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Psychiatric Center excels at meeting rural mental health needs

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EDITOR’S NOTE: The following is the second in a series of articles written by the St. Lawrence Psychiatric Center Task Force highlighting the personal stories of those impacted by the St. Lawrence Psychiatric Center’s care. The state’s plan to downsize the number of inpatient psychiatric beds, which could result in hospital closures, is expected to be released Monday.

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If the state wants to create regional centers of excellence in behavioral health care, Angela Doe argues at least one should focus on the unique needs of rural populations.

Ms. Doe, the director of St. Lawrence County’s community-based mental health program, says the state-operated St. Lawrence Psychiatric Center has a 100-year history of pioneering care for underserved rural communities across Northern New York and the Adirondacks.

“It’s an access issue,” Ms. Doe says. “The St. Lawrence Psychiatric Center has developed evidenced-based programs, strategies and treatment options” that allow individuals with recurring psychiatric conditions to be released back into their home community.

Ms. Doe, who has worked in three different states, including urban centers, says rural areas face radically different challenges to community-based mental health care than those in suburban areas and urban areas.

While most of the state’s psychiatric centers are located in large urban centers, the St. Lawrence Psychiatric Center is one of the few whose entire staff devotes all of its attention to serving the unique needs of individuals who live in rural communities. Isolated hamlets in the Adirondacks have no access to subways, bus systems or other forms of mass transit. Some poor families in rural townships with a loved one with a severe mental illness may not even have a reliable vehicle.

“When you are a mental health professional, you need to take those kinds of issues into account when you are developing effective discharge plans so they can return home,” Ms. Doe said.

Many rural communities lack even primary health care providers, Ms. Doe says. Even community-based hospitals with in-patient mental health services may be an hour away from some residents facing mental health relapses.

Ms. Doe says she agrees with Office of Mental Health Acting Commissioner Kristen Woodlock that the state needs to reform the way it provides mental health services, but she says the state ought to have more of its psychiatric centers adopt the best practices pioneered by the St. Lawrence Psychiatric Center’s staff. While mental health professionals across the state are talking about integrating community-based care with the kind of rehabilitative care provided by the St. Lawrence Psychiatric Center, the north country has led the state in developing rural initiatives and strategies to help the mentally ill function outside an institutional setting, she says.

Community-based mental health professionals worry that if New York consolidates its centers of excellence in large urban centers, the state’s approach to mental health care will eventually be influenced by the realities of big cities and suburbia while the nuanced needs of more rural areas will be neglected or ignored.

Ms. Doe says that as the director of a county-based program, she and other community-based mental health professionals agree they need the kind of rehabilitation programs provided in Ogdensburg that have allowed many people with severe mental health problems to function outside an institution. The community hospitals that provide in-patient mental health services are very worried that they will not have a place to send individuals who do not respond to hospital-based short term psychiatric treatment, Ms. Doe says.

Many people with chronic and severe mental illnesses are currently being served by a variety of community-based mental health programs, but when they suffer a severe relapse and do not respond to care at a community hospital with a mental health in-patient unit, Ms. Doe says they need the kind of specialized rehabilitative care provided by the behavioral health team at the St. Lawrence Psychiatric Center.

Ms. Doe says that when she came home to as administer for St. Lawrence County’s mental health agencies, she was impressed when she saw the extensive network of community-based programs that the St. Lawrence County Psychiatric Center works with across the six-county region it serves over the past two decades.

“When you look at best practices in mental health, you see that we have them here,” Ms. Doe says. “A lot of areas of the state don’t have them in place.”

But Ms. Doe says community-based care only works as long as mental health professionals have the kind of treatment options that can help people when they need the kind of specialized services the St. Lawrence Psychiatric Center offers.

Ms. Doe agrees with Mrs. Woodlock that the mental health system is moving away from a safety net to a wellness model.

The days of housing the mentally ill in institutions is over. Today, individuals with mental health issues need increased community-based support to effectively function in their communities.

But she says that in mental health, like any other chronic health condition, sometimes people who are sent to their local community hospital for acute mental health care don’t respond to treatment and need the kind of specialized help provided by the psychiatric center. Ms. Doe says the St. Lawrence Psychiatric Center has established a reputation among psychiatric professionals for providing the best quality of care for those specialized cases.

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