Healthcare Inspection A Follow-Up Review of VHA Mental Health Residential Rehabilitation Treatment Programs (MH RRTP)

OIG conducted a follow-up review to evaluate any improvements made or problems remaining since completion of our comprehensive 2009 review of VHA’s residential mental health care facilities. We found only moderate or little progress for the following areas: The presence of either a formal policy or consistent informal mechanism for capturing and addressing missed appointments for MH residential rehabilitation treatment program patients. Documentation of a progress note and prescriber’s order for patient safe medication management. Provision of minimum programming hours 7 days per week-4 hours per day; limiting dispensing of prescribed narcotics to up to 7 days for safe medication management for residential program (RRTP) patients (although overall compliance for this item was high-94%). Ensuring contact with patients during the time interval between acceptance into an MH RRTP program and program start. We also reviewed actual staffing at MH RRTP programs visited and whether mental health RRTP patients were assessed for occupational dysfunction and if present were they referred to vocational rehabilitation services. We found that patients were assessed, but based on program size and urban-rural status there were differences in the percentage referred. We made seven recommendations to the Under Secretary for Health to achieve full implementation of the Handbook.