Kingsboro Psychiatric Center to close — Brooklynian

Kingsboro Psychiatric Center to close

The recommendation of the Berger Commission is soon to become a reality. While it sounds as if Kingsboro needs improvement with safety, efficiency, and treatment quality, I worry about the impact that this closure will have on the most vulnerable of Brooklyn's mentally ill. Kingsboro takes in the long-term cases that acute care hospitals are not equipped to address. I fear that this will further clog area CPEPs/ERs and pressure Kings County, Brookdale, Interfaith, etc. to discharge patients too soon in order to free up space for new arrivals. Plus, South Beach is very far for family members - many of them indigent - to visit patients. No, I am not employed by Kingsboro and am not a member of the civil service employees union, but I do work with the mentally ill and am concerned that this could be yet another blow to a population that has already suffered enough.

Comments

  • Those who support the closure argue that such facilities waste money because the patients can be served effectively through cheaper options, such as Supportive Housing in combination with OMH community based programs.

    While everyone supports cost savings and people living independently, there continues to be a need for hospitals.

    Like Jack, I fear is that this wave of deinstituitionalization will replicate those of the past:

    - in adequate community supports will simply result in less services being provided to fewer people.

    - out of desperation, we will expand our use of prisons as places to house people who could have been more effectively served at hospitals.

    It does not take a skilled writer to use the rhetoric of "recovery" and "independence". ....some people do it merely to implement cost savings. Others genuinely embrace and understand the terms.

    Eventually the pendulum will again swing the other way. Until then, many people with severe mental illness and limited ability to "adjust" to be told to so.

  • I'll be the first to admit that some mental health programs hang on to patients too long and do not do enough to promote recovery and independence, but, like you, whynot, I think it sometimes becomes an excuse to cut services for people who have little, if any, political power. Some patients remain at state hospitals for months not because they need additional time to stabilize, but because they need concrete services that take time to arrange. For example, finding permanent housing for an undocumented immigrant suffering from mental illness and substance dependence is incredibly difficult - but until that placement is made, a patient should not be discharged to the street or a shelter, which will likely cause said patient to decompensate/relapse and wind up back in a hospital or in jail. The criminal justice system being the modern-day provider for psychiatric services is aptly named transinstitutionalization: from state hospitals to city/state prisons. As bad as a state hospital may be, it's superior to mental health services delivered in a correctional setting.

    I hope that the outpatient services intended to replace the beds at Kingsboro are successful. It's definitely an issue worth monitoring.

  • While it is important to work for macro changes (like improved services and increased funding), any successes take effect in the long run.

    Meanwhile, clients and providers receive and provide services in the short run.

    I hate that the two runs often conflict.

  • Mohawk Valley Psychiatric Center to See Layoffs, Ward Closings

    70 to 100 Jobs to be Affected

    By Elizabeth Cooper Utica Observer-Dispatch February 10, 2012

    Oneida County Mental Health officials expressed concern Wednesday over planned reductions to inpatient services at Mohawk Valley Psychiatric Center.

    Cuts handed down by the state Office of Mental Health Tuesday mean that between 35 and 40 people may be transferred from the Psychiatric Center’s inpatient wards to outpatient facilities.

    “These are very, very sick people, and I am concerned about them coping in the community,” county Mental Health Commissioner Linda Nelson said. “We can assimilate them, but is it the best level of care for them?”

    Office of Mental Health spokeswoman Leesa Rademacher could not be reached to respond to Nelson’s concerns, and did not respond to emailed questions about the proposed transfer to outpatient care.

    Under the plan, two wards at Mohawk Valley Psychiatric Center will be shuttered and a third ward, including about 24 patients, will be moved to Hutchings Psychiatric Center in Syracuse.

    This is the end of inpatient adult psychiatric services at the psychiatric center in West Utica. But existing state-operated residential non-inpatient services will remain, along with other outpatient services.

    So will an inpatient unit for Children and Youth, Rademacher said earlier Wednesday.

    About 100 jobs are being affected, though will be moved to Hutchings. After the cuts, about 200 people still will work at the facility, area officials said.

    The changes — which are part of changes to the state’s mental health system made in the 2011-12 state budget — will go into effect after at least 30 days, but preparations will begin immediately.

    “As part of becoming more efficient in delivering services in the 2011-2012 budget, OMH eliminated up to 600 surplus beds from its statewide psychiatric inpatient system,” Rademacher said.

    She said her agency was able to minimize the loss of filled staff positions by first reducing the workforce through attrition and retirements.

    Area officials blindsided

    Local officials said they had been caught off guard by the cuts and still were looking for answers Wednesday afternoon.

    “Utica is an area that is underserved in terms of mental health treatment,” Brindisi said. “This is only going to exacerbate the problem.”

    And State Sen. Joseph Griffo, R-Rome, said he doesn’t like the job losses associated with the plan.

    “Our community is again being asked to allow another exodus of public jobs to other areas of the state,” he said in a release.

    Oneida County Executive Anthony Picente said he has a slew of concerns over treatment, jobs and new costs to the county.

    “This one just runs the gamut,” he said of the problems the move could cause.

