Issue 1: The Inadequate Exchange of Treatment-Related Information When Rural Consumers Leave Their Community of Origin for Treatment

Goal: Enhance ways of sharing client-specific information among agencies assisting persons with mental illness.

Discussion

It is critical that there be a balance between confidentiality and collaboration regarding treatment-related services to persons with mental illnesses. Mental health consumers have fundamental rights regarding confidentiality which are set out through various laws and regulations. It is essential that these confidentiality rights be acknowledged and respected, particularly in rural communities where it is often difficult to maintain a sense of personal privacy, and where community ties may be stronger than in urban areas.

At the same time, to ensure continuity of care, it is essential that there be adequate collaboration and information sharing among providers, particularly when rural consumers receive services outside their home communities. Evidence indicates that this collaboration is seriously lacking at this time, and that confidentiality rules unintentionally delay, impede and obstruct routine service delivery to rural consumers.

Rural mental health providers frequently have difficulty receiving and/or obtaining from other programs routine discharge information such as discharge summaries, treatment recommendations and current medications. This typically results when rural consumers leave out-of-community programs and do not sign releases to forward information, or do not acknowledge that they will be seeking services in a rural community. Even when local programs are identified and an information release is obtained, information usually arrives long after the client has returned to the village.

The circumstances described above create great barriers to service provision for rural consumers. Rural mental health providers must often go to extraordinary lengths to obtain even routine information from out-of-community providers. This labor typically involves contacting the previous program, seeking and obtaining the client's written consent to the release, faxing the release (if this is acceptable to the program), contacting the program, and finding the appropriate individual with whom to discuss the case. If medication is an issue, the situation is more complex since the rural provider must also obtain or assist the client in obtaining the recommended medication.

Actions

127. Enhance the use of/develop the following protocols to facilitate client-related communication between rural providers and out-of community providers:

a. Two-way information releases that can be initiated either before a client leaves a rural community to receive treatment or prior to the client's release from an out-of-community program.

b. Mechanisms for multi-agency releases and enhanced case conferencing among mental health and other service providers.

c. Guidelines for enhanced communications between mental health and school personnel regarding children and youth who leave their communities to receive mental health services.

Responsible party: Division of Mental Health and Developmental Disabilities, Department of Education, Alaska Mental Health Board, Alaska Community Mental Health Services Association, Rural Alaska Program Directors Association

128. Provide a brochure or written instructions to programs impacted by the new information sharing protocols.
Responsible party: Division of Mental Health and Developmental Disabilities

129. Provide training to all affected provider organizations impacted by the newly developed protocols.
Responsible party: Division of Mental Health and Developmental Disabilities

130. Investigate the feasibility of law or regulations changes to require treatment programs to pursue front-end releases from clients prior to discharge.
Responsible party: Alaska Mental Health Board, Division of Mental Health and Developmental Disabilities, Department of Law