and treatment services for the at-risk for hospitalization
population. Pharmacy reviews are part of case consultations with nurses and a
pharmacologist. The Behavior and Intervention Team consists of two senior psychiatric
technicians formerly employed by the Developmental Disability State Hospital
(Lanterman Developmental Center) who travel to clients’ residence or work place to
obtain a functional analysis of presenting problems and make sophisticated
recommendations about how to decrease the probability of a client losing their
preferred living arrangement or day program. Telepsychiatry has been used to
facilitate access to appropriate Psychiatrists and medications. The mental health pilot
project consists of local mental health providers who hear individual cases presented
by regional center service coordinators and expedite the intake and delivery of mental
health services for individuals with a dual diagnosis. The mental health pilot project is
being replicated by other regional centers as a way of providing applied education
about differential diagnosis of commonly served clients and better understanding each
others systems.
As a result of regional centers and Department of Mental Health collaborations, more
clients are being deflected from public and private hospitals, identified earlier for more
sophisticated interventions and benefiting from new and innovative resources which
have been developed to improved the outcomes of psychiatric hospitalizations and
decrease the probability of multiple hospitalizations.
References
Los Angeles County Department of Mental Health Web Site http://dmh.lacounty.
gov/about_us.asp
California Department of Developmental Services Budget Web Site http://www.dds.
cahwnet.gov/Budget/budget_info.cfm
California
Health and Human Services Agency, Department of Mental Health Involuntary
Detention Data – Fiscal Year 2004-05 (July1, 2004 – June 30, 2005)
California
Welfare and Institutions Code, W.I.C. 5150
ANGELES USING TREATMENT AND PREVENTION MODELS
Journal: National Association of Dually Diagnosed, NADD; September/ October 2008
Volume 11 Number 5
Stephen Mouton, Psy.D.
Clinical Psychologist
San Gabriel Pomona Regional Center for
Developmental Disabilities Pomona, California
ABSTRACT
Los Angeles County developed its own network of specialized resources, liaisons and
protocols to increase the probability of successful mental health treatment and
meaningful psychiatric hospitalizations through collaborative efforts and unique
service provisions. Detailed discussion of the population, statistics and models are
presented.
Background:
California ’s population with a developmental disability and mental illness diagnosis
are served separately by the State Department of Mental Health (DMH) and the 21 non-
profit Regional Centers for Developmental Disabilities (Regional Centers) located
throughout California and created by California ’s Lanterman Act. According to the
Department of Developmental Services website, the 2006 -2006 California budget for
Regional Centers was $3,194,268,000
The Los Angeles County Department of Mental Health (DMH) serves approximately
one-quarter of a million residents each year, making it the largest mental health
service system in the nation (www.dmh.lacounty.gov).
Los Angeles County is one of the nation’s largest counties, with over 4,000 square
miles, 88 different cities, and over 130 unincorporated communities, containing over 10
million residents.
In May of 2007, California Health and Human Services Agency, Department of Mental
Health released the FY 2004-2005 involuntary detention statistics. California assessed
142, 737 adults who were placed on a 72-hour involuntary hold (W.I.C. 5150) in
California psychiatric hospitals. Los Angeles County had 48, 473 adults (34% of the
California detention total.) California Psychiatric hospitals also detained 20,284
children on 72-hour involuntary holds. Los Angeles County detained 6,058 children
(30% of the state detention total). California and Los Angeles County have difficulty
serving individuals with developmental disability and mental illness needs because of
issues about funding from state budgets, separation of service delivery protocols and a
lack of educated and experienced professionals available at service delivery sites who
understand the special needs of individuals with a dual diagnosis (developmental
disability and mental illness.)
In June 2007, California had over 225,000 individuals who qualified for regional center
services because of a diagnosis defined in the Lanterman Act. 55,807 regional center
clients reside in Los Angeles County
.Julie Jackson, Acting Deputy Director of D.D.S., presented data at the national
Association of State Developmental Disability Directors Bi-Annual Meeting in June,
2005 indicating over 33,713 regional center clients receive medications for behaviors
(approximately 16% , 14,785 clients have severe behavior problems (approximately
7%) and 20,106 had been identified with a dual diagnosis (approximately 10%) using
the statewide statistical data maintained by individual regional centers.
