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MENTAL ILLNESS

Patients with mental illness face difficulties gaining access to state hospitals

Doctors, families voice dismay at growing impact of Twin Valley’s closing

David and Ramona Acord fought to save Twin Valley Behavioral Healthcare. At 72, David Acord took over his 39-year-old son's successful salvage yard business as he deals with a bipolar disorder diagnosis seven years ago. It's not the business that worries David Acord but what he will do if his son needs to be hospitalized again, and he and his wife aren't able to visit him every day. Staff photos by Jim Witmer

Jim Witmer/Staff photographer David and Ramona Acord fought to save Twin Valley Behavioral Healthcare. At 72, David Acord took over his 39-year-old son's successful salvage yard business as he deals with a bipolar disorder diagnosis seven years ago. It's not the business that worries David Acord but what he will do if his son needs to be hospitalized again, and he and his wife aren't able to visit him every day. Staff photos by Jim Witmer

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Since Twin Valley's closing, battle rages over care of mentally ill

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By Mary McCarty and Tom Beyerlein
Staff Writers Updated 5:59 PM Sunday, November 22, 2009

When Gov. Ted Strickland approved the June 2008 closure of Dayton’s Twin Valley Behavioral Healthcare on Wayne Avenue, ending a 153-year history, it was with the promise that local people with severe mental illness would still have access to state hospital care, though they’d have to go to Cincinnati to get it.

In practice, that access has been curtailed as the local mental health services board, hit with major funding cutbacks, is approving far fewer state hospitalizations — only 69 admissions this fiscal year compared with 262 in 2008 and 291 in 2007.

Officials at Montgomery County’s general hospitals say that’s resulting in serious consequences. Patients aren’t getting the intensive care they need. In some cases, violently psychotic patients are being held for weeks at general hospitals ill-equipped to handle them, the cost of their care written off by the hospitals. In other cases, unstable patients are cycling through hospital emergency rooms and prematurely turned out into the community, where they might endanger themselves and others.

Dr. Douglas Songer, a medical director for psychiatry at Miami Valley Hospital, said none of his hospital’s 68 requests for admission to the nearest state mental hospital, Summit Behavioral Healthcare, were approved without repeated attempts. He believes that patients from Montgomery County have a much harder time being admitted to a state hospital than in most other areas: “It’s like a stuck door and we beg and we plead until someone opens it.”

Some psychiatrists feel the current system has broken their trust with their patients. At Good Samaritan Hospital, medical director Dr. J.J. Schulte feels ADAMHS constantly second-guesses his assessments. In the year after Twin Valley’s closing, the mental health board approved only 27 initial requests for admission to Summit, compared with 140 admissions to Twin Valley the year before.

“We cure as many people as cardiologists, yet we’re not being trusted to make these decisions,” he said. “We have the patient in front of us instead of an outside person who’s making a judgment.”

Songer and Schulte fear their psychiatric intensive care units have come to resemble miniature state hospitals, with dramatically longer stays and a higher percentage of violent patients. “Other (mental) patients are getting frightened by the severely ill or psychotic patients,” Songer observed. “They’ll say they’re better just because they want to get out of the unit.”

The problem has exposed a growing rift between groups with alphabet-soup names. The Greater Dayton Area Hospital Association (GDAHA) accuses the Alcohol, Drug Addiction and Mental Health Services Board of Montgomery County (ADAMHS) of shortchanging sick people by refusing to pay for state hospitalizations. ADAMHS is the funding conduit for mental health services, using county Human Services levy and state money. It’s required to pay for state hospitalizations, but not for stays in general hospitals.

Songer said board officials are trying to slough off their responsibilities on the hospitals: “They would like us to be a state hospital that the ADAMHS board doesn’t have to pay for.”

Joseph Szoke, the ADAMHS director, denied that, but acknowledged he’s trying to hold the line on admissions to Summit in an era of declining funds. The state cut its funding to the local ADAMHS board from $18 million to $12 million this year. “I don’t want this whole thing centering around funding and money,” he said. “It’s about how do you provide the best care for the people in the community with the resources that you have, knowing that the resources you have aren’t going to be enough?”

A failed system?

Margaret Gerken, 79, of Trotwood said the current system is failing people with severe mental illness. Her schizophrenic son set fire to their Trotwood home Sept. 4, two days after being discharged from a brief stay at Grandview Hospital. Craig “Rob” Gerken, 43, who spent time at Twin Valley years ago, is due for a court appearance Monday, Nov. 23, on a charge of aggravated arson. He has pleaded not guilty by reason of insanity. The house sustained heavy damage and several house cats died in the fire.

Dr. Gary Balster, medical director for Grandview’s psychiatric services, said he’s barred by privacy rules from commenting on the case. But, he said, “we treat people for as long as they need to be treated, through the acute phases of their illness. We would not discharge a person if we felt they were a danger to themselves or others.”

Gerken supports the controversial Morningstar project that ADAMHS has proposed as an alternative to Summit. Szoke wants to create a 16-bed adult “step-down” treatment center in Old North Dayton through Dayton’s Nova House. Morningstar would take people prescreened for transfer to state hospitals and people in state hospitals who no longer need such a high level of care. It would provide at least 30 hours a week of treatment, including therapy and medication stabilization.

“I’m not saying it’s an answer to all the problems, but, dear God, it’s a start,” Gerken said. “Somebody has to start somewhere.”

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Fran, nobody is going to look into the reason that New Dimensions/CSN was closed because there nothing to look at. It was just a outpatient clinic, like all the other clinics in town, only it cost lots more money to do the same job. Sorry you lost your cushy job, but Twin Valey people lost our jobs too. Nobody died because your clinic got closed. Be honest, and no more sour gripes.

snuggles
11:33 PM, 11/25/2009

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This ADAMHS is just a typical bunch of useless government leeches with nothing to do but line their pockets with our tax dollars. What do they do anyway? Sit around on their fat salaries and tell the hospitals who can get treated or not? Maybe ADAMHS can run the "Death Panels" after we get ObamaCare. Oh wait, it sounds like they already are the Death Panel.

timb
11:13 PM, 11/25/2009

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...anytime you need a real editor Mary, you just give me a call. Your writing is not improving but at least your headline matches your article's point. Suggestion: if you have given up on the transcript/birth certificate search, how about an article on why Detroit is now a 3rd world Muslim city occupied by private security companies now. Good luck.

awww yes
10:01 PM, 11/23/2009

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"Parity" "Anti-Stigma"..ha! Mentally ill persons are still discriminated against and the hospitalization issue shows just one side of it. Do you ever read letters about the poor people who need cardiac care who aren't getting it? Strickland said he would take care of the most vulnerable among us and he gave all the money to education. All mental health programs in all counties are just hanging on by a hair. Some won't survive. And no one, esp. the governor, cares.

MH Pro
6:53 PM, 11/23/2009

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Why does no one look into the reasons the ADAMHS board closed the only outpatient program that could have provided services to the high risk population. The New Dimensions/CSN program monitored those patients in the community on a daily sometimes twice a day basis and kept them in the community. The ADAMHS board closed this agency at the same time the Governor closed TVBH. Many of the deaths could have been prevented as those mentally ill were seen by CSN
and kept in the community
Fed UP

Fran Ingram
1:57 PM, 11/23/2009

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