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April 12, 2014

Not the 'most perfect village' for the mentally ill

By Shirley O'Shea Local Commentary
The Daily Star

---- — Just when I thought it couldn’t get any worse, it did.

On April 5, in these pages, I read the sorry tale — the Bassett Medical Center’s 10-bed Inpatient Psychiatry Unit in Cooperstown is closing.

After what has been described as numerous aggressive searches for psychiatrists and physicians’ assistants and nurse practitioners specializing in psychiatry, not a single provider could be induced to practice in Cooperstown, a place of such graciousness, historic importance and aesthetic appeal that it adopted the slogan “America’s Most Perfect Village,” or Oneonta, or any of the communities that the Bassett Healthcare network serves.

Without the additional providers, those treating patients in the inpatient unit were unable to manage the caseload, and the hospital decided to close the unit. Interested parties now await approval of the closing from the NYS Department of Mental Health.

It is hardly a secret in the central New York health care community that there has been a crisis-level shortage of mental health care providers. Wait lists to be seen by a psychiatrist are often months’ long. Anyone who has lived with major depression knows the agony of a protracted wait _ indeed, any wait _ for treatment. The author William Styron titled his depression memoir “Darkness Visible,” and Andrew Solomon his “The Noonday Demon.” And neither of them, we may be sure, had to wait months to see a psychiatrist, let alone be separated from family and friends by a remote hospitalization in their time of greatest need.

According to Bassett, going forward, individuals in a psychiatric crisis _ those who are unable to care for themselves, feel unsafe or are un danger of harming themselves or others _ will be sent to inpatient facilities in Binghamton, Schenectady or Utica, assuming beds will be available at those locations at such times.

All of this comes on the heels of the 50 percent reduction of the beds in the Bassett unit _ distressing in itself, to consider a region as large as this with only 10 beds for those in acute episodes _ and the threatened closure of the inpatient psychiatric unit in Binghamton.

While the public has been assured by Bassett that every possible effort was made to procure mental health practitioners, without any favorable results, it is the duty of not only those with mental illness who are well enough to advocate for themselves and their families and friends, and not only the National Alliance for the Mentally Ill, but of the public, to ask if Bassett’s highest tier of management has involved itself as deeply and with as much commitment and creativity as it might have. If specialists in cardiology, oncology, endocrinology, gastroenterology or any of the other dozens of medical fields could be secured by Bassett, why is psychiatry the great exception? The public deserves a forthright explanation, supported by data.

It is true that we are living in times of reduction. But we need not live in times of diminishment. And in our lean and mean times, sayings by the likes of Gandhi rise into consciousness. The one that surfaces in my mind the midst of Bassett’s decision is, “The true measure of any society can be found in how it treats its weakest members.”

As a person who has lived with a mood disorder for most of my life, I would take some umbrage at any implication that I, or any other person with a psychiatric condition, is weak. I know better than that. A more suitable word would be vulnerable. To see the world as it is and do one’s best to live a productive and meaningful life in it, without the strange gift, possessed by those without depression, of being able to overlook or avert one’s eyes and shield one’s heart from its dark aspects, is no mean feat. Yet that is what so many with mental illness do every day.

There is a medical practice in Oneonta, a group of doctors (whom I will not name) whose office bears a small and unassuming plaque awarded to them by an international organization of physicians, for their “unselfish service to humanity.” Merely to read those words is inspiring.

Apparently a critical mass of psychiatrists do not want to practice in a rural region with widespread, generational poverty. I see this as a sign of diminishment _ not shortage of capital, but a shortage of the spirit of service and concern. Without a greater reserve of these intangibles, we are a poor society indeed.

Mentally ill persons do not acquire their affliction through bad attitudes or moral weakness or any other fault of their own. Most often, it is a mysterious interplay of biology and personal history. Helping such persons could be the most rewarding work a physician can undertake. The time when those training to be doctors, and those seeking employment, choose to serve some of society’s most vulnerable cannot come soon enough.

And I wish to point out something that has confounded me over the years _ how can any place be “most perfect”? Either you are perfect, or you are not.

Shirley O’Shea is a contributor to The Daily Star.