HOSPITALS ADAPTING TO MENTAL HEALTH PATIENTS THOSE WITH PSYCHIATRIC CONDITIONS REQUIRE CONSIDERABLE MANAGEMENT AND 'A LOT OF ER TIME' Series: AFTER MAYVIEW

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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 to help.

"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 counties.

"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 closure.

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 hospitals.

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. …

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