General consideration. An important factor in a mental health treatment program in an inpatient service is a therapeutic atmosphere. Although intangible, the presence or lack of this atmosphere is pervasive and immediately apparent. It is important that all staff members treat each patient with respect, providing all freedoms his or her condition permits and allowing the patient to retain a sense of individuality, freedom of choice and independence. Patients shall be encouraged to behave appropriately and in a socially acceptable way. Patients shall be permitted to dress in individually selected street clothing and retain sentimentally important personal possessions as clinically indicated. They shall be permitted to write letters, subject to restrictions only as clinically indicated. Home-like living quarters with drapes, pictures and furnishings shall be provided, and normal needs for privacy and feelings of modesty respected. Conversely, severe restriction of freedom of movement by prison-like practices; implicit or explicit expectations of dangerous, unpredictable behavior; use of punishment, especially seclusion and restraint, in the guise of therapy; exploitation of patient labor; use of spoons only as eating utensils and the like, shall not be permitted.
2. Staff functions.
To maximize the therapeutic effect of hospitalization, all aspects of mental health inpatient care must be integrated into a continuous treatment program. The activities of all staff— psychiatrists, physicians, psychologists, social workers, activity therapists, nurses, aids, chaplains and others—must be coordinated in a concerted treatment effort, utilizing the special skills and roles of each in a complementary manner to effect a total therapeutic purpose. The services of volunteers must be used in the same way. The specific treatment responsibilities of psychiatrists, psychologists, social workers and activity therapists are generally well understood, but the contributions of volunteers and other staff, such as chaplains and food service workers, also have important implications for patients' welfare. Their work must be carried out in a manner which furthers the total treatment program. Nursing staff shall be full partners in therapeutic team and, as a significant portion of their nursing responsibilities, shall participate in activities such as group therapy, supportive counseling, and socializing experience for patients. Mental health aides are valuable contributors to the therapeutic milieu. As staff members who are constantly in close contact with patients, their activities are to be geared carefully to provide patients with emotional support and respite from inquiry into their difficulties, promote their independence, and provide them with companionship and assistance in personal care and grooming, recreational activities, social behavior, care of property and day to day living.
Every newly received patient shall be evaluated by the professional staff within 48 hours after admission. This evaluation shall include psychiatric examination, the initiation of family contact and social history taking, and psychological examination when indicated. A plan of treatment and/or disposition shall be formulated and periodically reviewed. Progress notes on all cases shall be written frequently and regularly as the patient's condition requires, but in no instance less than once a week.
(c) Clinical records.
The mental health inpatient service shall maintain a current treatment plan and clinical record on each patient admitted to the service.
(d) Drug and somatic therapy.
Every patient deemed an appropriate candidate shall receive treatment with modern drugs and somatic measures in accordance with existent laws, established medical practice, and therapeutic indications as determined by current knowledge.
(e) Group therapy.
Each mental health inpatient service is encouraged to develop group therapy programs, including remotivation groups where appropriate. Nursing and aid staff should be trained in these therapy techniques.
(f) Activity therapy.
The occupational therapist shall organize and maintain an activity therapy program on a year-round full time basis. This treatment and rehabilitation program shall be reality oriented and community focused. The program shall be carried on both in the facility and in the community. The activity therapy department shall also provide a program of recreational activities to meet the social, diversional and general developmental needs of all patients. A recreational therapist may be employed for this purpose. Activity therapy should be part of each patient's treatment plan and should be individually determined according to needs and limitations. The record of the patient's progress in activity therapy should be recorded weekly and kept with the patient's clinical record.
(g) Industrial therapy.
Industrial therapy assignments shall be based on the therapeutic needs of the patient rather than the needs of the inpatient service. Industrial therapy shall be provided only upon written order of the psychiatrist. The written order shall become part of the patient's clinical record. The industrial therapy assignment of patients shall be reviewed by the treatment staff weekly. The review shall be written and included in the patient's clinical record. Continued use of industrial therapy will require a new order from the psychiatrist weekly.
