Adopting a Novel Approach to Prevent and Address Patient Mistreatment of Staff in a Community Mental Health Center.

Verbal mistreatment of staff by patients is common in health care settings. Experiencing or witnessing mistreatment can have harmful psychological impacts, affecting well-being and clinical practice. As part of an effort to become an antiracist organization, an academic community mental health center based in Connecticut developed an initiative to address verbal mistreatment. Training in the Expect, Recognize, Address, Support, Establish (ERASE) framework was provided to 140 staff members. This training and subsequent actions to enhance the culture of safety were perceived as helpful by staff. Further development of the initiative is proceeding as the center's primary performance improvement program.

Assessing Equity in Mental Health Outreach Services to People Experiencing Unsheltered Homelessness.

OBJECTIVE: The study aimed to evaluate differences in age, gender, race, and ethnicity between a population served by a street psychiatry team and the local community of people experiencing unsheltered homelessness in order to identify intersectional inequities in care. METHODS: We tested for bivariate associations between patient affiliation and age, gender, race, and ethnicity using a Welch two sample t-test for the continuous term (age) and Pearson's chi-squared test with Yates' continuity correction for the categorical terms (gender, race, and ethnicity). RESULTS: The CMHC Street Psychiatry Team served a population (N = 200) that was significantly older (p<.001) and composed of proportionally fewer women (p = .010) and people of color (p<.001) than the local population experiencing unsheltered homelessness (N = 944). CONCLUSIONS: This process of critical evaluation identified disparities in service provision which prompted re-evaluation of services to target efforts to those most at risk of marginalization.

Medical Respite for People Experiencing Homelessness: Financial Impacts with Alternative Levels of Medicaid Coverage.

Medical respite (MR) programs provide medical care, social services, and a safe place to recuperate for people experiencing homelessness after hospital discharge. We examined the financial impact of MR on hospitals and insurers in states with varying Medicaid coverage. Urban case-study hospitals were selected from a state with Medicaid expansion under the Affordable Care Act (Connecticut) and without expansion (Florida). We calculated costs and savings from MR to hospitals and payers from the hospitals' financial data. These hospitals currently incur losses of 26% (Conn.) to 48% (Fla.) on inpatient care costs of patients experiencing homelessness. Medical respite would reduce these losses by reducing the index length of stay by two days, subsequent emergency department visits by 45%, and subsequent inpatient admissions by 35%, offsetting $1.81 in hospital costs for each dollar invested in MR. With appropriate sharing of costs between hospitals and payers, both would save money from MR.