The area's programs and collaboration to provide mental-health services won a glowing review from a state commissioner who visited the area last week.

But even as local administrators shared details about successful programs, they told the Office of Mental Health commissioner about continued needs for cooperation, funding and changes in regulations.

Commissioner Michael F. Hogan, Ph.D., met with the Four-County Mental Hygiene Directors Group of Chenango, Delaware, Otsego and Schoharie counties at the Eaton Conference Center in Norwich on Tuesday. The group, which meets monthly, also includes officials from other central New York counties.

``I'm impressed by the history of collaboration among these counties,'' Hogan said during a telephone interview Thursday.

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``I found the conversation to be tremendously helpful.''

Hogan, who started as commissioner in the Office of Mental Health about two years ago, said he was pleased to be invited to meet locally with a regional group. About 20 mental-health services providers and officials were at the meeting, officials said.

Hogan applauded local cooperative efforts that have resulted in the adolescent residence, Trillium Place, located in Oneonta but serving teens from the area; the after-hours collaboration to provide crisis care at night and on weekends when clinics aren't open; and sharing of resources to meet patient needs.

The cooperation has meant providing services that otherwise might have been overlooked, he said, and the group has kept meeting to solve problems.

Hogan said he was glad to have such examples to share as he works to increase cooperation at the state level between the Offices of Alcoholism and Substance Abuse Services (OASAS), Mental Retardation and Developmental Disabilities and Mental Health.

One in five New Yorkers experiences a diagnosable mental disorder annually, and one in 10 experiences an illness serious enough to impair functioning at home, school or work, according to the October update of the 2006-2010 Statewide Comprehensive Plan for Mental Health Services.

Less than 50 percent of people with serious disorders receive any care, the report said, and on average there is a nine-year lag from the onset of mental illness, which on average occurs at age 14, until a person enters care.

Hogan said agency and staff cooperation is key to providing services, especially when patients have multiple needs. For example, a patient being treated for depression and alcoholism might need support from both mental-health and substance-abuse departments, he said.

During his visit to Norwich, Hogan said, he heard from local agency officials that they've been sharing services ``all along.''

OMH and OASAS are striving to eliminate barriers to mental health and substance abuse treatment services, said a news release announcing a New York State Health Foundation grant earlier this month. The initiative is to integrate mental health and substance-use services at 1,223 licensed mental health and substance-abuse outpatient treatment centers across the state.

Locally, cooperative efforts have been on-going since the early 1990s, and one example is the after-hours approach to providing mental-health care for patients in crisis, said Dr. Celeste Johns, chief of psychiatry at Bassett Hospital in Cooperstown. The cooperation has helped in the transition when A.O. Fox Memorial Hospital in Oneonta closed its psychiatric unit in 2007 and Bassett, which has a 20-bed psychiatric unit, opened its crisis services program Feb. 15, she said.

At the Norwich meeting, Hogan also heard about challenges in rural areas to improve services, such as needs for an intermediate level of care, Johns said. For example, a patient in a psychiatric unit has daily care but is discharged into follow-up treatment of perhaps a once-a-week visit, though more frequent visits would be preferred, she said.

Susan Dalesandro, director of community services at the Otsego County Mental Health Department, said other challenges of care in rural areas include regulatory barriers, funding and transportation. Patients needing to see a doctor and a clinician sometimes have faced restrictions that limit payment to one service per day, she said, but making two trips is impractical because of limited transportation access or funds or ability to take time off from work.

Smaller staffs in rural counties are familiar with other agencies and can make connections to meet patients needs, share resources and manage payment hurdles, Dalesandro said. However, concerns remain about funding, losing staff, salary issues, and changing regulations, she said.

Hogan's visit was reassurance that ``we will continue to work together on our priorities,'' Dalesandro said.

Hogan said he will continue working on meeting the treatment needs of adolescents and introducing more appropriate reimbursement methods.

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