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Monitoring Residential Facilities

SAMHSA recently released two reports to help Federal and state policymakers improve procedures for monitoring the quality of care provided in residential facilities for adults and children living with mental illness.

State Regulation of Residential Facilities for Adults with Mental Illness includes responses from officials in 34 states and the District of Columbia who provided information on 63 types of residential facilities. These include 7,327 facilities that, in total, had 103,393 beds as of September 30, 2003.

State Regulation of Residential Facilities for Children with Mental Illness includes responses from officials in 38 states who reported on 71 types of facilities. These include 3,628 facilities that, in total, had 50,507 beds as of September 30, 2003.

Using a national survey of state officials, the two reports present a systematic overview of the states’ regulatory methods.

The reports provide the most accurate national data available concerning methods that states use to license, regulate, and monitor residential facilities for children and adults with mental illnesses.

Background

Since deinstitutionalization of individuals with mental illness began in the 1960s, residential facilities for adults with mental illness have changed substantially. They are now an important component of state mental health service systems.

Despite their importance, little comprehensive information exists on the policies and procedures used by states to regulate residential treatment facilities for adults and children with mental illnesses.

As a result, policymakers and program administrators faced major difficulties in determining both the effectiveness of current policies and the potential need for new policies that are responsive to emerging trends in mental health care.

The Studies

To be included in the study, residential facilities for adults and children with mental illness had to be licensed or certified by the state as providers of therapeutic services in addition to room and board.

In addition, officials in state departments of mental health, social services, and health and human services responded to a structured questionnaire on facility characteristics and programs, licensing and oversight procedures, and sources of financing.

The two studies found that states use a variety of methods to monitor residential facilities for adults and children with mental illness, and that states vary in the extent to which they use one method or another.

Typical monitoring methods included onsite inspections, documentation of staff training and qualifications, record reviews, resident interviews, critical-incident reports, standards for resident-to-staff ratios, and educational levels of facility directors. All states used at least several of these methods, but few states used all of them.

The studies also found that the regulatory and monitoring environment for residential facilities is complex. In most states, several agencies, each with a different mission and function, are involved in facility licensing, funding, and oversight.

Copies of both reports are available online from SAMHSA’s National Mental Health Information Center at www.mentalhealth.samhsa.gov or by calling 1 (800) 789-2647 (English and Spanish) or 1 (866) 889-2647 (TTY).

Criteria for Residential Facilities

To be part of this study, “residential facilities” all shared certain characteristics. They:

Specialize in the treatment of individuals with serious emotional or behavioral disorders, including those who are dually diagnosed (mental illness and substance abuse or mental illness and developmental disability) as long as mental illness was the primary problem.
Are establishments that furnished (in single or several facilities) food, shelter, and some treatment or services to three or more persons unrelated to the proprietor.
Provide staffing 24 hours per day, 7 days per week.
Operate under a state authority, such as a state office granting pertinent licenses or a state mental health authority.
Include 50 percent (minimum) of residents whose need for placement was based on mental illness.
Include individuals with average stays of 30 days or longer.
Provide at least some onsite therapeutic services beyond housing (e.g., group therapy, individual therapy, medication management) either by staff or under contract.

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