In designing a new emergency department last year, officials at
Jameson Health System in New Castle, Lawrence County, made special
provisions for patients with mental-health needs.
Three of the 30 new examination rooms were built for people in
mental-health, or behavioral-health, crises. These rooms, bare
except for beds and soothing murals, are located away from exits in
a quiet corner of the rectangle-shaped department. The patients who
use them are brought in by police or people who don't know how else
"They use us as a last resort," said Sybil Rossi, a registered
nurse and the hospital's patient care manager and program director
for behavioral-health services.
Community hospitals across the region are struggling to serve an
influx of patients with severe and chronic mental illness. Some
attribute the wave of complex cases to the December 2008 closure of
Mayview State Hospital, which served the sickest, most violent
patients from Allegheny, Beaver, Greene, Lawrence and Washington
"As far as I'm concerned, several counties made a deal with the
devil when they closed Mayview," said Patton V. Nickell, chairman of
psychiatry for the Allegheny Health Network.
State and county officials said they closed Mayview in the belief
that people with mental illness deserve to live in the community, or
the least restrictive environment possible.
But now, some of those with serious, persistent mental illness
account for repeated visits to the emergency departments and
repeated admissions to the inpatient psychiatric units of community
hospitals, Dr. Nickell said.
Though planners of Mayview's closure may have envisioned building
an outpatient treatment system strong enough to support people with
severe mental illness, that hasn't materialized, said Joseph
Cvitkovic, director of behavioral health care for Jefferson Regional
Medical Center in Jefferson Hills.
The local hospital has "become what Mayview was. That's what
happened. We pick up the slack for that," he said.
Besides an increase in the severity of patients' illness,
hospitals said they have:
* Repeatedly treated some patients who have difficulty managing
serious illnesses in the community.
* Treated a growing number of violent patients.
* Kept some mental-health patients longer than medically
necessary because of a shortage of beds in step-down programs or,
because of the shortages, discharged patients to locations they
considered safe but less than ideal.
* Taken a financial loss when insurers cut off payment for
patients who stay longer than strictly necessary.
State and local officials disputed the impact of Mayview's
Valerie Vicari, director of the Division of Western Operations
for the state Department of Public Welfare's Office of Mental Health
and Substance Abuse Services, said mental-health professionals in
other parts of the state have seen an increasing severity of mental-
health cases, partly because of complications from some patients'
use of illegal drugs.
Pat Valentine, executive deputy director for integrated program
services at Allegheny County's Department of Human Services, said
hospitals could be feeling the impact of recent cuts to the state's
medical assistance rolls. Because of the cuts, she said, people who
once received mental-health care on a regular basis from outpatient
providers now may be accessing it only on a crisis basis in
Ellie Medved, vice president of ambulatory and crisis operations
at Western Psychiatric Institute and Clinic of UPMC, said emergency
department visits have been up in recent years. She said they've
also been up at UPMC Mercy and UPMC McKeesport.
But she said various factors could be responsible, including last
year's elimination of the state's general-assistance program. She
said the program, which provided about $200 cash each month to tens
of thousands of sick and disadvantaged Pennsylvanians, was used to
buy medication, pay for housing and provide other stability. …