Using state percentiles of 16% for medications for behaviors, Los Angeles County ’s
regional center population would have approximately 8,929 clients with behavioral
needs, 7% with severe behavior problems (3,906) and 10% (5,580) with an established
dual diagnosis.
Factors leading to Psychiatric Hospitalization:
Los Angeles County has a memorandum of understanding (MOU) with DMH and the
7 Los Angeles County Regional Centers to provide services for commonly served
clients. Los Angeles County DMH and Regional Centers meet every two months to
discuss improvements in service delivery, share resources and discuss policy to better
serve the mutually served clients. The California Mental Health Task Force, which
meets Quarterly in Sacramento, conducted surveys with regional centers and
psychiatric hospitals in 2005-2006 and identified the factors of physical aggression
(towards others / self) and property damage as the two most common factors involved
with involuntary psychiatric hospitalization of clients with a dual diagnosis of mental
illness and a developmental disability.
Additionally, multiple psychiatric hospitalizations have other factors which facilitate
the learned aggressive behaviors and property damage including: inappropriate
medication, overmedication, residential issues, inappropriate staffing levels,
personality dynamics, lack of therapeutic follow up and day program issues which may
not be resolved upon discharge from the hospital.
Traditional involuntary hospitalization involves transportation to a psychiatric hospital
following an assessment by law enforcement or a psychiatric evaluation team (PET).
Services for developmentally disable clients with a mental illness usually consist of
heavy medication (to reduce symptoms) and group therapy, followed by discharge
within 72 hours. Low functioning individuals, individuals with a diagnosis of autism
and individuals with sensory impairments receive a band aid approach to the
symptoms due to the ineffectiveness, and often inability to participate in “talk” therapy
as a primary non-medication intervention and are discharged back to the community
with a few days supply of freshly dispensed psychiatric medication, which often masks
the underlying symptoms which resulted in hospitalization.
In response to the lack of appropriate psychiatric hospital resources, California
Regional Centers have developed a psychiatric wing (DDMI wing) at College Hospital
in Cerritos, California http://www.DDMIWing.com to provide exclusive services for
individuals with a dual diagnosis using non-verbal therapies, a team of consulting
Psychiatrists and using a behavior modification approach to therapeutic intervention.
Hospitalizations are paid exclusively by the regional center and do not have a time
limitation for therapeutic intervention and treatment.
Additionally, Regional Centers have developed hospitalization reduction models which
include: contracting with specialized Psychiatrists to provide short-term out-patient
treatment to dually diagnosed individuals with special medication needs.
San Gabriel Pomona Regional Center uses a Bio-Behavioral Team which includes a
specialized Psychiatrist, Behavioral Psychologist and Pharmacologist to review
medications, behavior and treatment services for the at-risk for hospitalization
population. Pharmacy reviews are part of case consultations with nurses and a
pharmacologist. The Behavior and Intervention Team consists of two senior psychiatric
technicians formerly employed by the Developmental Disability State Hospital
(Lanterman Developmental Center) who travel to clients’ residence or work place to
obtain a functional analysis of presenting problems and make sophisticated
recommendations about how to decrease the probability of a client losing their
preferred living arrangement or day program. Telepsychiatry has been used to
facilitate access to appropriate Psychiatrists and medications. The mental health pilot
project consists of local mental health providers who hear individual cases presented
by regional center service coordinators and expedite the intake and delivery of mental
health services for individuals with a dual diagnosis. The mental health pilot project is
being replicated by other regional centers as a way of providing applied education
about differential diagnosis of commonly served clients and better understanding each
others systems.
As a result of regional centers and Department of Mental Health collaborations, more
clients are being deflected from public and private hospitals, identified earlier for more
sophisticated interventions and benefiting from new and innovative resources which
have been developed to improved the outcomes of psychiatric hospitalizations and
decrease the probability of multiple hospitalizations.
References
Los Angeles County Department of Mental Health Web Site http://dmh.lacounty.
gov/about_us.asp
California Department of Developmental Services Budget Web Site http://www.dds.
cahwnet.gov/Budget/budget_info.cfm
California
Health and Human Services Agency, Department of Mental Health Involuntary
Detention Data – Fiscal Year 2004-05 (July1, 2004 – June 30, 2005)
California
Welfare and Institutions Code, W.I.C. 5150
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