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The state’s treatment of the north country’s most vulnerable is an unforgivable sin


I felt really fortunate last week to get somebody with a clinical psychiatry background on the record about the state Office of Mental Health’s plan to shift inpatient care away from the St. Lawrence Psychiatric Center, Ogdensburg, to hospitals in Syracuse and Utica.

He told me in no uncertain terms that state officials are crazy if they think this plan will provide better care for people struggling with mental illness, especially those with severe diagnoses who need — not choose — to be treated in a hospital.

Dr. E. Fuller Torrey is executive director of the Stanley Medical Research Institute, Chevy Chase, Md., founder of the Treatment Advocacy Center in Arlington, Va., author of numerous books about schizophrenia and studies about the performance of publicly operated mental health services. He was interviewed by the CBS news program 60 Minutes in September. He has authored opinion pieces in the New York Times, Wall Street Journal, and a host of online national news outlets. He is widely respected as a top psychiatrist and researcher. He knows a little something about mental illness.

And he is intimately familiar with the state’s mental health system. He is a Utica native whose sister had schizophrenia and was in the state mental health system for much of her life.

Dr. Torrey was able to confirm something I already knew but needed somebody with his pedigree to say: the state is reducing inpatient capacity to save money, not to improve care.

Let’s think about who the St. Lawrence Psychiatric Center treats. Its patients are those who are admitted because a doctor has determined they are a danger to themselves or others. That is the guideline for involuntary psychiatric admission under the law. It’s not like people show up at the front door of the psychiatric center, say they would like to be admitted and get treated. It doesn’t work that way.

The state is selling its plan on the premise that community-based supports will somehow take the place of inpatient care. The proper community-based services will undoubtedly help prevent some hospitalizations, as Harvey Rosenthal of the state Association of Psychiatric Rehabilitation Services told me Friday, but to think that such services will do away with the need for inpatient care is unrealistic.

Because the legal guideline for involuntary admission is very clear, there is no way to predict how many people will need inpatient psychiatric treatment. If a doctor has determined somebody needs to be admitted, community-based services are no longer an option.

I would like to believe that more and better community supports will be available to prevent people from needing hospitalization. Mr. Rosenthal told me he is confident that the state will give generous funding to community agencies in our own back yards to support housing, outpatient treatment, education and employment. I hope he is right, because outpatient community services as they currently stand are woefully lacking.

But history has a way of repeating itself. We know that the state’s past promises for adequate community services were made with the best of intentions, but didn’t get adequately funded and therefore have never been able to meet the demand. As a result, people go untreated until they reach crisis state and are hospitalized.

And no matter how the state tries to spin the notion that the loss of inpatient services in the north country is somehow good for consumers, uprooting children in need of inpatient care and sending them hundreds of miles away from their families and friends — the people they need to support them through recovery — shows a callous disregard for them.

Dr. Torrey believes the state is trying to force hospitals to take up the slack, shifting the cost burden to away from the state’s coffers to federally funded Medicare. Medicare pays most of the cost for hospitalization in general hospitals, he said, whereas Albany pays the whole shot for hospitalization in a state-run psychiatric facility.

Mr. Rosenthal suggested that if access to inpatient care in the north country is a concern, local hospitals could choose to expand the number of inpatient psych beds to take up the slack.

Our hospitals currently can’t care for people with serious mental health diagnoses who need hospitalization, and it will take significant private investment to meet that need.

The state is clearly taking a “not my problem” attitude when it comes to providing inpatient care for those who need it. Maybe Dr. Torrey is onto something when he says the desire to save money, not a desire to provide better care, is behind the state’s plan.

The state wants to balance its budget on the backs of community hospitals, at the expense of adequate access to care for people who need hospitalization to help them recover, with no guarantee that outpatient supports will be in place to help them avoid the need for hospitalization. Once again, the state is turning its back on the most vulnerable among us. That is an unforgivable sin.

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