Adequate religious services must be provided to assure every patient the right to pursue the religious activities of his or her faith.
Each service shall provide regularly scheduled visits by clergy.
Each service may utilize the services of a clinical pastoral counselor as a member of the treatment team, provided he or she has had clinical training in a mental health setting.
(i) Use of mechanical restraint and seclusion.
Mechanical restraint and seclusion are measures to be avoided if at all possible. In most cases control of behavior can be attained by the presence of a sympathetic and understanding person or appropriate use of tranquilizers and sedatives upon order of the psychiatrist. To eliminate unnecessary restraint and seclusion, the following rules shall be observed.
Except in an emergency, no patient shall be put in restraints or seclusion without a medical order. In an emergency the administrator of the service or designee may give the order. Such action shall be reviewed by a physician within 8 hours.
Patients in seclusion—restraints must be observed every 15 minutes and a record kept of observations.
(j) Extramural relations.
Inpatient mental health services are one component of community based comprehensive mental health program provided or contracted by the unified boards under s. 51.42
, Stats. As a component of the community based comprehensive program the inpatient service program must be integrated and coordinated with all services provided through the unified board. Evidence of integration and coordination shall be detailed in the unified board's plan. Professional staff should be used jointly by the inpatient and other services and clinical records shall be readily transferable between services.
1. Alternate care settings.
Every effort shall be made to find and develop facilities for patients who require medical or social care or less than full time inpatient mental health treatment. Such facilities, known as alternate care settings, shall include but not be limited to group homes, foster homes, residential care facilities, nursing homes, halfway houses, partial hospitalization and day services. Special effort shall be made to place patients in family care settings whenever possible.
2. Vocational rehabilitation.
The inpatient service shall establish an ongoing relationship with vocational rehabilitation counselors. Every effort shall be made to identify patients amenable to vocational rehabilitation and to refer them to the appropriate agency. Sheltered workshops shall be utilized to the fullest possible extent.
3. Family and community ties.
Active effort shall be made to maintain the family and community ties of all patients. In many cases the inpatient service staff must take the initiative to develop and maintain family contact. Visiting of patients in the hospital and patient visits outside the hospital shall be as frequent and as long as circumstances permit. Maintaining community ties would include such activities as arranging for patients to do their own shopping, attending church, continuing employment, and participating in recreational activities within the community.
DHS 61.71 History
Cr. Register, December, 1973, No. 216
, eff. 1-1-74; renum. from PW-MH 60.62, Register, September, 1982, No. 321
, eff. 10-1-82; corrections made under s. 13.93 (2m) (b) 5., Stats., Register, June, 1995, No. 474
DHS 61.72 Enforcement of inpatient program standards. DHS 61.72(1)(1)
All community mental health inpatient services receiving state aid must meet the above standards. Departmental personnel familiar with all aspects of mental health treatment shall review each inpatient service at least annually in connection with state funding of county programs.
State funding shall be discontinued to any inpatient service not maintaining an acceptable program in compliance with the above standards after the service has had reasonable notice and opportunity for hearing by the department as provided in ch. 227, Stats.
The service will be deemed in compliance with these standards if its governing body can demonstrate progress toward meeting standards to the department; however, all services must be in full compliance with these standards within a maximum of 2 years of the issuance of these rules.
DHS 61.72 History
Cr. Register, December, 1973, No. 216
, eff. 1-1-74; renum. from PW-MH 60.63, Register, September, 1982, No. 321
, eff. 10-1-82.
DHS 61.73 Other community program standards - introduction.
The following standards have been developed for community mental health programs receiving state aids, whether directly operated by counties or contracted from private providers. The standards are intended to insure that each mental health program will provide appropriate treatment to restore mentally disordered persons to an optimal level of functioning and, if possible, keep them in the community.
DHS 61.73 History
Cr. Register, March, 1977, No. 255
, eff. 4-1-77; renum. from PW-MH 60.64, Register, September, 1982, No. 321
, eff. 10-1-82.
DHS 61.75 Day treatment program.
