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Discharge

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									                        Ready for Discharge
A Mental Health Consumer’s Guide to Discharge Planning, Rights and
       Sources of Help in the Community, and Self-Advocacy
                  Program and Rights Information
Ready for Discharge

As you prepare to return to the community, there are a number of adjustments that you
will make and a number of potential problems you may face. This brochure was
developed with the help of people with mental illness who have been hospitalized. We
hope this information will be helpful to you as you leave the hospital.

Most people who are discharged are successful in their return to their home community.
There are things that you and your treatment team can do that will help you succeed.

   Help develop a treatment plan that says what you and the team agree should
    happen before discharge. Be sure that you understand the treatment team’s
    expectations and that they understand yours.

   You should understand your particular illness and know what to do to reduce your
    chances of re-hospitalization.

   As you make progress in your treatment, work with your treatment team to get a
    good discharge plan.

The discharge plan should:

   say where you will live after you leave the hospital;
   tell who will provide mental health services for you;
   list the medications that you will be taking;
   explain the purpose of each medication and its side effects; and
   list other services or needs you have following discharge.

If you plan to live with family or friends after you leave the hospital or if you rely on your
family and friends for transportation or support, it will be helpful for them to meet with
your therapist or treatment team. At the meeting, you may discuss your diagnosis,
medications, and future treatment. This may help them understand your mental illness
and some of the side effects of the medication that you may experience.

The discharge plan should be complete well before your actual discharge. If you will be
receiving services from a local mental health service provider, you will be given the
name, address, and phone number of a staff person who can be contacted in case of an
emergency. The plan should also give the date and place for your first appointment.
   You should meet with any community providers whenever possible. You should
    receive a copy of your discharge plan.

   Be sure to keep the follow-up appointments for treatment and medication after
    discharge.

   Studies show that failure to stay on prescribed medication is the biggest single
    cause of re-hospitalization.

   Use of alcohol or illegal drugs is another reason that some people have to return to
    the hospital.

   If something happens and you think that you will run out of your prescription
    medication before your appointment for a refill, call the doctor or clinic and make
    sure that they know.

   If they cannot or will not help you, call the emergency number listed on your
    discharge plan and explain your problem.

Housing

When you leave the hospital and move into the community, housing may be a problem.
Choices may be limited. Therefore, you may need to advocate for yourself (or seek
help) in working out some of the problems that may arise.

If you are living in a group housing complex, an adult care residence, a nursing home,
or a group home, you will have certain specific rights. These rights may vary some from
place to place but generally include the:

   the right to be treated with respect;
   the right to be free of abuse and neglect;
   the right to make a complaint without punishment;
   the right to make decisions about your finances and your care or treatment;
   the right to privacy;
   the right to choose your own friends and to take part in social activities; and
   the right to participate in religious activities.

You may also have other rights. Ask for a copy of your rights if you are in a facility or a
copy of your lease and any housing complex rules if you live independently.

For those who plan to live independently, rental assistance may be available. However,
getting rental assistance takes time. There is a first-come/first-serve policy and there is
usually a waiting list. Even if you qualify for assistance, there may not be apartments or
assistance readily available.


September 2002                                                                                  Page 2
                    This publication was prepared with 100% federal funding through the
                  Protection and Advocacy for Individuals with Mental Illness (PAIMI) Act.

                  Virginia's Protection and Advocacy System Serving Persons with Disabilities
Section 8 vouchers and other rental assistance programs probably will not be options to
you at discharge, but may be useful to you in your long-range planning. For further
information and to identify local contacts, call the Virginia Housing Development
Authority (VHDA), at (800) 968-7837 (toll-free) or visit them on the web at:
www.vhda.com.

Employment

When you leave the hospital, you may return to your old job, look for a new job, or you
may need rehabilitation to learn new job skills.

If you are not able to go to work, you may be eligible for disability payments. These
decisions should be discussed prior to discharge and the treatment and discharge plans
should describe the decisions made.

Both state and federal law prohibit employment discrimination based on disability. If
you can do the job, employers cannot refuse to hire or promote you just because you
have a mental illness or have a history of mental illness. This does not mean that the
employer cannot fire a person who cannot do the job because of a disability. It does
mean that the law protects you from the assumption that you cannot do the job.

The law also requires that the employer provide reasonable accommodations for your
disability. This is evaluated on a case-by-case basis because what you might need may
be very different from what another person might need in order to do the job.

What the employer can reasonably provide will change a lot depending on the type and
size of the business. For example, some people find background noise very upsetting.
Depending on the job, wearing earphones to block the noise might be a reasonable
accommodation. This might work for someone performing stocking in a warehouse but
might not work on a construction site where the person needs to be able to hear
instructions and warnings.

