Report on mental health suggests 'robust' approach to treatment

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A year in the making, a new state report recommends more funding for mental-health services, a system for tracking the availability of psychiatric beds and broadening the guidelines for forcing people into psychiatric care -- but it doesn't go as far as the legislator behind the study had hoped.

The Joint State Government Commission, the Legislature's research service, conducted the study after state Rep. Thomas Caltagirone, D-Berks County, pushed through a resolution last May requesting it.

Mr. Caltagirone, who is minority chairman of the Judiciary Committee and concerned about the growing number of people with mental illness showing up in jails and prisons, hoped the commission would recommend re-establishing some of the state hospital beds closed in recent decades as part of a national push for community-based treatment.

The commission echoed his concern about incarceration of the mentally ill, saying "it is particularly ironic" that three shuttered state hospitals ultimately were turned into prisons. However, while the commission made recommendations for keeping people with mental illness out of the justice system -- such as developing a better-funded, more robust system of community mental-health services -- it did not recommend more hospital beds.

In an email, Glenn J. Pasewicz, the commission's executive director, said "a state hospital bed is supposed to be a last resort."

"The whole notion of a robust community mental health services system is to prevent persons with mental illness from becoming so ill that institutionalization is necessary," he said.

Mr. Caltagirone said the report was a starting point but not the dynamic road map for change he had sought.

"It's not the alpha and the omega," he said. "It's just the alpha."

Mr. Caltagirone said he would consider convening workshops or hearings with some of the mental-health experts interviewed for the study to hear directly what ideas they have for improving the mental health system and ultimately will introduce legislation to move forward the initiatives he considers most relevant.

"You have to be bold and dynamic," he said, predicting that reopening hospital beds -- and diverting money from the corrections system to fund them -- is the "biggest hurdle to overcome."

Allegheny County Judge John Zottola, chairman of the state's Mental Health and Justice Advisory Committee, said the report represented a needed review of policies that are as much as 50 years old.

Deb Shoemaker, executive director of Pennsylvania Psychiatric Society, a group representing psychiatrists, said she was pleased with the report.

"The funding is the biggest issue, and it's paramount," she said.

In recommending more funding for community treatment, the commission echoed the sentiments of county officials, service providers and advocates, all of whom have lamented service cuts that followed a 10 percent reduction in state funding for mental-health services in 2012-13. It said support for community care only makes sense.

"The average cost per person in a state mental hospital in Pennsylvania is $144,072. The average cost per inmate in the state corrections institutions is $36,300," compared with an average annual cost of $2,322 for community treatment, it said.

The report did not give an opinion about how much more money is needed for community treatment.

"We did find that providers/counties would like to receive, at a minimum, restoration of the 10 percent cut from the 2013 budget, although they realize that the 10 percent would be a drop in the bucket," Mr. Pasewicz said in the email. "Also, while new money is needed, more efficient use of existing money is necessary."

The report provided additional support for some initiatives already in progress.

For example, it recommended a system for tracking availability of psychiatric beds at community hospitals. The Pennsylvania Medical Society last year called for such a system, saying patients with mental-health needs may spend hours, if not days, in emergency departments, because psychiatric beds are difficult to locate.

The study also recommended modifications to the state law regulating involuntary commitments for psychiatric care, saying the current standard for forcing a person into care is not broad enough.

State Sen. Patricia Vance, R-Cumberland County, introduced legislation in April 2013 to liberalize the standard, but the bill remains in committee. Judge Zottola said his committee has expressed interest in changes to the involuntary commitment law, but he questioned the study's proposal to include damaging property as a behavior that could force someone into care.

To give inmates stability when they leave a county jail, the commission recommended giving them up to a 30-day supply of psychiatric medications at the time of their releases. It said the state already provides departing prisoners with such a supply.

Allegheny County once provided a month's supply but cut back -- it now provides up to two weeks worth of medication and a prescription for a refill -- because of concern that medications would be sold on the street or otherwise fall into the wrong hands, said Sue Martone, the county's assistant deputy director for behavioral-health services.

The report also recommended the Legislature establish a student-loan-forgiveness program to lure more people into the mental-health field and keep them there. The federal government already offers such programs for psychiatrists, psychologists, social workers and other professionals.

Without identifying specific positions, Mr. Pasewicz said he envisions a state program for "front-line caseworkers/social workers, who comprise the bulk of personnel caught in the revolving door in human services staffing. People working in these positions are usually fresh out of college and are paid only slightly more than minimum wage."

Joe Smydo: jsmydo@post-gazette.com or 412-263-1548.


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