Day treatment is a basic element of the mental health program providing treatment while the patient is living in the community. Its services shall be closely integrated with other program elements to ensure easy accessibility, effective utilization and coordinated provision of services to a broad segment of the population. Day treatment provides treatment services for patients with mental or emotional disturbances, who spend only part of the 24 hour period in the services. Day treatment is conducted during day or evening hours.
Day treatment staff shall include various professionals composing a mental health team. They shall be directly involved in the evaluation of patients for admission to the service, determining plan of treatment and amount of time the patient participates in the service and in evaluating patients for changes in treatment or discharge.
A qualified mental health professional shall be on duty whenever patients are present.
A psychiatrist shall be present at least weekly on a scheduled basis and shall be available on call whenever the day treatment service is operating.
A social worker shall participate in program planning and implementation.
A psychologist shall be available for psychological services as indicated.
A registered nurse and a registered activity therapist shall be on duty to participate in program planning and carry out the appropriate part of the individual treatment plan.
Additional personnel may include licensed practical nurses, occupational therapy assistants, other therapists, psychiatric aides, mental health technicians or other paraprofessionals, educators, sociologists, and others, as applicable.
Volunteers may be used in day treatment and programs are encouraged to use the services of volunteers.
A day treatment program shall provide services to meet the treatment needs of its patients on a long or short term basis as needed. The program shall include treatment modalities as indicated by the needs of the individual patient. Goals shall include improvement in interpersonal relationships, problem solving, development of adaptive behaviors and establishment of basic living skills.
There shall be a written individual plan of treatment for each patient in the day treatment service. The plan of treatment shall be reviewed no less frequently than monthly.
There shall be a written individual current record for each patient in the day treatment service. The record shall include individual goals and the treatment modalities used to achieve these goals.
DHS 61.75 History
Cr. Register, March, 1977, No. 255
, eff. 4-1-77; renum. from PW-MH 60.67, Register, September, 1982, No. 321
, eff. 10-1-82.
DHS 61.76 Rehabilitation program.
The community mental health program shall be responsible for the provision of an organized rehabilitation service designed to reduce the residual effects of emotional disturbances and to facilitate the adjustment of the mentally ill, mentally handicapped and emotionally disturbed in the community through a variety of rehabilitation services. When possible, these services should be provided in conjunction with similar services for other disabilities.
(1) Required personnel.
A person responsible for coordination of rehabilitation services shall be named and all staff shall have qualifications appropriate to their functions. Each such person shall have the required educational degree for his or her profession and shall meet all requirements for registration or licensure for that position in the state of Wisconsin.
(2) Program operation and content.
Because of the variety of programs and services which are rehabilitative in nature, individual program content is not enumerated. Such facilities as halfway houses, residential care facilities, foster and group homes shall meet all departmental and other applicable state codes. The department of health services shall evaluate each proposal for funding of rehabilitation services on the basis of individual merit, feasibility and consistency with the approved community plan required in s. 51.42
, Stats. Applicants for aid under this section must fully describe the rehabilitation service designed to meet the particular needs of the residents of their county or counties, taking into consideration existing community resources and services.
DHS 61.76 History
Cr. Register, March, 1977, No. 255
, eff. 4-1-77; renum. from PW-MH 60.68, Register, September, 1982, No. 321
, eff. 10-1-82; correction in (2) made under s. 13.92 (4) (b) 6.
, Stats., Register November 2008 No. 635
DHS 61.77 Consultation and education program.
Prevention is as important to mental illness as it is to physical illness. Certain facts and relationships between mental illness and environmental factors, individual personal contacts, and human development stages can be the basis for sound primary prevention programs. Education programs designed to increase the understanding and acceptance of the mentally ill are especially vital as increased numbers of persons receive needed treatment in their own community. Such programs can help prevent the chronicity of recurrence of mental illness. They can bring persons to seek counsel or treatment earlier and help to remove what has been an unacceptable “label" for family, friends, and co-workers. Because consultation and education programs are required elements of community mental health programs, the activities must be as well defined, organized and provided for as those for other program elements. Mental health staff and time allocations must be made and structured consultation and education programs designed and carried out.