    Under the law, the county may have to pay for the transport of some mentally ill people to Syracuse, he said.

    Nelson said she will be meeting with officials from the state and the Psychiatric Center to discuss the transition.

    The psychiatric center, which was opened in 1843, has a long history in the heart of West Utica.

    The massive stone Greek Revival building that was once its centerpiece now stands empty on Court Street. The current inpatient facility is at the opposite end of the campus, on Noyes Street.

    Not the only one

    Utica’s Psychiatric Center is not the only one getting hit by cuts this week, the Office of Mental Health website shows.

    Bronx Psychiatric Center, Creedmoor Psychiatric Center in Queens, and Sagamore Psychiatric Center in Dix Hills also are seeing cuts or other changes.

    Kingsboro Psychiatric Center in Brooklyn is being closed entirely.

    In its 2011-12 budget, the state made 5 percent cuts to its sprawling $3.5 billion mental health system.

    Glenn Liebman, CEO of the Mental Health Association in New York State, said the state has more psychiatric centers than any other in the nation and the emphasis on community-based alternatives is a positive.

    “Clearly there is a need for a small cadre of people to be hospitalized,” he said.

    Liebman also said he would like to see funds saved by the reductions go toward community-based programs.

    http://www.uticaod.com/news/x1508889728/Mohawk-Valley-Psychiatric-Center-to-see-layoffs-ward-closings

  • Mohawk Valley Psychiatric Center to See Layoffs, Ward Closings

    70 to 100 Jobs to be Affected

    By Elizabeth Cooper Utica Observer-Dispatch February 10, 2012

    Oneida County Mental Health officials expressed concern Wednesday over planned reductions to inpatient services at Mohawk Valley Psychiatric Center.

    Cuts handed down by the state Office of Mental Health Tuesday mean that between 35 and 40 people may be transferred from the Psychiatric Center’s inpatient wards to outpatient facilities.

    “These are very, very sick people, and I am concerned about them coping in the community,” county Mental Health Commissioner Linda Nelson said. “We can assimilate them, but is it the best level of care for them?”

    Office of Mental Health spokeswoman Leesa Rademacher could not be reached to respond to Nelson’s concerns, and did not respond to emailed questions about the proposed transfer to outpatient care.

    Under the plan, two wards at Mohawk Valley Psychiatric Center will be shuttered and a third ward, including about 24 patients, will be moved to Hutchings Psychiatric Center in Syracuse.

    This is the end of inpatient adult psychiatric services at the psychiatric center in West Utica. But existing state-operated residential non-inpatient services will remain, along with other outpatient services.

    So will an inpatient unit for Children and Youth, Rademacher said earlier Wednesday.

    About 100 jobs are being affected, though will be moved to Hutchings. After the cuts, about 200 people still will work at the facility, area officials said.

    The changes — which are part of changes to the state’s mental health system made in the 2011-12 state budget — will go into effect after at least 30 days, but preparations will begin immediately.

    “As part of becoming more efficient in delivering services in the 2011-2012 budget, OMH eliminated up to 600 surplus beds from its statewide psychiatric inpatient system,” Rademacher said.

    She said her agency was able to minimize the loss of filled staff positions by first reducing the workforce through attrition and retirements.

    Area officials blindsided

    Local officials said they had been caught off guard by the cuts and still were looking for answers Wednesday afternoon.

    “Utica is an area that is underserved in terms of mental health treatment,” Brindisi said. “This is only going to exacerbate the problem.”

    And State Sen. Joseph Griffo, R-Rome, said he doesn’t like the job losses associated with the plan.

    “Our community is again being asked to allow another exodus of public jobs to other areas of the state,” he said in a release.

    Oneida County Executive Anthony Picente said he has a slew of concerns over treatment, jobs and new costs to the county.

    “This one just runs the gamut,” he said of the problems the move could cause.

    Under the law, the county may have to pay for the transport of some mentally ill people to Syracuse, he said.

    Nelson said she will be meeting with officials from the state and the Psychiatric Center to discuss the transition.

    The psychiatric center, which was opened in 1843, has a long history in the heart of West Utica.

    The massive stone Greek Revival building that was once its centerpiece now stands empty on Court Street. The current inpatient facility is at the opposite end of the campus, on Noyes Street.

    Not the only one

    Utica’s Psychiatric Center is not the only one getting hit by cuts this week, the Office of Mental Health website shows.

    Bronx Psychiatric Center, Creedmoor Psychiatric Center in Queens, and Sagamore Psychiatric Center in Dix Hills also are seeing cuts or other changes.

    Kingsboro Psychiatric Center in Brooklyn is being closed entirely.

    In its 2011-12 budget, the state made 5 percent cuts to its sprawling $3.5 billion mental health system.

    Glenn Liebman, CEO of the Mental Health Association in New York State, said the state has more psychiatric centers than any other in the nation and the emphasis on community-based alternatives is a positive.

    “Clearly there is a need for a small cadre of people to be hospitalized,” he said.

