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State team member: community services will prevent the need for psychiatric hospitalization

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A member of a state steering committee looking to boost community-based support programs for the mentally ill says the Office of Mental Health plan to downsize inpatient psychiatric care is the right path to recovery for those with mental illness and for overburdened taxpayers shouldering an inefficient system.

“Hospitalizations are going to happen, but there are so many things we can do upstream of a relapse and even in the middle of a relapse; we have so many tools now that a hospital bed should be the last resort,” Harvey Rosenthal, executive director of the New York Association of Psychiatric Rehabilitation Services, said in an interview Friday. “It costs $310,000 for a state hospital stay for a year. It’s not like we lack money in New York. We just have it in the wrong place.”

Mr. Rosenthal is also a member of the state Office of Mental Health’s Regional Centers of Excellence Steering Committee to develop community-based services to fill the gap from a loss of inpatient capacity under OMH’s plan to overhaul its mental health care delivery system. Under the plan, inpatient capacity for adults and children will be moved out of the St. Lawrence Psychiatric Center, Ogdensburg, and be absorbed by state-run hospitals in Syracuse and Utica. He spoke in favor of the plan during the OMH listening tour in Ogdensburg earlier this year.

The OMH plan is intended to steer care away from a model that officials have said is antiquated in its reliance on costly hospitalization and toward more community-based supports for the mentally ill that include housing, employment, education and crisis intervention.

North country officials have argued that the loss of inpatient psychiatric capacity in Ogdensburg will place an undue hardship on those who require hospitalization by forcing them to seek treatment hundreds of miles away.

Mr. Rosenthal said, however, that programs geared toward relapse prevention can greatly reduce the need for psychiatric hospitalization.

“We used to be a really reactive system that relied almost exclusively on medication and day programs,” he said. “I think what will take up the slack from a closed state hospital will be something more appropriate — a community-based outreach that emphasizes engagement, a mobile crisis program and then, if need be, a hospital bed. There are increasing amounts of support for people who need something that is a step down from a hospital, in some cases where case managers or peer workers visit a person on a regular basis.”

Mr. Rosenthal is also a member of the state’s Medicaid Redesign Team, which is charged with determining the most effective and appropriate use of funding for the public health insurance program for the needy.

“The whole focus is on moving services from hospitals and clinic offices onto the street where appropriate, and a quick response by whole teams of people, nurses and peer workers,” he said. “I am getting assurances that in the 2014 budget there will be significant money to expand those services because the success of the Medicaid redesign is based on community services.”

He said he understands the concern about the loss of inpatient capacity and the need to travel for treatment, but those who need the treatment will do what they have to do to get well.

“If I have cancer, I’m going to go to Sloan-Kettering in New York City,” he said. “I’m not going to just stick with the hospital that’s in my neighborhood. You do what you have to do.”

He also said local hospitals should expand inpatient offerings in the absence of state-run services.

Community-based services will be put in place as soon as possible to ease the transition away from inpatient care, but Mr. Rosenthal said the transition could be bumpy for a time.

“Can I say that on April 1 a bed will close in Ogdensburg and on April 2 there are five peer workers who are redeployed? I can’t,” he said. “I think we all have to be strong on this. I think we all have to work together to make sure it happens as quickly as possible.”

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