Examining mental health care

John Christensen
Several health care, school and government leaders met Monday in Penn Yan to discuss the needs for Rural Mental Health Care.

Responding to the alarm among local schools and government, mental health providers, and child advocates over the shutdown of inpatient mental health care at Soldiers & Sailors Hospital in Penn Yan, Representative Tom Reed (R-NY), State Sen. Tom O’Mara (R,C,I-Big Flats), and State Assemblyman Phil Palmesano (R,C,I-Corning) sponsored a community roundtable, “Crisis in Care: Mental Health Services in Rural Communities,” to bring together regional leaders for a discussion on the short- and long-term future of local mental health care.

Held Monday morning in the Yates County Auditorium, the roundtable featured a panel of area leaders in government, community development, education, law enforcement, and health care to examine the need and discuss strategies for providing mental health care in Yates County and the surrounding area.

The area representatives said that community fears have been heightened since February when Finger Lakes Health announced that no new patients would be admitted to the 10-bed Inpatient Behavioral Health Unit at Soldiers & Sailors Memorial Hospital in Penn Yan. They share community concerns that the lack of conveniently accessible, affordable, efficient, and cost-effective mental health care will worsen what is already a mental health crisis in Yates County and the rest of the region. Since then, Reed, O’Mara, and Palmesano have urged Finger Lakes Health and the state Office of Mental Health (OMH) to work together to enhance the area’s mental health services.

Jose Acevedo, President and CEO of Soldiers & Sailors Memorial Hospital, said that S&S doesn’t have the volume of patients to support the unit, so they propose to shift resources from inpatient to outpatient care. Saying the hospital wants to prevent the crisis ahead of time, he added, “We want to move from being excellent at acute care to being excellent at preventative care.”

Acevedo pointed to the recruitment difficulties in finding qualified child psychiatrists and mental health workers, who he says are usually attracted to large, specialized care and academic hospitals. He says the shortage is everywhere in the state, not just Yates County. He says S&S is undertaking other treatment options including tele-health remote consultations, evening mental health clinics, and providing preventative mental health care through the schools.

That was good news to Dundee School Superintendent Kelly Houck, who is given a great deal of credit for raising the awareness of the mental health care crisis in Yates County. She and Penn Yan Superintendent Howard Dennis concur that the entering populations of children in schools are “needier and needier.” Dennis said, “Catching them earlier is critical to their education.” 

Houck said that the community must move from discussion to action. “We need resources and services that are tangible and accessible without challenge, for all ages from cradle to grave.” Specifically, she asked for the creation of a Yates County Mental Health Department/Clinic. Currently, Schuyler County Health Services operates a satellite children’s mental health clinic at Dundee Central School, as that district straddles the county line, but only two days per week, which all agree is not enough even to meet Dundee’s needs.

In Penn Yan Schools, Hillside Family Services had been offering a child counselor one or two days per week, mainly at the elementary school, but Elizabeth Nolan, Hillside’s COO, says they are closing all their mental health services. Liberty Resources out of Syracuse will be taking over for them this Friday and have hired that same counselor, but Dennis too says this is not enough.

Donna Bradbury from New York State Office of Mental Health, stated that for children, the state is shifting to community based care because it is more effective to treat children in the home and the community than in inpatient facilities. While some services are being implemented now and specialized services are becoming more widely available, Bradbury says there can still be problems with service access, and stressed the need for a coordinated network between existing agencies like Child Protective Services, Probation, and Public Health. How they talk to each other is to be addressed in a series of meetings this summer. 

Director of Western New York Field Office for OMH, Christina Doherty Smith, said intensive outpatient programs are recommended, with tele-health psychiatric consultation services for primary care doctors. She also spoke of regional planning with counties working together, especially in Medicaid managed care. Reed commented that “breaking down the silos of care” is a key part of the solution, and applauded what cooperation has begun between Strong Hospital, Rochester Regional Health, and Finger Lakes Health. 

In his comments, George Roets, Director of Yates County Community Services, said those silos still exist and cause difficulty in matching services to individual needs. “We have a health care system, a mental health care system, and drug treatment system. We need to become one health care system.” He says there is support for integrated care. “I know we can do better. We’re meeting only about half the need if we’re lucky. It should be an embarrassment to all of us in the field.” 

Shawn Rosno, Director of Community Services, Schuyler County Health Services, spoke of the disorder and traumas of so many families impacted by poverty, mental health problems, and rising drug addiction that are leading to the increase in children’s mental health problems. He said people in need of inpatient care are being turned away from hospitals and children are being shipped downstate for the lack of pediatric beds in this area. He added that the “frontline people, police, jails, schools, are suffering the impact of this lack of treatment. Rosno believes that inpatient facilities that can remove people, especially children, from the environment of their trauma and regulate their medication and care, are still important for proper treatment and diagnosis.

Yates County Undersheriff Howard Davis, backed up Rosno’s observation, and stated that the criminal justice system should not be used in place of mental health care. He says that most calls of this nature come after 5 p.m. when the outpatient clinics are closed. Evening clinics recently approved by the state for S&S will help to some degree. 

In a joint statement, Reed, O’Mara, and Palmesano said, “We share the widespread concern and care over a growing crisis and the lack of available services to respond to ever-increasing needs for mental health care.  Consequently, we appreciate this outpouring of community input.  Rural communities and regions face unique obstacles to accessibility, efficiency, and cost effectiveness in this arena of care.  Today’s roundtable highlights this community’s determination to face this challenge and find the best ways to address it.”

Tracy Mitrano, the Penn Yan Democrat who opposed Reed in the last election and has announced a 2020 challenge, was in the audience during the meeting. She stated afterward, “I salute the superintendents of Penn Yan and Dundee schools to bring this critical issue to our attention, the first responders and law-enforcement who must deal with the consequences of the lack of area resources, and the Yates County community that have come out to express their views and priorities and ask for help.

“It nonetheless remains disingenuous for our elected officials who fail to take responsibility for the policies in social services, healthcare, education, drug and alcohol addiction, infrastructure, transportation, Internet and economic development in our area that has resulted in this crisis to sit there and act as if they don’t understand it is their chickens that are coming home to roost.”