(1) Consultation required personnel.
The mental health coordinator or designee shall be responsible for the consultation program. Mental health staff shall respond to individual consultation requests. In addition staff shall actively initiate consultation relationships with community service agency staff and human service personnel such as clergy, teachers, police officers and others.
No less than 20% of the total mental health program staff time, exclusive of clerical personnel and inpatient staff shall be devoted to consultation. The service shall include:
There shall be a planned consultation program using individual staff skills to provide technical work-related assistance and to advise on mental health programs and principles. The following human service agencies and individuals shall have priority for the service:
(3) Education required personnel.
The qualified educator maintained by the community board shall be responsible for the mental health education program. Refer to this chapter. Mental health staff members shall cooperate and assist in designing and carrying out the mental health education program, providing their specialized knowledge on a regular, established basis to a variety of specified activities of the service. In cooperation with the education specialist maintained by the board, additional education staff may be employed on a full-time or part-time basis. Education services can also be contracted for through the same procedures followed for other service elements contracts.
(4) Education service content.
No less than 10% of the total mental health program staff time exclusive of clerical personnel and inpatient staff shall be devoted to education. The service shall include:
(5) Education program.
There shall be a planned program of public education designed primarily to prevent mental illness and to foster understanding and acceptance of the mentally ill. A variety of adult education methods shall be used including institutes, workshops, projects, classes and community development for human services agencies, individuals and for organized law groups and also the public information techniques for the general public. There shall be a planned program of continuing education using a variety of adult education methods and available educational offerings of universities, professional associations, etc. for agency staff and related care-giving staff.
DHS 61.77 History
Cr. Register, March, 1977, No. 255
, eff. 4-1-77; renum. from PW-MH 60.69, Register, September, 1982, No. 321
, eff. 10-1-82; correction made under s. 13.93 (2m) (b) 7., Stats., Register, June, 1995, No. 474
DHS 61.78 Additional requirements for programs serving children and adolescents - introduction and personnel. DHS 61.78(1)(1)
The following standards have been developed for community mental health services for children and adolescents. Except for the substitution of minimal hourly requirements, these standards are intended to be in addition to ss. DHS 61.70
and are consistent with those stated in Standards for Psychiatric Facilities Serving Children and Adolescents,
published by the American Psychiatric Association; and the Joint Commission on Accreditation of Hospitals. Planning psychiatric facilities and services for children and adolescents is difficult and complex. These standards are intended to insure a continuity of care notwithstanding the complexities involved. To accomplish this each service must:
Consider the children and adolescents' development needs as well as the demands of the illness;
Have cognizance of the vital meaning to children and adolescents that group and peer relationships provide;
Recognize the central importance of cognitive issues and educational experiences;
Recognize the children and adolescents' relative dependence on adults;
Place some importance on the children and adolescents receiving repeated recognition for accomplishments;
Provide an individualized treatment program by so structuring the environment to allow for optimal maturational, emotional and chronological growth.
(2) Personnel requirements.
The following personnel requirements are relevant only to children and adolescents' services and are applicable for each program. These requirements are in addition to the personnel qualifications listed in the General Provisions of Standards for Community Mental Health, Developmental Disabilities, and Alcoholism and Other Drug Abuse Services, ss. DHS 61.01
Special effort shall be made to procure the services of a child psychiatrist who is licensed to practice medicine in the state of Wisconsin and is either board eligible or certified in child psychiatry by the American board of psychiatry and neurology. If a child psychiatrist is unobtainable, special effort shall be made to procure a psychiatrist who has had a minimum of 2 years clinical experience working with children and adolescents.
Registered nurses and licensed practical nurses. Special effort shall be made to procure the services of registered nurses and practical nurses who have had training in psychiatric nursing. A portion of this training shall have been with emotionally disturbed children and adolescents.
Aides, child care workers and other paraprofessionals. Each service shall make a special effort to recruit the aides, child care workers and paraprofessionals who have the following background.
College or university credit or non-credit courses related to child care.
High school diploma and experience in children or adolescents' related activities.