Help Keep Our Mental Health Units Open!

My name is Marguerite Adelman, and I'm the Executive Director of the National Alliance on Mental Illness of Champlain Valley (better known as NAMI: CV).  We are here to discuss the need to keep CVPH's inpatient psychiatric units for adults and children open in the North Country. I'd like to begin by telling you why we decided to start this petition and why we believe this issue is important to all of us.

In October, we received a phone call from a staff person in the New York State Office of Mental Health's Central Field Office.  She began by asking us what we had heard about CVPH's possible closure of the adult and/or child and adolescent mental health units.  The staff person asked us to talk with our families and consumers and gather "impact statements."  She also asked us to plan what we would need in terms of services to replace the inpatient units in our area if they closed.  She told us that Fox Hospital in Oneonta had recently closed both of its inpatient units and that the lesson that OMH had learned was a need to start the planning process early.

Needless to say, we were disturbed to learn about the possibility of the closures from OMH, but promised to look into gathering "impact statements."  An Ad Hoc Committee of NAMI: CV members began work on pulling together a community meeting for all interested parties.  We did not adopt OMH's second part of the agenda; we did not want to plan for what we would need if the unit or units closed -- instead we wanted to talk about how we could work with the hospital, OMH, and our legislators to keep these units open.  We contacted Stephens Mundy, the hospital CEO, and met with him, Mary Krakowski and Dr. Diane Zuniga.

To date, the hospital has not filed to close either unit.  CVPH is still negotiating with OMH on a number of issues.

As we understand it, the 3 major issues facing CVPH are as follows:
1.    CVPH's mental health units are less profitable and are costing the hospital money, especially the Child and Adolescent Unit.
2.    CVPH is having difficulty recruiting and retaining psychiatrists.  We have learned that our state prison system has taken two of CVPH's psychiatrists as well as other mental health staff.  Sadly, the prison system has been able to offer more pay and better benefits than our community hospital.
3.    CVPH is unable to get private community psychiatrists to provide inpatient or on-call services in the hospital.

The issues confronted by CVPH, our non-profit community hospital, are issues being faced by other community hospitals across the country.  I have made copies of two excellent articles on these systemic issues in acute inpatient psychiatric care.  The first article is from the American Hospital Association's Behavioral Health Care Task Force and is entitled, Behavioral Health Challenges in the General Hospital:  Practical Help for Hospital Leaders.  The second article is from National Health Policy Forum at George Washington University and is entitled, Shrinking Inpatient Psychiatric Capacity:  Cause for Celebration or Concern? The articles are on the table in the hallway.

So why is this happening?
Since the mid-1990s, this downsizing trend of inpatient hospital units was initially evident among private psychiatric hospitals.  Then in the late 1990s, partly as a result of changing financial incentives, general community hospitals also began to close or reduce the size of their inpatient psychiatric units.  A 2006 national survey revealed that over 80% of the states are reporting a shortage in psychiatric beds; with 34 states reporting a shortage of acute care beds and 24 states reporting a shortage of forensic beds.  Reports of long wait times to find inpatient placement for psychiatric patients and increased reliance on jails to address persons in mental health crisis are becoming increasingly common across the country.

What is the reality in community hospitals?
1.    First, every hospital treats patients with behavioral health disorders, even when acute care units are not available.
2.    Second, patients with psychiatric disorders frequently access care through the hospital's emergency room.
3.    Third, as access to an appropriate continuum of psychiatric care services within a community diminishes, hospital CEOs report a dramatic increase in the average length of stay for emergency room patients requiring psychiatric admission.  Many hospitals report an increase in emergency room boarding of patients until a bed can be located in another hospital that has an acute unit.  The "boarding" of psychiatric patients interrupts ER flow, prolongs care, delays disposition, and results in considerable inconvenience and distress to ER patients and their families.
4.    Fourth, almost ¼ of all stays in US Community Hospitals for individuals 18 years and older involves individuals with depression, bipolar disorder, schizophrenia, and other mental health disorders or substance use related disorders.
5.    Fifth, psychiatric disorders co-occur with a significant number of general medical illnesses, such as heart disease, diabetes, and cancer.  Current research studies are showing that the mind must be treated if the body is to heal.  Furthermore, 1/5 of patients hospitalized for a heart attack suffer from major depression.  Evidence from multiple studies documents that post-heart-attack depression triples the risk of dying from a future attack or other health condition.  Community hospitals need to treat the mind and the body if they are to be effective.
6.    Sixth, significant under-funding of public agencies historically responsible for behavioral health care is increasing hospital utilization and shifting the costs and care of these patients to the community hospital.

In short, the continuing discrimination against psychiatric illnesses in medical care funding, the stigma associated with people with mental illnesses, and the fragmentation and underfunding of agencies that serve the mentally ill are fueling a system that is in "slow" collapse.  Here in the rural North Country, we are feeling that "collapse" at an accelerated rate.