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Sara Foss's Thinking It Through
by Sara Foss

Thinking It Through

A Daily Gazette life blog
Her column and blog rolled into one
 

Plan is healthy beginning

By Sara Foss
Monday, February 24, 2014

I made my first visit to a hospital psychiatric unit during my senior year of high school, when a friend of mine was sent there after a suicide attempt.
Over the years, I’ve visited other friends confined to psychiatric units.
The visits were never fun.
They weren’t fun for me and they weren’t fun for my friends. The units themselves were pleasant enough. But it didn’t matter. Because the simple truth is that nobody likes being in a psychiatric hospital. Not the visitors and not the patients.
For people with serious mental health issues, a trip to the psychiatric hospital might sometimes be necessary. The friends I’ve visited at psychiatric hospitals were struggling with depression, bipolar disorder and schizophrenia, and they were in danger of harming themselves. When the danger passed, they were sent home.
In an ideal world, the vast majority of people admitted to psychiatric hospitals would be treated, released and provided with the services they need to live in the community. We don’t live in an ideal world, of course. But New York is taking some encouraging steps toward ensuring that people with mental illnesses receive the support and care they need to live as independently as possible.
The state has an ambitious plan to downsize the number of psychiatric hospitals statewide and reinvest the money it saves into outpatient care for the mentally ill. If passed, Gov. Andrew Cuomo’s 2014-2015 budget would reinvest $25 million into community services — supported housing, crisis-intervention teams, family resource centers, etc.
Now, I support moving as many people out of institutions as possible.
But I do have some questions about the state’s plan.
One big question is whether the state is reinvesting enough money into community-based mental health services. Another is whether the infrastructure exists to absorb all of the people who are going to need extra support to live in the community.
Earlier this month, state Sen. Cecilia Tkaczyk, D-Duanesburg, suggested that the state Office of Mental Health is underestimating the savings that will be generated from downsizing New York’s psychiatric hospital system. Referring to a billing statement provided from a patient, she said that the 399 bed closures would generate more than $163 million in annualized savings, rather than the $43 million claimed by OMH.
“I’m concerned they’re low-balling the savings,” said Tkaczyk, who serves on the Senate Committee on Mental Health and Developmental Disabilities. She said she supports downsizing the state’s psychiatric facilities, but only if local providers are capable of meeting the needs of people leaving institutions. And it isn’t clear that they are. Right now, there’s a shortage of community-based housing.
Joe Gallagher is the execu-
tive director of Mohawk Opportunities, a Schenectady-based nonprofit that provides an array of housing services for people with serious mental illnesses.
He said that his organization usually has a waiting list and that the average number of people waiting for supported housing is about 30.
“It would be nice to have a few more beds so that we could be more responsive to need,” Gallagher told me. In his mind, “community services are optimal. Hospital care is care of last resort. . . . We don’t need to house [people with mental illnesses] forever and ever.”
Under the governor’s plan, New York’s 24 inpatient facilities would be consolidated into 15 regional centers by 2017; the facility in Albany, the Capital District Psychiatric Center, would actually expand to help absorb patients whose hospitals were shuttered.
Glenn Liebman, CEO of the Mental Health Association of New York State, said he was pleased with the governor’s plan, noting that the state has a long history of underfunding and neglecting mental health.
“We think this is a good start,” he said. The expectation is that the money reinvested by the state will increase to $44 million, he said.
It is a good start. But will it be adequate? I don’t know.
But I do know this: With treatment, people with serious mental health illnesses can live productive, meaningful lives. And without it, terrible things can happen.
The friend I visited in a psychiatric unit during my senior year of high school eventually died by suicide. She wasn’t somebody who needed to be in a psychiatric institution for the rest of her life — when she was well, she was an intelligent, energetic and fun-loving person. But she wasn’t always well. In some basic way, the system failed her. She fell through the cracks.
We need a system that prevents people from falling through the cracks. Is such a thing possible?
I don’t know. But I’d like to think that it is.
Reach Gazette columnist Sara Foss at sfoss@dailygazette.net. Opinions expressed here are her own and not necessarily the newspaper’s. Her blog is at www.dailygazette.com/weblogs/foss.

 
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