If you believe that you can go back to work without any particular problems, that is fine.
If you think that you may need additional help or accommodations, you may want to talk
with your treatment team about the type of work you do and the changes in the job or
work environment that might make it easier for you to be a productive employee.

If you need to ask your employer for accommodations, it helps if you have a letter from
your doctor or therapist explaining what you need and why. Another source of help is
the Department of Rehabilitative Services (DRS).

If you are also blind or visually impaired, the Department for the Blind and Vision
Impaired (DBVI) may be able to help you.



September 2002                                                                                 Page 3
                   This publication was prepared with 100% federal funding through the
                 Protection and Advocacy for Individuals with Mental Illness (PAIMI) Act.

                 Virginia's Protection and Advocacy System Serving Persons with Disabilities
DRS and DBVI have offices throughout the state and can offer rehabilitation counseling,
evaluation, and vocational services for eligible persons. You may have an opportunity
to meet with a DRS/DBVI counselor while you are at the hospital.

Talk with your therapist or social worker if you are interested in knowing what kinds of
job training or other services DRS/DBVI may be able to offer you.

If you have problems with employment discrimination or in getting accommodations, be
sure that you have provided your employer with the necessary reports to show that you
are protected as a person with a disability and what kinds of accommodation, if any, you
need.

If your boss is not responsive, use your employer’s grievance process to try to work
things out. Many people know little about mental illness and may need additional
information in order to understand your situation.

Employment issues are complicated. It is a good idea to ask for help in resolving these
issues.

The Virginia Office for Protection and Advocacy (VOPA) can explain your rights and
help you identify ways to protect them. DRS/DBVI may also be of help in solving
employer-related problems.

Financial Assistance

Ideally, your therapist and social worker will have talked with you about your finances as
part of developing your discharge plan. Both your housing and the services you receive
may depend on your income.

If you have worked in the past but are now unable to do so because of your mental
illness, you may be eligible for Social Security Disability Income (SSDI).

If you do not have much prior work history and cannot work because of your disability,
you might be eligible for Supplemental Security Income (SSI).

The Social Security Administration administers both programs. You apply by calling
(800) 772-1213. Applications can be made by phone or in person. If you make an
appointment, it will be at the office closest to your home.

Your local Department of Social Services (DSS) may also be able to provide assistance.
DSS determines eligibility for programs like Food Stamps, Medicaid, and Temporary
Assistance to Needy Families (TANF).




September 2002                                                                                 Page 4
                   This publication was prepared with 100% federal funding through the
                 Protection and Advocacy for Individuals with Mental Illness (PAIMI) Act.

                 Virginia's Protection and Advocacy System Serving Persons with Disabilities
DSS may also be able to help you find other sources of help, particularly with short-term
or one-time problems. Your local DSS may have other programs which could help you
around the home. Your social worker or case manager can help you find out what may
be available in your locality.

Military veterans and their families may be eligible for additional benefits and services.
Some of the benefits are federal and others are specific to Virginia.

For information on services and benefits and for assistance in filing claims, call the
Virginia Department of Veterans’ Affairs. The Department has 16 field offices
throughout the state. Call (804) 786-2261 for information or to locate the office nearest
you.

The U.S. Department of Veterans’ Affairs has a regional office in Roanoke, Virginia.
Their number is (800) 827-1000.

If you have been working, your employer may also offer benefits in the form of short–
term or long-term disability payments. Check with the personnel manager to see if you
are covered.

Mental Health Service Providers

Most people continue to need mental health services after they leave the hospital.
Case managers and therapists who work for the local community services board (CSB)
or local mental health authority provide mental health services to many people leaving
the hospital. Others may be seen by private providers.

Mental health professionals must meet certain accepted standards for their skills and
professional behavior and most are licensed. There are standards that they must meet
in order to maintain licensure and/or employment.

Community mental health programs that are licensed or funded by the Department of
Mental Health, Mental Retardation and Substance Abuse Services (DMHMRSAS) also
must comply with human rights regulations that are the same as in the hospital. They
are required to have a human rights plan and procedures for assisting clients to resolve
disagreements and complaints.

The state Department of Mental Health, Mental Retardation and Substance Abuse
Services employs “Regional Advocates” who can help you work out differences.




September 2002                                                                                 Page 5
                   This publication was prepared with 100% federal funding through the
                 Protection and Advocacy for Individuals with Mental Illness (PAIMI) Act.

