Ten years ago this month Ohio closed its inpatient psychiatric hospital in Dayton - called Twin Valley when it closed but known for years as the Dayton State Hospital.
Critics of the move of all political stripes warned the decision by the state of Ohio to close the Dayton campus on Wayne Avenue would leave a huge gap in the region for people with serious mental illness and their families.
Today, critics say their fears came true. Local private hospitals saw more patients seek treatment who couldn’t get access to state facilities. People who can get a bed in a facility in Cincinnati, Columbus or Toledo are now far from family support. County jail officials say their facilities have become a de facto psych ward, holding people with serious mental illness who can’t get the treatment they need elsewhere.
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Since Twin Valley’s closing there have been some efforts to fill the gap. A 16-bed adult mental health treatment center opened in Dayton in 2011, treating patients who need inpatient care but can be a step down from a secure state facility. Medicaid, which covers the majority of people in need of crisis mental health care, changed its rules to pay more for-profit psychiatric hospitals. And Ohio has plans to add 30 more psychiatric beds in their Columbus facilities by 2022. Local health officials say they’ve improved coordination and use of community-based mental health services.
But none of these steps have added up to replacement value for Twin Valley, and patients and their families continue to seek options as there is little chance a state psychiatric hospital would be brought back to Dayton.
“The net legacy of this is its still impacting residents in the Dayton region today negatively,” Bryan Bucklew, president of the Greater Dayton Area Hospital Association said. “It continues to impact our families and patients differently than other parts of the state.”
Admissions of local residents — particularly for people not sent to state hospitals by the criminal courts — to the state’s mental hospitals plummeted in the years following the closure of Twin Valley Behavioral Healthcare’s Dayton campus.
“With the closure, it forced people for the most part to leave town to get treatment, and the remaining health institutions — the hospitals — were not designed to handle that population and couldn’t handle that population,” said Ohio Secretary of State Jon Husted, who was speaker of the Ohio House in the late 2000s and tried to stop the closing.
“People in the community are doing their best to try to fill in the gaps, but there is no way to fill in the gaps when you lose a psychiatric hospital,” Husted said.
In June 2008 the state of Ohio, under the administration of then Gov. Ted Strickland, closed Twin Valley Behavioral Healthcare’s Dayton campus, a 110-bed mental health facility located on Wayne Avenue. About 80 jobs at the facility were cut, but state officials said at the time that those workers would be offered jobs in Cincinnati, Toledo or Columbus.
Shuttering the aging Twin Valley facility and a second mental hospital in Cambridge in Guernsey County were part of Strickland’s effort to close a projected $733 million budget gap. Closing the hospital was expected to save the state $13 million in 2009.
Local patients in need of long-term and intensive psychiatric hospitalization still have Twin Valley Behavioral Healthcare Hospital in Columbus, Summit Behavioral Healthcare Hospital in Cincinnati or Northwest Ohio Psychiatric Hospital in Toledo.
About five years after Twin Valley closed its doors, the local mental health services board approved just 69 admissions for state hospitalization, which was a decrease of 76 percent from the year before the facility’s closure, this newspaper found.
In recent years, getting into a state psychiatric hospital has been nearly impossible except for patients who have committed a violent crime, said Eli Sperry, a probate attorney with Pickrel, Schaeffer & Ebeling Co. in Dayton.
“The threshold to get into a state hospital is so high that if you haven’t committed a crime involving violence, there’s a waiting list for regular people,” he said.
The latest state budget included $112 million to replace the aging Twin Valley Behavioral Healthcare hospital in Columbus and add an additional 30 beds, bringing the total to 208 beds after the project is completed around 2022.
The state hospitals that are still open house about 75 percent forensic patients, sent from courts, and 25 percent are civilly committed, said Dr. Justin Trevino, assistant medical director at Ohio Department of Mental Health and Addiction Services. The department operates the state psychiatric hospitals.
Medicaid has expanded which private psychiatric hospitals it will cover. Trevino said if the state has difficulty placing a patient they work to find a private facility that’s a good fit. He said if the patient is determined to need a state hospital and the closest option doesn’t have a bed, the state will look for space at another one of its facilities.
“But we have really tried to partner with communities, since our facilities, they tend to run very full. That forensic population is not a population that comes and goes in a very quick fashion,” Trevino said.
