Press Release  Audit Calls on Department of Mental Health to Improve Client Discharge Process, Make Better Use of Available Beds

Boston — In an audit released today, State Auditor Suzanne M. Bump calls on the Department of Mental Health (DMH) to enhance management of its client discharge process from psychiatric hospitals. Bump noted this can help to ensure clients receive mental health care in an appropriate setting, in a timely manner. The audit, which examined the period of July 1, 2016 through September 30, 2018, calls on DMH to implement monitoring procedures to ensure anticipated discharge dates are recorded and discharges are as prompt as possible.

DMH has established a goal to place clients deemed “discharge ready” in less restrictive community-based settings within 30 days of that determination. However, the audit found the agency sometimes did not discharge clients in a timely manner and frequently did not document when it anticipated a client would be discharged. From a sample of 67 DMH clients, Bump’s audit found 27 clients did not have anticipated discharge dates recorded, making it difficult for DMH to effectively monitor its client discharge process and identify any problems in an appropriate time frame. In addition, four clients in the sample were not discharged to a less restrictive community-based setting within 60 days of the anticipated discharge date, with one of these clients not being released from a DMH facility for 354 days after being deemed ready for discharge.

The audit notes the number of continuous-care beds in the Commonwealth has decreased since 1970, from approximately 12,000 beds to the current level of 693 beds. Further, during the audit period, the DMH hospital admission waiting periods averaged 79 days.

“We all have a stake in ensuring individuals struggling with serious mental illness get adequate care in an appropriate setting,” Bump said. “With a dwindling number of available beds in the Commonwealth’s mental health care system, it is imperative that the Department of Mental Health set strong standards and monitor its efficiency.”

DMH pointed to the limited number of available beds throughout the state, issues with client medication, and mismanagement of the discharge process by staff as primary factors causing the delays. The audit also notes DMH did not have adequate monitoring to ensure discharge dates are recorded and met. 

Additionally, the audit found DMH did not revoke employee access to the agency’s Mental Health Information System immediately when their employment ended. A sample conducted by Bump’s office showed former employee access was revoked an average of 128 days after the end of their employment. As a result, there is an increased risk of these individuals improperly accessing or altering sensitive DMH client information. In its response, DMH indicated it is taking steps to address this concern.

During the audit period, DMH operated five area offices, two state hospitals, units in two Department of Public Health hospitals, one mental health center, and one privately contracted unit. During fiscal years 2017 and 2018, DMH expended a total of $410.3 million to provide services to people with mental health disorders.

The audit of the Department of Mental Health is available here.

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