                 Virginia's Protection and Advocacy System Serving Persons with Disabilities
                              DMHMRSAS Human Rights Director
                                     (804) 786-3988

Regional Advocates (toll-free)

                 Staunton Area                                                (877) 600-7437
                 Northern Virginia Area                                       (877) 600-7431
                 Marion Area                                                  (877) 600-7434
                 Richmond/Petersburg Area                                     (866) 256-5290
                 Tidewater Area                                               (877) 600-7436
                 Lynchburg Area                                               (866) 645-4510

Problem-Solving

If any of your rights are violated or you have a problem or complaint about your living
situation, you may want to try the following steps:

   Identify the problem. Exactly what happened? Who was involved? Did other
    people see it happen or are there others who have the same problem? Writing
    down the details may help you get ready to talk about your concerns.

   Figure out who to talk to about your problem. Usually, it is best to try to work things
    out right where you are as the problem can be fixed fastest that way and most
    facilities and businesses have a complaint procedure for handling such issues.

   Using the business’ or facility’s complaint procedures, try to work through the
    problem. Generally, it is best to start at the lowest level and work your way up to the
    administrator or other manager.

   When you state your concern, also be ready to say what it is that you want to have
    happen as a result of your complaint. Set a specific time in which that is to be done.

   Be polite but firm. You are not being unreasonable in asking for your rights.

   Be focused in what you say and reasonable about what you ask. People appreciate
    your understanding that their time is valuable.

Problem-Solving — the Next Level

You have tried but have been unsuccessful in resolving your problems. Where do you
go now? Each type of housing facility has its own licensure requirements and complaint
processes outside the facility. Each profession also has its own requirements. There
are also community resources that may help you find a solution. You can contact one
of the following for assistance:

September 2002                                                                                    Page 6
                      This publication was prepared with 100% federal funding through the
                    Protection and Advocacy for Individuals with Mental Illness (PAIMI) Act.

                    Virginia's Protection and Advocacy System Serving Persons with Disabilities
                                                   Advocacy

                    Virginia Office for Protection and Advocacy (VOPA)
                                        (800) 552-3962

                      Office of the State Long-Term Care Ombudsman
                                        (800) 552-3402

                               DMHMRSAS Office of Human Rights
                                      (804) 786-3988

                                      Discrimination in Housing

                                           Fair Housing Office
                                             (804) 367-8530

                          HOME (in the Richmond Metropolitan area)
                                       (804) 354-0641

                 Investigations of Abuse or Neglect Conditions in Facilities

      Adult Care Residences, Adult Protective Services, or Domestic Violence
                                    (888) 832-3858
                  or call your local Department of Social Services

                                  Child Protective Services
                                        (800) 522-7096
                      or call your local Department of Social Services

                                    Nursing Homes and Hospitals
                                           (800) 955-1819

                   Group Homes and Licensed Mental Health Programs
                                   (804) 786-1747

The Virginia Office for Protection and Advocacy (VOPA) investigates allegations of
abuse and neglect or conditions in facilities, under some circumstances. You may call
VOPA for further information or assistance at (800) 552-3962.

The Ombudsman Program through the Department on Aging may also do investigations
in some cases at (800) 552-3402.




September 2002                                                                                     Page 7
                       This publication was prepared with 100% federal funding through the
                     Protection and Advocacy for Individuals with Mental Illness (PAIMI) Act.

                     Virginia's Protection and Advocacy System Serving Persons with Disabilities
                 Complaints About Health and Mental Health Care Providers

                                 Department of Health Professions
                                         (800) 533-1560

                                   Medicaid Fraud (by a Provider)

                                    Office of the Attorney General
                                            (804) 786-2071

                                     Employment Discrimination

                    Equal Employment Opportunity Commission (EEOC)
                                    (800) 669-4000

 For additional information regarding reasonable accommodations and employment of
        persons with disabilities and the Americans with Disabilities Act. (ADA)

                               Job Accommodation Network (JAN)
                                        (800) 232-9675

                                       General ADA Information
                                           (800) 949-4232

                                       Vocational Rehabilitation

                         Department of Rehabilitative Services (DRS)
                                       (800) 552-5019

                    Department for the Blind and Vision Impaired (DBVI)
                                      (800) 622-2155

                 General Information About Rights, Services, and Providers

                    Virginia Office for Protection and Advocacy (VOPA)
                                        (800) 552-3962


Other Sources of Help

Families, friends, and churches, mosques, and synagogues provide emotional support
for many people. However, sometimes you may find that you need to talk with
someone else who has also been hospitalized or who has the same diagnosis.



September 2002                                                                                     Page 8
                       This publication was prepared with 100% federal funding through the
                     Protection and Advocacy for Individuals with Mental Illness (PAIMI) Act.

                     Virginia's Protection and Advocacy System Serving Persons with Disabilities
You may be looking for information on support groups or other people’s experience with
a particular medication. There are a number of organizations that may be able to help
you or may help your family or friends to understand you. These statewide
organizations can assist you in locating groups in or close to your community.