The closure of Twin Valley was in line with a national push for de-institutionalization among many in the field; the goal was to cut costs of care and improve treatment and life quality for people with mental disorders. Other states had closed similar facilities going back decades.
Local inpatient psych units have beds, but unlike the state hospital, they are not designed to keep people long-term.
“I think the original fear in Twin Valley closing was that the psychiatric units would come to resemble miniature state hospitals with longer length of stays and a higher percentage of violent patients and basically that’s what’s happened. And that’s what we’ve had to learn how to manage,”said Sharon Guenther, manager of social work services at Miami Valley Hospital.
Guenther said it’s “very rare” that the hospital staff can get a patient admitted to the state hospital in Cincinnati.
Bucklew said this type of inpatient care is expensive and local hospitals have to absorb large losses while caring for patients who can’t get in to a state facility.
Worse has been the number of people with mental disorders who have ended up in jail.
Joe Szoke, who was the director of executive director of the Alcohol, Drug Addiction and Mental Health Services Board of Montgomery County between 1990 and 2011, said he is frustrated that while people with physical illnesses are treated with medical care, too often people with mental illnesses are arrested and held in jail.
“Personally, I think it would be much better if we had a state hospital much closer,” Szoke said.
The National Alliance on Mental Illness says that people who are in a mental health crisis are more likely to encounter police officers than get actual medical help.
In 2016, Dayton police responded to 1,857 calls for service involving people who may have needed assistance with mental health issues, an increase of 47 percent from five years earlier.
Nationwide, state prisons and jails hold as many as 10 times more people with serious mental illnesses than state psychiatric hospitals, according to the Treatment Advocacy Center.
People who were once institutionalized are being released without adequate care. Some end up arrested and jailed for minor violations like panhandling, petty theft, menacing, said Montgomery County Sheriff Phil Plummer.
“When we used to work at the jail, then compared to now, it’s a whole different environment,” Plummer said. “You know, we have people throw urine and feces on us — we had to get a special shield designed just to go through some of our housing, because they throw stuff on our officers.”
About one-third of inmates at the Montgomery County Jail are on psychotropic medications, which affect mind, mood and behavior, jail officials said. The jail has some “frequent flyers” who have been jailed dozens or more times and whose behavior while incarcerated has led to nearly as many jail incident reports, Plummer said.
In the first four months of this year, there were 112 reports of inmates who made suicidal gestures. That compares to just 10 reports during the same time period in 2007, before Twin Valley closed.
If Twin Valley were still open, Plummer said the sheriff’s office wouldn’t need to devote so much of its resources to handling mentally ill individuals who need treatment.
“This is a tremendous drain on resources,” he said. “We spend a lot of money, human service levy dollars, and we need to evaluate how that money is being spent and build up programs that work to properly treat these people, because it is inhumane how they are being treated — it’s not right.”
Sue McGatha, president and CEO of Samaritan Behavioral Health, said it is more difficult for families to be supportive of patients in state hospitals when they are an hour or more drive away.
“The closure of Twin Valley was very difficult for families. One of the things that help people get better is having a support system,” she said.
When Twin Valley closed its campus in Dayton the local private, the local non-profit addiction services treatment agency Nova Behavioral Health was given funding to launch Morningstar, a 16-bed mental health inpatient services unit. Morningstar was intended to treat patients who don’t need acute care at a community or state hospital, but who aren’t ready to go home.
John Goris, Nova CEO, said Morningstar instead has acted as a program for people with dual mental health and addiction diagnoses, and a Morningstar client has to be more stable than the patients at a secure state psychiatric hospital.
“They are voluntary, which they may not be at Summit or Twin Valley,” Goris said. “If someone wants to leave, we encourage them to stay but certainly we can’t stop them from leaving, as opposed to the state hospital where all the doors are locked.”
While the role is different than the state hospital that closed, Morningstar still helps in Twin Valley’s absence, said Goris.
“Because a client can get some stabilization time before they get so severe that they have to be at Twin Valley or Summit,” he said.
McGatha said while the closure of Twin Valley in Dayton created new challenges, mental health providers were scraping for resources and jails already had high numbers of people with mental illness.
“We’ve never had enough funding. We’ve never had enough beds. There’s just always this sense of demand far exceeding capacity,” McGatha said.
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