How is PACT doing?
In October 2017, PACT was launched at McLean Hospital. There was immediate demand for spots. The program will grow to 25 individuals by Oct 2018 and 60 the year after.
Within the first week, there were 5 people in the program. By January 2018, there were 15 with two “alums”.
A common goal for everyone is to avoid hospitalization – and the PACT team has been making a real difference. Most people have not been re-hospitalized and those who have needed that extra care have had shorter stays – partly because they can return to the supportive environment of PACT.
In addition to returning to work, school and volunteering, program participants are going bowling and playing laser tag. You might wonder why that’s important. When life has been disrupted by a psychotic episode, it can be hard to find new friends and things to talk about that are not related to psychosis. It’s so important to have friends and be able to hang out with people. Bowling, laser tag and other social events are all opportunities for just being you.
The PACT program “turned” one year old in October 2018. There are so many highlights from year one, but just to name a few
- PACThas been converted to a cost center of the hospital. That means it’s no longer a pilot and will be a continuing program indefinitely
- The team hit the bullseye on the target of having 25 participants by Oct 2018. Even more impressive, there are six “alums” – meaning in year one, 31 people have been in PACT.
- Since starting PACT, not a single participant has been arrested or otherwise involved in new legal charges. And over the course of the year, the PACT team has assisted in resolving multiple legal issues for participants
- Every month, PACT avoids as many as 4 inpatient admissions. That included over the toughest time of the year – the holidays in 2017 – when PACT was just starting out. When someone has required a hospitalization, the PACT time helps to reduce the duration and improve the care by working closely with the hospital team.
- And – drum roll – those in PACT currently are – as of November 2018 –
- 7 – currently employed
- 4 – in school
- 2 – in internships
- 1 – recent graduate looking for work in their field
Paying for PACT
The Living Assistance Fund is dedicated to increasing access to mental health care by removing financial barriers. Today, the PACT program at McLean incurs an out-of-pocket cost of $1,000/month. Compared with many other programs which typically start at $20,000/month, this is more affordable to many families. In that respect, LAF has already succeeded. But really, we want to have PACT be fully covered by commercial insurers.
Insurance typically covers acute care like hospitalization. Historically, that has meant that individuals with severe mental illness (SMI) end up cycling in and out of hospitals. Research shows this is very bad for the individual. And ironically, it’s actually not cost effective either. The resistance to paying for programs like PACT has been that wraparound services are not “medically necessary.” And also typically in the past, insurers could avoid this type of care by not covering this population.
That’s not the case anymore. A combination of the ACA’s provision that children stay on their parents plan until age 26 and parity regulations (the need to cover mental health on a par with physical health), is creating pressure to find appropriate programs for individuals with SMI – a disease that onsets typically between ages 16-22.
So our focus is on employers’ self-funded plans. The McLean team is collecting data on the impact on caregivers of individuals with SMI in absenteeism and presenteeism. We will bring this information, plus the wealth of research of PACT to selected large employers to discuss broadening their mental health benefits to cover PACT programs. Read Monica’s story