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September 28, 2013

N.Y. eyes overhaul of mental health care

By Denise Richardson Staff Writer
The Daily Star

---- — The state plans to consolidate inpatient psychiatric care in an overhaul that aims to deliver more mental health services at the community level. 

But the regional impact is both unclear and evolving. A team, including local representatives, is working to identify resources and needs to provide more services to consumers closer to home. 

Improved treatment at the community level means fewer patients would need hospitalized care, according to the state Office of Mental Health Regional Centers of Excellence plan, which was presented in July. Under the OMH proposal, the state’s 24 psychiatric centers will be consolidated into 15 regional centers. 

The state’s treatment of mental illness is a hospital system based on a business model developed in the 1840s, OMH officials said. The goal of the plan is to move from the hospital system to a network of services and supports provided by state staff in communities. 

The three-year implementation would start in July and be complete in 2017. 

As state legislative committees hold hearings, two local lawmakers are monitoring developments.  

Assemblyman Clifford Crouch, R-Bainbridge, opposes the plan’s move to close inpatient services at the Greater Binghamton Health Center, which provides outpatient and inpatient services to children and adults who are mentally ill. 

“The plan to provide only outpatient and other services to patients in the Southern Tier is simply not enough,” Crouch said in a statement earlier this month. Families would have to travel to Syracuse or Utica for inpatient services under the proposal, which doesn’t “hold muster” given GBHC’s outstanding ranking, he said. 

The governor must seek legislative approval of funding before the plan can be implemented, Crouch said. The assemblyman pledged to work with OMH and the governor on an alternative that would benefit affected New Yorkers in the plan’s Empire Upstate Regional Center for Excellence area, which includes Otsego, Delaware and Chenango counties. 

State Sen. James Seward, R-Milford, also is concerned about the impact of proposed changes on area residents, Seward spokesman Jeff Bishop said Wednesday. Other issues include the presence of “dangerous patients” in communities and an economic threat of lost jobs, Bishop said. 

“It’s a multi-level concern,” Bishop said. 

On a listening tour earlier this year, the state OMH met with 30 communities, members of the Legislature and labor unions to explain the forces of change facing the mental health system. Officials said the Regional Centers of Excellence plan aims to ensure continuity of employment for the staff. 

A multi-region plan

Under the state’s proposal, 15 Regional Centers of Excellence in five areas would be established across the state. The state would be divided into western, central, Hudson River, New York and Long Island regions. 

Otsego, Delaware and Chenango counties would be among 20 counties in the OMH Central New York Region, which would serve almost 2 million residents. Under the three-year implementation of the RCE plan, the local center would be established in the state’s 2014-15 year. 

According to the plan, the Greater Binghamton Health Center, Hutchings Psychiatric Center in Syracuse and the Mohawk Valley Psychiatric Center in Utica would be merged to form the Empire Upstate Regional Center of Excellence.

The Empire Upstate RCE would have a campus in Syracuse with a capacity to serve 185 adults and another campus in Utica with a capacity of 75 beds to serve children and adolescents for inpatient care. The center would “build on the long-standing affiliation OMH has enjoyed with SUNY Upstate Medical University’s Department of Psychiatry,” the proposal said. 

Community-based services will be provided through hubs in Binghamton, Utica and Syracuse, according to the proposal.

Benjamin Rosen, OMH spokesman, said under the plan, communities in Otsego, Delaware and Chenango counties would see earlier interventions, a stronger and more-effective mental health system and more emphasis on community-based treatment.

“For the families of individuals who still require inpatient care, which would be provided at Empire Upstate Regional Center of Excellence in Utica and Syracuse, OMH plans to offer services such as travel assistance, hospitality housing and video conferencing, services which allow families to take part in recovery as never before,” he said. 

OMH operates 24 state-operated psychiatric hospitals, which is the largest system in the United States, Rosen said, and for one one individual served within a psychiatric center, five can be served in a community.

“Maintaining an oversized state hospital system is not good for the people OMH serves and consequently underfunds community mental health,’’ he said. “As New York moves into ‘managed care’ for behavioral health services, it is important that OMH remain competitive and that we make our services affordable, accessible and available to more New Yorkers.”

Schoharie County would be part of the Hudson River Region, which is to have three centers of excellence. 

