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The safety net in Buffalo for the mentally ill is under strain

The safety net for people with a serious mental illness was at its breaking point in the middle of June.

About 90 people were packed into the psychiatric emergency room at Erie County Medical Center, a space that grows crowded with half that number.

Patients waited for hours to be assessed and admitted. People were sprawled on the floor, and the staff was overwhelmed, said one visitor, who watched 12 hours pass before his daughter was given a bed.

ECMC’s psychiatric emergency room is already one of the state’s busiest. But its June traffic jumped by some 200 patients over the previous month, in part because Kaleida Health closed what was left of Buffalo General Medical Center’s 47-bed “behavioral health” unit June 14.

Kaleida closed off its beds months before its officials unveil the new behavioral health center they will operate with ECMC on the ECMC campus.

Kaleida said it had no choice. Its employees, were transferring out of a unit slated to close, and there were too few people left to provide care.

But the Kaleida decision stripped away one out of every three inpatient psychiatric beds that the two hospitals offered, and an important option for people with a serious mental illness.

Meanwhile, the bedlam at ECMC invited comparisons to jails, which double as psychiatric centers in today’s mental health system, though some said jails are typically calmer than ECMC was back in June.

“One of the families said to me, ‘At least when you go to the Holding Center, you get a bed and a phone call,’ ” said Jenny Laney, who supports families through her post with the Mental Health Association of Erie County.

Families in the mental health system have long complained that it is dispersed and inadequate. A mentally ill person who needs help right away often meets a network moving at its own pace, with a shortage of both beds and psychiatrists.

“New York State has a serious mental health epidemic, and unfortunately the state is in full-blown denial,” James Seifert of Orchard Park told Erie County’s Community Corrections Advisory Board earlier this year. “... It turns out that it is functionally illegal to have certain types of mental disorders. The de facto solution for the current mental health crisis is a park bench or prison.’’

Seifert and his family tried for years to have one of his sons, diagnosed with schizophrenia, placed into an institution. Today he is in the Erie County Holding Center.

The state recently announced that it will expand the Buffalo Psychiatric Center starting next year, but there will be no net gain in state-provided beds for Erie County because the Buffalo expansion is part of a statewide consolidation that removes beds from the Children’s Psychiatric Center in West Seneca.

New York’s Office of Mental Health says it cannot afford to run 24 psychiatric centers. But people who watch the system believe there should be thousands more beds for people who are severely mentally ill.

“New York State is short 4,300 beds for people with serious mental illness, and that assumes we have perfect community services, and we don’t,” said D.J. Jaffe, who runs a think tank in New York City about the mental health system. “The largest psychiatric facility in New York is Rikers Island, and when they close these centers, they will probably have to make that one bigger.”

A shock to the system

Buffalo General’s move shocked the system locally. More beds have been added elsewhere to soften the blow. But again, there will be no meaningful local increase.

“We were in a challenging situation even before those beds were taken out of the system,” said Kenneth Houseknecht, the Mental Health Association’s executive director. “Then you take those beds out of the system and that challenge just becomes exacerbated.”

One woman, Gail, was among those affected. Her husband was in Buffalo General after a schizophrenic episode. He was released to her care days or weeks early, in her opinion, when Buffalo General closed its unit and discharged about 25 patients.

Gail, asking to be identified only by her middle name so as not to expose her emotionally fragile husband, said the hospital gave her a discharge plan that didn’t work because it directed her husband to agencies that didn’t offer the recommended services.

“This county is not prepared to care for its most vulnerable,” she said. “Not only do we need places to take our loved ones, we need good care. ... To leave a vulnerable population with no place to go with their sickness, it makes us look like a Third World country.”

Fragmented and costly

ECMC and Kaleida Health acknowledged the fractured state of the mental health system in Western New York when they announced back in February 2012 that they would combine their psychiatric care efforts on the ECMC campus. They would build a $25 million center handling 180 psychiatric beds, fewer than they were licensed to offer separately.

“Mental health care in Western New York, like the rest of the state, is fragmented and costly to the state’s Medicaid payment system,” the entities said in a news release at the time. “In the last 20 years, the Buffalo Psychiatric Center went from 1,200 beds to 160 and the Gowanda Psychiatric and West Seneca Developmental centers closed.” It’s now 185 beds at Buffalo Psychiatric Center.

The “crisis for mental health patients and their families” stems from a short supply of psychiatrists, downsizings and a lack of coordination among outpatient services, ECMC and Kaleida said.

