David LeCount Report

Challenges

Given the above information, some of the most critical challenges remain:

• How to create sufficient community capacity to accelerate decreasing hospitalizations.
  
• How to fund both the hospital industry and pay for the needed community services at the same time.
  
• Alternative uses for hospitals.
  
• How to train, educate, and change attitudes and perceptions about mental illness and current practices amongst professionals and the community at large.
  
• Providing services in the context of the community that promotes community inclusion and natural supports.
  
• Incorporating consumer involvement in all aspects of the service delivery system, including the hiring of consumers as providers and paying for peer support.
  
• Being consumer centered and recovery oriented in practice.

Recommendations

The primary objective of this report is to promote and accelerate the direction of decreasing hospitalization while increasing community mental health services that will evolve a system of care for a vast number of people. This community system should be comprehensive, well coordinated, integrated, and have a continuum of services that are responsive to a wide variety of needs and various levels of care, along with service continuity. All of these services should build on the inherent strengths of the existing system. They should be planned, developed, and implemented at the local level, with centralized authority in a single agency that is responsible for the community services, as well as in-patient services. All levels of government and authority should promote this new power structure and change process through laws, policies, procedures, mandates, funding, and training, that is written into a master plan.

I am recommending a different set of services and approaches needed for people to live in the community, that here-to-fore, have not been developed. These include:

• 24-hour mobile crisis intervention service response. In addition to providing crisis intervention services, this unit would authorize and monitor all approved in-patient treatment episodes, as well as facilitate aftercare planning and community placement in a timely manner.
  
• A variety of staff supervised living arrangements within the settings.
  
• Comprehensive, interdisciplinary, assertive team approaches with a 24-hour response and capability of providing services wherever the people are at in the community.
  
• Case management within each program and system case management assigned when there are multiple agencies and/or programs involved.
  
• Day services, such as life support centers, clubhouse models, etc., where psychosocial rehabilitation (including work) services and peer supports are provided along with psychotropics.
  
• Work in integrated and natural community work sites based on interests, skills, and abilities, with adequate accommodations and supervision.
  
• Medications and case management services for those who are functionally capable of going to the places these services are provided.
  
• Community-oriented psychiatry that understands and appreciates the respective roles and contributions of each team member, and the ability to support each discipline's practices and expertise, as well as knowing when and how to use each other as consultants.

The above are some of the elements and values that can further contribute to the change process throughout Japan. I will now summarize some guiding principles of community-based treatment.