                   National Alliance for the Mentally Ill-VA (NAMI-VA)
                                     (888) 486-8264

NAMI-VA is a statewide self-help, support, and advocacy organization for families and
friends of individuals with serious mental illness. The purpose of NAMI-VA is to help
each other share valuable information on medications, housing, research, community-
based care, and many other issues.

                      Mental Health Association of Virginia (MHAV)
                                     (804) 225-5591

MHAV promotes mental health, develops services to prevent mental illness, and
assures the proper care and treatment of mentally ill children and adults through public
policy advocacy, public education and training, and promotion and provision of services
and programs designed to improve mental health and to reduce conditions which
impede the attainment of mental health.

            Virginia Department for the Deaf and Hard of Hearing (VDDHH)
                                    (800) 552-7917

Specialized support for persons who are deaf, hard of hearing, late deafened, or deaf-
blind.

                                     Consumer-Run Programs

There are consumer-run programs which are located throughout the state. These
programs differ widely but all provide assistance to persons with mental illness. For
information on a consumer-run program located near you, talk with your case manager,
your local DMHMRSAS Human Rights Advocate, or call VOPA at (800) 552-3962.

                 National Mental Health Association Information Center
                                    (800) 969-6642

          National Depressive and Manic Depressive Disorders Association
                                  (800) 826-3632

                          DMHMRSAS Office of Consumer Affairs
                                (800) 451-5544 (Voice)
                                 (800) 513-6767 (TTY)


September 2002                                                                                   Page 9
                     This publication was prepared with 100% federal funding through the
                   Protection and Advocacy for Individuals with Mental Illness (PAIMI) Act.

                   Virginia's Protection and Advocacy System Serving Persons with Disabilities
                          For Those Who Have Internet Access:

www.mentalhealth.org          Center for Mental Health Services

www.nimh.nih.gov              National Institute of Mental Health

www.ndmda.org                 National Depressive Manic Depressive Association

www.dmdav.org                 Depressive Manic Depressive Association of Virginia

www.nmha.org                  National Mental Health Association

www.nami.org                  National Alliance for the Mentally Ill

www.mentalhealth.com          “Free encyclopedia of MH info,” links to other sites

www.schizophrenia.com         Excellent links

www.mhselfhelp.org            National Mental Health Consumers Self-Help Clearinghouse

The Virginia Office for Protection and Advocacy (VOPA) is an independent state agency
with a mission of providing responsive, expert assistance, and representation
addressing disability-related abuse and neglect, discrimination, and inappropriate
services and treatment.

VOPA can help by:

   identifying resources;
   answering questions about services and benefits;
   explaining rights and responsibilities;
   providing guidance in solving problems;
   investigating complaints;
   negotiating solutions to disagreements; and
   providing representation in administrative and legal proceedings.

All callers receive information, referrals to other sources of help and/or technical help
with their issue. Due to limited resources, VOPA is required to set annual priorities and
case selection standards. VOPA may provide advocacy and legal representation for
those people whose problems fall within the annual priorities and case selection criteria.
Call (800) 552-3962 for information on current priorities and case selection standards.

VOPA does not unlawfully discriminate on the basis of sex, age, race, color, religion,
disability, or national origin in employment or in its programs and activities. To ensure
full and equal access, VOPA will provide reasonable accommodation and auxiliary aids
upon request.
September 2002                                                                                 Page 10
                   This publication was prepared with 100% federal funding through the
                 Protection and Advocacy for Individuals with Mental Illness (PAIMI) Act.

                 Virginia's Protection and Advocacy System Serving Persons with Disabilities
                 Virginia Office for Protection and Advocacy

                              Richmond and Central Offices
                                Ninth Street Office Building
                             202 North Ninth Street, Ninth Floor
                                 Richmond, Virginia 23219
                           800-552-3962 (Toll-Free/Voice & TTY)
                               804-225-2042 (Voice & TTY)
                                    Fax: 804-225-3221


                                        Staunton Office
                                      114 MacTanly Place
                                    Staunton, Virginia 24401


                                   Virginia Beach Office
                          287 Independence Boulevard, Suite 120
                               Virginia Beach, Virginia 23462


For more information about VOPA programs, investigations, publications, and upcoming
               events, log onto our web site at: www.vopa.state.va.us


                            For other disability agencies visit the
                          Virginia’s Disability Services web site at:
                                       www.vadsa.org




September 2002                                                                                 Page 11
                   This publication was prepared with 100% federal funding through the
                 Protection and Advocacy for Individuals with Mental Illness (PAIMI) Act.

                 Virginia's Protection and Advocacy System Serving Persons with Disabilities

								
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