They said that “mentally ill and chemically dependent patients in crisis are, many times, forced to find care in crowded hospital emergency rooms.”

But complications in merging the two hospitals’ psychiatric care efforts led to the recent shock to the mental health system and the crowded psychiatric emergency room at ECMC.

Outside Kaleida’s control

Aware that the program inside their hospital was winding down, Buffalo General staff members began transferring to other Kaleida jobs. The hospital then announced that it was unable to “retain and attract staff.”

After consulting with the state Office of Mental Health, Buffalo General closed the unit in the middle of June. Kaleida also told ambulance services to take people needing inpatient psychiatric care to other hospitals, some as far as Rochester, Olean, Jamestown and Warsaw.

“There are some issues we can’t control,” said Michael Hughes, a Kaleida vice president and spokesman. “We can control the planning perspective. We can control construction, and things like that. But the things we can’t control, such as when a union member is allowed to bump out of that service line and into a different location in the hospital or in the system, you have to adjust. And that’s what we’ve done.”

Hughes, however, knew of no similar interruptions in service when Buffalo General collaborated with ECMC to create the Gates Vascular Institute on the Buffalo Niagara Medical Campus or the Regional Center for Transplantation and Kidney Care at ECMC.

Further, he was unable to say whether Kaleida could have offered bonuses to employees to remain in the mental health unit until the new center could open: “The word ‘bonus’ in a union environment sometimes doesn’t go over well. I don’t know the answer to that,’’ Hughes said.

“They wouldn’t do this with any other disorder,” said Marcy Rose, president of the Buffalo and Erie County chapter of the National Alliance on Mental Illness. “They are expanding cancer treatment. They are expanding heart treatment. And these are the very people who are cutting back on psychiatric treatment and saying, ‘trust me.’ ”

Handling the overflow

ECMC saw Buffalo General’s decision coming.

“We were included in the decision in terms of knowing that this decision was going to be made,” said Richard C. Cleland, ECMC’s chief operating officer.

“It’s a tough situation for Kaleida,” he added. “Employees are starting to look around and saying, ‘Hey, there is not going to be a program here.’ By rights employees can bid on other jobs in the organization.”

ECMC soon added 10 psychiatric beds and the Office of Mental Health added seven at Buffalo Psychiatric Center. ECMC also hired someone to reach out to BryLin, Niagara Falls Memorial and Lake Shore hospitals to help handle overflow as needed, Cleland said.

As expected, the psychiatric emergency room at ECMC got busier.

Year round, it usually receives about one person every hour. In June, it averaged an additional seven people a day when compared with the previous month, he said. Year to date, admissions to psychiatric beds are up 11.7 percent over the prior year.

But Cleland, when asked about the ECMC emergency room being overrun with patients in the wake of the Buffalo General closure, said the emergency room has always had busy days.

“We do see days that are much more busy. But we have always seen that,” he said. “I haven’t seen anything outside of what we have seen in the past. Not that it is acceptable. We just don’t have control with what is going on in the community.”

He said days early in the week tend to be busy, and the hospital has a shortage of beds on Saturdays and Sundays because it’s more difficult to discharge patients on weekends.

To bolster ECMC’s argument that it prepared well for the rush of patients after Buffalo General’s closure, Cleland offered a measure showing that patients throughout June averaged shorter waits for a doctor’s full assessment than in May. With the hospital’s faster triage system, the average wait fell from 7.6 hours to 6 hours, he said.

As part of the new behavioral health effort, ECMC will open 36 psychiatric beds in its existing tower in September and 36 more in late November or early December, Cleland said. He expects the new freestanding building, which will contain a greatly expanded psychiatric emergency room, to open in January.

Following Buffalo General’s decision in June, a number of mental health organization have been meeting to strategize.

“In a way, there might be a silver lining to this,” said Houseknecht of the Mental Health Association. “And the silver lining might be that because the situation has become even more acute in the short run, I think it is provoking a conversation where we take a more systemic look, and we try to come up with more permanent solutions.”

Among the topics: “Can we give families a better level of support? Can we provide more resources to them? Can we reduce the number of times that people are coming back again? Because if you leave someone in a compromised position at the end of a stay, you are enhancing the likelihood that you will see them again ...

‘‘We are only going to do it if we work together,’’ he said, ‘‘if we all acknowledge that what we’ve got right now is not acceptable, and if everybody is willing to cast aside a commitment to always doing things the way they were done.’’