< All Topics

Mental Health Guide

Mental Health Plan

  1. We need to ensure that for all participants that have a Mental health diagnosis that we are capturing the plan for how their mental health is being managed.
    1. Examples of Mental Health Diagnosis
      1. Depression
      2. Anxiety
      3. Schizophrenia
      4. Borderline personality Disorder
      5. Post Traumatic Stress Disorder (PTSD) 
      6. Bipolar Disorder
    2. If you are unsure if a current diagnosis that the participant has falls into the category of Mental Health, then please follow up with your supervisor for guidance. 
  2. Mental Health information is captured in the PCSP
    1. You will need to gather information from the participant/POA during the visit to document a plan.
      1. Examples of questions to ask at the visit
        1. Do you currently take any medications to treat the diagnosis?
        2. Who prescribes the medication? (ie. Psychiatrist or PCP)
        3. How often do you see the prescribing physician? 
        4. Does anyone assist you with taking or remember to take these medications?
        5. Does anyone help monitor the effectiveness of your medication?
        6. Do you see a Therapist? If so, how often do you see them?
    2. Examples of ways that Mental health plan can be documented appropriately
      1. Mrs. Smith is diagnosed with anxiety and depression.  Mrs. Smith sees her PCP/Dr. Doe every month to review the effectiveness of her mental health medications.  Mrs. Smith has assistance from her HHA to remember to take her MH medications each day.  Mrs. Smith reports that her current medications are managing her diagnosis effectively at this time.
      2. Mr. Smith is diagnosed with schizophrenia and sees his Psychiatrist/Dr.Wright once every other month for medication review.  Mr. Smith’s daughter/Betty Smith provides supervision to ensure Mr. Smith is not exhibiting any unsafe behaviors and also monitors for medication effectiveness. A medication dispenser is used each day to ensure Mr. Smith takes his MH medications as prescribed.
      3. Mrs. Smith is diagnosed with depression and anxiety.  Mrs. Smith reported that she is not taking medication for these diagnoses and is not interested in a Behavioral health referral at this time.  Mrs. Smith feels she is managing her symptoms effectively at this time and is aware of the Mental health services available to her, but she is not interested at this time.
  3. You will need to document this information in the PCSP, in the following questions: (“yes” must be selected for any participant with a BH diagnosis)

Writing that the Participant has Mental health Diagnosis and writing that there is no plan or indicating that the plan is not fully effective to meet the participants needs would not be considered sufficient.

If during the discussion of the Mental Health Plan with the participant, they express that they would like to attain Mental Health services (ie. Therapist, Psychiatrist, etc) then a Behavioral Health Referral can be done. The Service Coordinator will email their Supervisor with the participants name, the best phone number where providers for these services will be able to reach the participant, the Diagnosis that is related to the referral (ie. Depression, Anxiety, etc), what specific service they would lik

Table of Contents