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“Troubled minds: Discharges creating treatment backlog, experts say”

The following article was found in the September 20, 2008 Johnstown Tribune-Democrat at the following address … http://www.tribune-democrat.com/local/local_story_264234435.html

The article discusses the impact of the closure of Mayview State Hospital on community based mental health services.

Troubled minds: Discharges creating treatment backlog, experts say

The Tribune-Democrat

September 20, 2008 11:43 pm

New fences at Torrance State Hospital’s fledgling criminal unit illustrate the official preparations for closing another state hospital, but local mental-health leaders say much more is needed.
Discharged state hospital patients from soon-to-be-closed Mayview State Hospital near Pittsburgh and downsized Torrance are given first priority in community programs.
The situation is creating a backlog, psychiatrists Larry Nulton and Burton Singerman say.
Not only do current facilities need expansion, but new intervention programs and treatment facilities will be required.
While the state is looking into those additions, discharges at both hospitals continue.
“The state is behind,” Nulton said at Nulton Diagnostic and Treatment Center, 214 College Park Plaza, Richland. “They should have had these programs and other supports before they deinstitutionalized.”
Closing Mayview is part of a 40-year program to move mentally ill patients out of institutions and into community settings, Deputy Welfare Secretary Joan Erney said.
Her Office of Mental Health and Substance Abuse Services oversees the closing, working with community-based programs and local hospitals to help continue care.
“The seriously mentally ill can live very successful lives in the community if they have stable housing, support and treatment,” Erney said.
Mayview’s discharges have raised alarms in Allegheny County, where several former patients and others treated for mental illness have been involved in senseless violent crimes.
Shadyside resident Terrence Andrews told police he complained to his doctor that he felt like killing someone before he was arrested in May for the stabbing death of 18-year-old Lisa Maas.
In June, former Mayview patient Andrea Curry-Demus was accused of killing a pregnant teenage girl and cutting an infant boy from the woman’s womb.
It was among at least seven serious incidents involving former Mayview patients that triggered investigations since the state in August 2007 announced plans to close the facility by the end of this year. The investigations led to a temporary moratorium on discharges in November, and a one-month halt to new referrals to Western Psychiatric Institute of UPMC last month. Several of the discharged Mayview patients were assigned to Western Psych for follow-up.
Western Psych was just a scapegoat, Singerman insists.
“They have blamed (Western Psych) for many deaths of outpatients who were put in personal care homes after discharge from years of state hospital care, without acknowledging that closing the state hospital led to people being discharged who were too ill,” Singerman said.
“They either killed themselves or someone else because of the severity of their illness.”
Cambria County mental-health leaders agree that community environments are the least-expensive, most-effective way to treat the mentally ill.
“I think the philosophy and the theory are good,” Nulton said.
“The state has the right model. They have researched it well.”
But it’s too slow in coming, Nulton stressed, characterizing it as a “cart before the horse.”
Local advocates are pushing for more inpatient care facilities and more extensive response teams.
Memorial Medical Center’s psychiatric units often are filled because there is no facility that can accept patients ready for less intensive care, said Singerman, who chairs Memorial’s behavior health program.
Admissions at Cambria County’s long-term structured residence facility on Windy Valley Road outside Ebensburg are now limited to those being discharged from Torrence.
Singerman said what is needed is a step-down unit – a place for those who don’t need constant supervision, but aren’t ready for a group home or personal care home. His cousin, David Cutler, helped develop a step-down, or sub-acute care unit for Salem State Hospital in Oregon.
Those coming out of a short-term psychiatric hospital unit like Memorial’s can be placed in the sub-acute unit for up to three months to see if they are ready for the community or should be admitted to a state hospital. Oregon’s program was able to reduce admissions to the state hospital, Singerman said.
Newly formed Crisis Intervention Team of the Laurel Highlands is a good start, said Wendy Stewart, director of National Alliance on Mental Illness of Cambria County.
Based on the proven Memphis, Tenn., model, Laurel Highlands’ law enforcement officers have been trained to handle mental-health patients in crisis to defuse situations and get needed help.
Stewart and the psychiatrists would like local leaders to expand the program to include a 24-hour crisis stabilization unit like Memphis’, where mentally ill patients can be taken for care and evaluation. The next step would be an assertive community treatment team of professionals available 24 hours to help mentally ill people stay out of crises. The team would monitor medication and other life issues, getting help as needed.
“It’s a very expensive program to start up, but well worth sparing people the hospitalization,” Stewart said. “It’s cost effective in the end. You are keeping people out of the hospital.”

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