Audit Report on the Department Of Health And Mental Hygiene’s Follow-Up Efforts on The Provision Of Mental Health Services to Discharged Inmates

THE CITY OF NEW YORK OFFICE OF THE COMPTROLLER
MANAGEMENT AUDIT

Audit Report on the Department Of Health And Mental Hygiene’s Follow-Up Efforts on The Provision Of Mental Health Services to Discharged Inmates

AUDIT REPORT IN BRIEF

The audit’s objective was to determine whether the Department of Health and Mental Hygiene (DOHMH) made adequate follow-up efforts in connection with the mental health treatment of discharged inmates designated as class members under a 2003 settlement agreement, known as Brad H. v. City of New York (the Brad H. Settlement).

Pursuant to the Brad H. Settlement, DOHMH must provide discharge planning services to those inmates in New York City jails who are deemed or designated to be plaintiff class members. Discharge planning services include an assessment of inmates’ needs for ongoing mental health treatment and, based upon the needs identified by DOHMH mental health staff, the creation of an individual plan of care for all class members.

Also according to the terms of the Brad H. Settlement, DOHMH must maintain contact with discharged inmates categorized as Severely and Persistently Mentally Ill (SPMI) for up to 30 days following their release from jail. The Brad H. Settlement does not explicitly require follow-up with discharged individuals who are not categorized as SPMI. However, DOHMH is not precluded by the Brad H. Settlement from performing any other follow-up that the agency deems appropriate in its implementation of the discharge planning program.

Audit Findings and Conclusions

DOHMH should improve the mandated follow-up it performs under the Brad H. Settlement. In addition, it should consider leveraging the money and resources it has devoted to complying with the Brad H. Settlement to expand its follow-up to include all class members (both SPMI and non-SPMI inmates) for whom discharge plans are created so that the agency can better evaluate the program’s effectiveness.

As reflected in DOHMH’s Brad H. tracking database, DOHMH did not conduct required follow-up for 11 percent of the SPMI inmates discharged during our review period regarding the status of their mental health appointments. As also reflected in the database, DOHMH conducted no follow-up for 82 percent of the non-SPMI inmates discharged during the same period. Although the Brad H. Settlement does not require DOHMH to monitor discharged non-SPMI inmates’ participation in their treatment plans, follow-up efforts would allow the agency to determine the degree of participation by discharged inmates, as well as the impact that the program has on recidivism. DOHMH, despite spending nearly $10 million on the creation of discharge plans over a three-year period, has limited assurance that the discharged inmates with mental health treatment plans actually obtain the services outlined in those plans. Without this information, DOHMH cannot accurately assess the program’s success.

Audit Recommendations
To address the issues raised by this audit, we make four recommendations:

• DOHMH should ensure that it maintains contact with all discharged SPMI inmates within 30 days of their release and that it documents the results of these attempts.
• DOHMH should consider reallocating its resources to expand its follow-up efforts beyond the current requirements of the Brad H. Settlement.
• DOHMH should consider following up with all discharged inmates for whom Comprehensive Treatment Discharge Plans have been created, both SPMI and non-SPMI, to identify those who follow and complete their treatment plans (rather than only determining whether discharged SPMI individuals attend an initial treatment session).
• DOHMH should consider analyzing the impact that the provision of mental health services to discharged inmates has on recidivism rates for released inmates in need of such services.

Agency Response

In their response, DOHMH officials disagreed with all four audit recommendations offered in the report, stating that they were already in compliance with the Brad H. Settlement. However, as we note in the audit report, by only adhering to the terms of the Brad H. Settlement in the strictest sense, DOHMH has limited assurance regarding the effectiveness of the program. In fact, DOHMH officials acknowledged during the course of the audit that they do not monitor the effectiveness of the program. By not doing so, DOHMH is unable to determine the degree to which the program is helping those it was designed to assist or ensure that the funds expended to administer the program—nearly $10 million in Fiscal Years 2011-2013—are being utilized in an effective manner. Accordingly, we urge DOHMH to reconsider its response and implement the audit’s recommendations.