Review of patient response issues and continuity of care in the 13 counties served by Warren State Hospital led to discussion of the larger mental health services climate in the region during the hospital's board of trustees meeting Wednesday morning.
Psychiatric Emergency Response Team (PERT) Captain Jeff Darling presented an overview of the PERT program to trustees.
Darling explained PERT is an interdepartmental initiative to coordinate people to respond to individuals, both in times of psychiatric crisis and in situations with the potential for psychiatric crisis.
"It involves all different aspects from people throughout the hospital," Darling said. "Response is not the old way of physical management. Response is 99 percent verbal."
According to Darling, the initiative is an effort to respond to situations before they escalate into serious incidents and to provide an alternative to seclusion and restraint responses which can hinder mental health recovery.
He noted situations still arise requiring standard emergency protocols, "but it's rare. It is meant to greatly reduce those types of incidents before they happen."
Hospital CEO Charlotte Uber reported on service area issues and legal issues resulting from patient behavior.
Uber said current bed usage at the hospital is at 177, a number fast approaching the 190-bed cap set by the state. She noted that within the 13-county area served by the hospital, some counties are using more than their allotted bed cap while others were using less.
"Because we're getting so many referrals," Uber explained, "we're encouraging counties over their bed cap to have someone discharged before sending somebody else."
She noted the state is continually lowering the hospital's bed cap, while the number of referrals to the facility, and the number of high acuity cases amongst those referrals, has steadily increased.
Uber brought up the issue of legal issues arising while patients are being treated at the hospital.
"We as a hospital... are always working on reducing incarceration of mental health treatment individuals," Uber said.
She noted the hospital has developed an in-house community service program as an alternative to sentencing of defendants from the hospital.
"(Jail) doesn't really address the needs of their treatment," Uber said.
She also noted the hospital has a conflict resolution team to resolve patient-to-patient issues and works with the Warren County Jail if an individual is incarcerated.
As a result, individuals from the hospital facing criminal charges are usually those who have had repeated incidents.
Chief Performance Improvement Executive Dave Markley pointed out patient rates of assault at WSH have consistently remained at or near the lowest levels among hospitals in the state system. He also noted "hands-on" restraint usage is near the lowest in the state.
Trustee Mary Kushner pointed out increased bath salts usage has precipitated a rise in diagnoses of individuals as clinically psychotic.
"It's (bath salts) so new, they're not sure if they're (the diagnoses) going to be permanent," Kushner said. "It's been showing up months after use."
Trustees also pointed to cuts in mental health spending, cash assistance and prescription drug coverage assistance as being partly to blame for a reduced ability among those with mental health issues to receive the health they need within the community.
Kushner pointed out cuts at the county level are preventing community organizations from securing matching funds for state money.
Trustee Keith Bell pointed out elimination of cash assistance benefits has made a significant difference in the ability of individuals with serious mental health issues to get to appointments and make prescription co-payments.
Trustees attributed the combination of these and other factors to more people being referred to the state mental health system or ending up incarcerated rather than being treated in their communities.
"They're just going from mental health to the criminal system," Kushner lamented.
"It seems to me... It's really progressed significantly," Bell said. "We kept a lid on things... Our system seemed to manage it... Now it's unraveling."