Mental Health Intensive Case Management Program (MHICM)
Elizabeth Bromley, MD; Caryn Bernstein, MD; Emily Defraites, MD
MHICM is an intensive case management program. MHICM is the VA version of Assertive Community Treatment (ACT) or Full Service Partnership (FSP). We have 100 patients, 3 attendings (Bromley, Bernstein, DeFraites), and 8 case managers (RNs, MSWs, Psychologist) who function as primary clinicians for the patients. Case managers see their patients often, sometimes several times a week. We have a drop-in clinic on Wednesdays. Residents can follow patients closely (e.g., every week). Residents are encouraged to meet patients with case managers in the room and to travel to the patient’s residence for visits (i.e., “in the field”). Patients have severe mental illnesses, primarily chronic psychotic disorders. Residents will become familiar with the use of Clozapine and complex psychopharmacology for individuals with treatment refractory psychotic disorders. Complex medical comorbidities are also common. Care coordination with primary care can also be a focus.
Once a month, Wednesday clinic takes place in the community. The residents will be accompanied by an attending and will visit Board and Care facilities and/or other sites where MHICM patients are treated. More time in the community is possible if the resident prefers. Other opportunities for research, leading groups, etc., are available, as the resident prefers. Current research/QI emphases are peer-led smoking cessation and recovery-oriented discharge from MHICM (i.e., for patients who have made considerable gains in the program).