Susan Matt, director of community services in Otsego County and its mental health department, said the state’s proposal is a start to address changes in treatment and its agenda needs to be supported, though details need to be worked out. A concern exists that state hospitals are being phased out without having alternatives in place, she said, and community-based services should be in place before state hospitals are closed.

The Otsego County Mental Health clinic sent an average of two children or adolescents and 1.5 adults monthly to the Greater Binghamton Health Center for inpatient services between January 2012 and Aug. 28, 2013, Matt said. The local clinic also uses other facilities. 

Treating patients with persistent mental illness today is different than 30 years ago because of advances in medications, among other reasons, Matt said. More patients are living with their mental illness instead of being ruled by it, she said.

Not many consumers want to go to a state hospital, said Matt, who added that she doesn’t like to send children a state hospital.

“We would all like to be successful in keeping people in their communities,” Matt said. “We need to have a system that meets the needs of people today.”

Supreme Court: Appropriate settings

Rosen said the OMH plan also addresses treatment issues reviewed by the U.S. Supreme Court. In the 1999 Olmsted Decision, a case brought under the Americans with Disabilities Act, the high court ruled that individuals with disabilities have a right to care in the “most integrated setting appropriate” to their needs, he said. 

“This setting, in the majority of circumstances, is not a psychiatric hospital,” Rosen said. “New York is legally obligated to support treatment options apart from a psychiatric hospitalization — options which have better recovery outcomes, optimize community living for children and adults who prefer to be close to their families, friends, school and work while pursuing their own recovery.”

In any given year, one of four New York adults has a diagnosable mental disorder, while one in 17 has a serious mental illness, state officials said, and today, the majority of patients with mental illness choose to access treatment in primary care settings. 

About 715,000 individuals access care in specialty mental health settings each year. Officials said 10,000 of those individuals were served in OMH inpatient hospitals in 2012, which now has a census below 4,000, compared with 93,000 in the 1950s. 

That leaves more than 700,000 New Yorkers being served in the community, according to the OMH proposal.

Regarding costs, officials said, more than $1.3 billion per year is spent on OMH hospital treatment and care for 10,000 individuals, while $5.3 billion is spent on mental health care in the community for a population of more than 700,000 people.

Regional teams identify needs

“RCE Teams” have been established in each of the five regions under the OHM plan. Each panel will contribute to implementation of the RCE plan, identify priorities for community service expansion and develop regional outcome metrics, officials said. 

The team also will develop alternative use plans for state property in consultation with Regional Economic Development Councils. 

Matt, who is a co-chairwoman of the Central New York Regional Team, said the panel’s first scheduled meeting was Friday, Sept. 20. After a series of task-oriented meetings, recommendations for a steering committee will be ready later this year, she said.

The team also includes Rina Riba of the Delaware County National Alliance on Mental Illness chapter. 

The team is looking at existing services in communities and considering which services can be developed or added to become “more client centered,” Matt said. Mobile treatment providers, crisis and residential housing are among resources to be considered, she said. 

Matt said Greater Binghamton Health Clinic is convenient for inpatient care to many Otsego County residents.

The most significant negative geographical impact with the OMH plan would on children and adults living in the southern portion of the county, such as Unadilla, she said. Those clinic patients would have to drive an additional hour to be admitted to a hospital for psychiatric services, she said.

Distances for patients in Delaware County would be greater, Matt said. Families in rural counties have to travel a long distance if relatives want to be involved in treatment, she said, and the distance and cost can be a tremendous hardship.

The Otsego clinic’s rapport with the Greater Binghamton Health Center benefits patients needing admission, Matt said, and a major question is if that relationship can be developed with the two designated hospitals under the state’s redesign.

Matt said the Otsego County Mental Health Clinic also works with Bassett Healthcare Network to meet needs of area patients.

Dr. William Streck, Bassett Healthcare Network president and chief executive officer, said the OMH plan should have limited impact on services in the immediate future. 

“We do not yet know the overall impact of these changes on Bassett but we do anticipate that there will be changes,” Streck said in a prepared statement. “Community-based outpatient care has been an area of emphasis in Bassett’s efforts as seen in regional services and school-based health center programs.

“The role of inpatient services across the state is clearly undergoing reconfiguration and will require more analysis and understanding,” Streck said. “This is a major change that will have results that are yet to be determined.”