“Many questions remain regarding hospital’s closing”

This article found on Almanac.net at http://www.thealmanac.net/ALM/Story/12_26_SF_Mayview_questions_  dated December 26, 2007 raises questions regarding where Consumers from Mayview will end up being placed when the closure of Mayview is finalized.

Many questions remain regarding hospital’s closing
by Terry Kish, Freelance Reporter

With the decision to close Mayview State Hospital next December already made, there are still questions about how and where the residents will go when the doors finally close.

The Mayview closure is part of the state’s program to reduce reliance on institutional care while improving access to home and community based care for those with mental illness.

According to the Pennsylvania Department of Public Welfare’s (DPW) Web site, during the past two years the state has worked with county partners to “develop and enhance community service and support those leaving the hospital for the community.”

The resident population of Pennsylvania’s eight state hospitals-Allentown, Clarks Summit, Danville, Mayview, Norristown, Torrance, Warren, and Wernersville-has decreased from 4,934 in 1994, to 1,927 in June of 2007, with 224 of those residents located at Mayview. The state’s plan is to move the residents to less restrictive, community-based settings.

“Our intent is to expand the existing community infrastructure and invest in millions of dollars used to run more restrictive, costly hospital services to the community to enhance and sustain recovery-supporting services as well as continue to improve Pennsylvania’s mental health delivery system.”

The state is also gathering information about the creation of two privately run, regionally based forensic facilities, one in eastern Pennsylvania at Norristown State Hospital, and the at Torrance State Hospital, Westmoreland County.

The majority of residents at Mayview receive services for major depression, bi-polar disorder, schizophrenia, personality disorders, and substance abuse disorders. When asked which patients would be placed in the community, a representative from DPW responded that “each individual at Mayview is participating in a rigorous planning process which includes a broad range of participants to support the needs and choices of each person. This process is referred to as the Community Planning Support process.

The end result is a plan which will identify the individual’s preference for type of residence; needed treatment supports; case-management and/or education and employment goals and options, recreational activities etc. There are existing community hospitals to the extent that acute treatment needs arise, an extended acute hospital option at UPMC Western Psychiatric Institute with another being developed, and Torrance State Hospital if state hospital services are needed.”

The DPW announcement on Aug. 15 to close the clinical services of the civil section of Mayview by Dec. 31, 2008 means a loss of acute extended beds for those with mental illness.

Dr. Barry Fisher, the immediate past president of the Pennsylvania Psychiatric Society, said that while they are not opposed to closing a brick and mortar building, there needs to be an independent assessment of what the needs are going to be before closing the facility.

As the number of beds decrease, patients can wait three to nine months, and up to a year, for a bed. While the focus is to have community residential outpatient treatment, Fisher said beds are needed because some people with mental illness don’t stabilize at the same rate; some never stabilize.

The problem isn’t that there’s going to be enough out patient services, said Fisher, but that there are some mental illnesses that need inpatient treatment. Schizophrenia, severe bi-polar, severe personality, and psychotic disorders are some of the conditions that may require longer lengths of stays. Indicating that while the move to de-institutionalize is “well intentioned, but unrealistic,” Fisher said there is still a need for inpatient treatment.

Fisher commented that when a Harrisburg mental hospital closed, about one quarter of the patients went to Torrance State Hospital in Westmoreland Hospital.

Fisher expected a similar situation when Mayview closes, saying there are a certain number of patients who won’t be able to be treated outside of an institution.

Local emergency rooms are burdened with patients waiting for a day or two before getting a bed in an acute unit, sometimes at facilities located several counties away.

The DPW Web site states that home and community based care is less expensive than institutionalized care. In the 2004-2005 fiscal year, 3,644 patients with mental illness utilized 2,100 beds for an average yearly expenditure of $201,940 per bed, while during the same time period, 220,000 patients were served in the community with an average expenditure of $7,000 per patient.

The Mayview closing is the latest Pennsylvania state hospital to close. Between 1969 and 1979 the state hospital census was down by almost 17,000 patients, resulting in the closure of twelve state hospitals: Hollidaysburg State Hospital (1979), Retreat State Hospital; Embreeville State Hospital (1980), Eastern Pennsylvania Psychiatric Institute (1981), Dixmont State Hospital (1984), Philadelphia State Hospital (1990), Woodville State Hospital (1992), Fairview State Hospital (1995), Somerset State Hospital (1996), Eastern State School and Hospital (1997), Haverford State Hospital (1998), Harrisburg State Hospital (2006).