A year after A.O. Fox Memorial Hospital in Oneonta closed its 28-bed psychiatric unit, Bassett Healthcare, through its 20-bed unit and the crisis services it started earlier this year, is working to close the gap, officials said last week.
But Bassett's program doesn't include hospitalization for adolescents, and some advocates for the mentally ill remain worried about meeting needs of teenagers and their families.
When Fox shut down its psych units, many in the mental health community said they were concerned about teens in crisis who would have to travel outside the area for inpatient care.
The closure at Fox did present ``a bit of a deficit'' in services, Joe Fodero, NAMI-Otsego advocacy chairman, said, and having to admit a teen to a hospital outside the area adds stress to an already traumatic situation.
Bassett crisis team members will speak about their services at the State University College at Oneonta at 7 p.m. Thursday. The program will provide information about care and answer questions, said advocates who organized the meeting.
The public program was scheduled to raise awareness that treatments exist for mental illnesses, which affect people of all backgrounds, said Fodero, a retired health sciences professor at the State University College at Oneonta.
``People are stigmatized for something they have no control over,'' he said.
A year after the closing of Fox's units, mental health-care needs are being met for all age groups, according to providers, but referrals might take longer than the ideal.
The end of the Fox services resulted in a mobilization of preventive and support care, said Susan Dalesandro, director of community services in Otsego County, which includes the Otsego County Mental Health Clinic in Oneonta, and the clinic has an excellent working relationship with Bassett.
Dalesandro said the county's Mental Health Clinic tallies about 12,000 visits a year, with 650 patients being seen at any given time. The staff sees Otsego County residents and treats conditions from anxiety to psychotic illnesses, she said.
Bassett staff has been seeing a comparable number of patients who would have been seen at Fox, Dalesandro said. Of between 100 and 140 patients a month seen in the Bassett crisis center, about 50 percent are admitted to a hospital, she said.
However, the closest hospital units for teenagers are in Binghamton, Saratoga or Utica.
The Fox Hospital 12-bed adolescent unit was welcomed when it opened in 1998.
Fox's teen services were a ``great asset'' for the county and losing the program ``has been close to a disaster,'' said Charles J. Hudson, a member of the National Association for the Mentally Ill_Otsego.
Since Fox closed its units, seven more beds at Mohawk Valley Psychiatric Center have been made available for adolescent patients referred through Bassett, Dalesandro said, and officials plan to open a crisis bed for teen care at Trillium Place, a home in Oneonta for teenagers with mental health problems.
Of the 95 teenagers in crisis, about a third were hospitalized, Dr. Celeste Johns, Bassett chief of psychiatry, said. The staff has faced a lack of available beds at hospitals with inpatient programs, and that meant patients had to stay overnight in the crisis unit, she said, but the issue is a statewide problem that Fox also faced when it was open.
Finding an available bed also is an issue elsewhere, not just for Fox or Bassett, Dalesandro said, and the goal in providing mental-health care reflects the mission of medicine in general _ to give preventive care on an out-patient basis, Dalesandro said. Locally, the goal is to provide a single, strong network, she said.
Dr. Samuel Press, a psychiatrist, continues working at the county clinic, which is finalizing the hiring of Dr. Joseph Touchstone, a psychiatrist who will be able to prescribe medications, Dalesandro said.
According to the Substance Abuse and Mental Health Services Administration, there were 2 million youths, or 8.2 percent of the population aged 12 to 17, who had major depressive episodes during 2007. A major depressive episode was defined as a period of two or more weeks when there is either depressed mood or loss of interest or pleasure and at least four other symptoms that reflect a change in functioning, such as problems sleeping, eating or concentrating.
The local chapter of the National Alliance for the Mentally Ill, along with other groups, arranged Thursday's program for care-givers, consumers and the public to learn about services at Bassett Hospital. Johns and others will speak at in the Morris Conference Center at SUCO on Thursday.
Bassett Healthcare started crises services Feb. 15. Johns, who developed the crisis center, said the hospital, like other health-care providers, faces constraints from a shortage of psychiatrists and a limited number of beds. But overall, Johns said, she is pleased with how well needs have been met.
Fox closed its psychiatric services because it had trouble recruiting and retaining psychiatrists and its programs were a financial drain on other services the hospital provides, Maggie Barnes, Fox spokeswoman said last week.
In 2006, the last complete year of service, Fox's average daily census reported 13.36 patients per day in the adult psychiatric unit and 8.38 patients per day in the adolescent unit for a total of 21.74, officials said. Fox unsuccessfully proposed opening an outpatient mental-health clinic in Oneonta to add to follow up with discharged patients.
But community services directors in Otsego, Schoharie, Delaware and Chenango counties last year didn't support the hospital's argument based on need.
Fox's closure of psychiatric units left Bassett Hospital the sole provider in Otsego County and the only psychiatric unit near Chenango, Delaware and Schoharie counties.
Hudson said patients also have mentioned they need a group therapy program for those who are persistently mentally ill. If Fox's application for an outpatient clinic had been approved, it would have provided a significant addition to services in the county, he said.
However, Dalesandro, who opposed Fox's application, said she supports enhancing and coordinating existing resources instead of adding services.
``We should not be competing for the scarce resources,'' she said. ``We're really working at creating one strong system.''
About a year ago, Bassett announced it would offer crisis services, and after staffing and renovations were complete, the center opened, Johns said.
Demand rose at Bassett in the months after the Fox services ended, Johns said, but Bassett's crisis team has smoothed out response.
Between Feb. 15 and Sept. 18, Bassett has seen 766 patients in crisis situations, including 637 adults, 34 children and 95 adolescents ages 13 to 17, Johns said. The center doesn't begin treatment or prescribe medication, she said, but does help the patient by arranging appointments within 24 hours, accessing emergency housing and identifying other assistance toward a safe resolution.
Bassett crisis services are provided in three rooms near the emergency department, Johns said, and 24-hour staffing includes a psychiatric nurse and an aide. Johns said she usually is the psychiatrist on-call around the clock. The center also has two coordinators who monitor a patient's transition through the care network, Johns said.
A recommendation for patient hospitalization is made through staff consultation that sometimes includes an emergency room physician, she said.