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Top psychiatrist says the state’s plan to reduce inpatient psychiatric capacity is mad

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One of the nation’s top psychiatrists and a leading researcher in schizophrenia claims the state Office of Mental Health’s plan to reduce inpatient psychiatric treatment capacity will place unbearable pressure on a system that is already ill-equipped to treat those with the most serious diagnoses.

Dr. E. Fuller Torrey, who was interviewed in September by the CBS News program “60 Minutes” about deficiencies in the nation’s publicly run mental health care system, told Northern New York Newspapers on Wednesday that the state’s plan to beef up outpatient community services while reducing inpatient psychiatric capacity is based on a desire to save money, not improve care.

“This is another chapter in New York trying to shift the cost of the care of people with severe mental illnesses, who need hospitalization, from Albany to Washington,” Dr. Torrey said. “If you have somebody in Massena who becomes acutely psychotic and goes to the Ogdensburg state hospital, Albany is paying most of the cost. If you close those beds, you are trying to force his hospitalization to a general hospital, so maybe he ends up at St. Elizabeth’s in Utica. Then federal Medicare will pay most of the cost.”

Dr. Torrey is executive director of the Stanley Research Medical Institute in Chevy Chase, Md., founder of the Treatment Advocacy Center in Arlington, Va., and the author of numerous books about schizophrenia. A 2012 study he authored with the Treatment Advocacy Center titled “No Room At The Inn; Trends and Consequences of Closing Public Psychiatric Hospitals 2005-2010,” found that New York had only about half of the beds needed to meet the demand for inpatient psychiatric care. The study, online at www.tacreports.org/bedstudy, looked solely at state-operated psychiatric beds, as those beds are occupied by patients who are admitted involuntarily and are often poor enough to qualify for publicly funded health coverage.

“Community services will not reduce the need for inpatient services, because most of the community services are set up to take care of people who have depression, eating disorders, post-traumatic stress disorder, and they are not interested in somebody who is acutely manic or a paranoid schizophrenic off his meds,” he said. “These people do not get treatment in the community.”

OMH plans to reduce inpatient capacity across the state by 15 percent, including eliminating inpatient beds for adults and children at the St. Lawrence Psychiatric Center, Ogdensburg. Those beds will be transferred to hospitals in Syracuse and Utica, which will merge to form the Central New York Regional Center of Excellence.

Community-based support services will be augmented under the plan, to be based on the needs of each region and developed by a team of community members, medical and mental health professionals and outpatient service providers.

The state has cited a need to shift away from an antiquated care model that relies on extended hospital stays, a need to better coordinate medical care with psychiatric care, the likely success of improved community supports to help people with mental illness recover and declining patient census numbers as justifications for the plan.

The promise of better outpatient services to fill the gap left by reduced inpatient capacity is made every time a psychiatric hospital is downsized, Dr. Torrey said, but is never fulfilled.

“It just gets worse and worse because there are fewer and fewer beds,” he said. “Anybody at this point who believes these community services are going to exist for people who are severely mentally ill should probably see a psychiatrist themselves.”

He said the situation will be especially dire for children, as inpatient capacity for that population is already severely strained.

“If you can find a bed anywhere for a child, you’re doing very well,” Dr. Torrey said.

On Nov. 12, for instance, the St. Lawrence Psychiatric Center’s 28-bed Children and Youth Unit was at capacity, as was the children’s unit at Mohawk Valley Psychiatric Center, Utica, where 29 out of 30 beds were occupied. The state’s plan will increase capacity at Mohawk to 90 beds.

Asked what alternatives for inpatient treatment an adolescent would have if the Utica hospital is full, OMH spokesman Benjamin Rosen said, “Under the Regional Centers for Excellence plan, catchment areas will be eliminated and individuals and families will be able to choose which Regional Center of Excellence is best for them.”

Mr. Rosen also said that children’s settings are provided in “multiple settings throughout the state, including Article 28 general hospitals, Article 31 psychiatric hospitals and state-operated hospitals.”

But Dr. Torrey said most general hospitals are not equipped to deal with children in psychiatric distress. As a result, children must seek care hundreds of miles away from home. In some instances, he said, children aren’t admitted for treatment simply because there is no hospital able to take them.

“In New York State, to think you can just choose to send somebody over to Massena (hospital for treatment), it’s mythical,” he said. “These psych units are not set up for people who are acutely psychotic or a 17-year-old who is acting out.”

Claxton-Hepburn Medical Center has a mental health unit, but it cannot treat children. As a result, children often stay for days in an emergency room bed before they can be placed in inpatient care, said Claxton-Hepburn Chief of Emergency Medicine Dr. H. Theodore Klaudt. Available beds often cannot be found within a reasonable distance, he said.

“We’ve transferred a few kids this week to Plattsburgh,” he said Thursday. “That’s two hours away. Taking a kid and moving them two, three or four hours away from their home is a huge issue. A lot of the care and interventions involve the whole family, and this is a huge burden on a family. Some of these folks don’t have independent transportation or money for gas.”

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