    Liebman also said he would like to see funds saved by the reductions go toward community-based programs.

    http://www.uticaod.com/news/x1508889728/Mohawk-Valley-Psychiatric-Center-to-see-layoffs-ward-closings

  • Mohawk Valley Psychiatric Center to See Layoffs, Ward Closings

    70 to 100 Jobs to be Affected

    By Elizabeth Cooper Utica Observer-Dispatch February 10, 2012

    Oneida County Mental Health officials expressed concern Wednesday over planned reductions to inpatient services at Mohawk Valley Psychiatric Center.

    Cuts handed down by the state Office of Mental Health Tuesday mean that between 35 and 40 people may be transferred from the Psychiatric Center’s inpatient wards to outpatient facilities.

    “These are very, very sick people, and I am concerned about them coping in the community,” county Mental Health Commissioner Linda Nelson said. “We can assimilate them, but is it the best level of care for them?”

    Office of Mental Health spokeswoman Leesa Rademacher could not be reached to respond to Nelson’s concerns, and did not respond to emailed questions about the proposed transfer to outpatient care.

    Under the plan, two wards at Mohawk Valley Psychiatric Center will be shuttered and a third ward, including about 24 patients, will be moved to Hutchings Psychiatric Center in Syracuse.

    This is the end of inpatient adult psychiatric services at the psychiatric center in West Utica. But existing state-operated residential non-inpatient services will remain, along with other outpatient services.

    So will an inpatient unit for Children and Youth, Rademacher said earlier Wednesday.

    About 100 jobs are being affected, though will be moved to Hutchings. After the cuts, about 200 people still will work at the facility, area officials said.

    The changes — which are part of changes to the state’s mental health system made in the 2011-12 state budget — will go into effect after at least 30 days, but preparations will begin immediately.

    “As part of becoming more efficient in delivering services in the 2011-2012 budget, OMH eliminated up to 600 surplus beds from its statewide psychiatric inpatient system,” Rademacher said.

    She said her agency was able to minimize the loss of filled staff positions by first reducing the workforce through attrition and retirements.

    Area officials blindsided

    Local officials said they had been caught off guard by the cuts and still were looking for answers Wednesday afternoon.

    “Utica is an area that is underserved in terms of mental health treatment,” Brindisi said. “This is only going to exacerbate the problem.”

    And State Sen. Joseph Griffo, R-Rome, said he doesn’t like the job losses associated with the plan.

    “Our community is again being asked to allow another exodus of public jobs to other areas of the state,” he said in a release.

    Oneida County Executive Anthony Picente said he has a slew of concerns over treatment, jobs and new costs to the county.

    “This one just runs the gamut,” he said of the problems the move could cause.

    Under the law, the county may have to pay for the transport of some mentally ill people to Syracuse, he said.

    Nelson said she will be meeting with officials from the state and the Psychiatric Center to discuss the transition.

    The psychiatric center, which was opened in 1843, has a long history in the heart of West Utica.

    The massive stone Greek Revival building that was once its centerpiece now stands empty on Court Street. The current inpatient facility is at the opposite end of the campus, on Noyes Street.

    Not the only one

    Utica’s Psychiatric Center is not the only one getting hit by cuts this week, the Office of Mental Health website shows.

    Bronx Psychiatric Center, Creedmoor Psychiatric Center in Queens, and Sagamore Psychiatric Center in Dix Hills also are seeing cuts or other changes.

    Kingsboro Psychiatric Center in Brooklyn is being closed entirely.

    In its 2011-12 budget, the state made 5 percent cuts to its sprawling $3.5 billion mental health system.

    Glenn Liebman, CEO of the Mental Health Association in New York State, said the state has more psychiatric centers than any other in the nation and the emphasis on community-based alternatives is a positive.

    “Clearly there is a need for a small cadre of people to be hospitalized,” he said.

    Liebman also said he would like to see funds saved by the reductions go toward community-based programs.

    http://www.uticaod.com/news/x1508889728/Mohawk-Valley-Psychiatric-Center-to-see-layoffs-ward-closings

  • While the Daily News credits activism by Brooklyn politicians for stopping/delaying the closure of Kingsboro, I wish someone would write an article about other factors that may be behind this "success", such as:

    - the failure of NYS to roll out Health Homes in NYC in a timely, coherent manner.

    http://www.health.ny.gov/health_care/medicaid/program/medicaid_health_homes/

    -The nearly impossible task of creating a model of residential care that complies with Olmstead, yet provides the level of care and supervision often required, while saving money.

    In my opinion, congregate supportive housing with ACT isn't ready yet for the task. To attempt to serve this population via a discharge from inpatient to scattersite is fantasy. OMH is unable to open any more CR/SROs.

    http://en.m.wikipedia.org/wiki/Olmstead_v._L.C.

    http://bi.omh.ny.gov/act/index

    http://shnny.org/

    http://www.urbanpathways.org/hous_ss.asp

    http://bi.omh.ny.gov/adult_housing/index?p=res-programs

    -The state must also try to make sure that those who volunteer for MRT and MISCC feel as if they are heard, so they do not file additional pesky lawsuits.

    http://www.opwdd.ny.gov/MISCC/

    http://www.health.ny.gov/health_care/medicaid/redesign/

    Until progress is made on these fronts, I'm with you: Let's continue to fight for Kingsboro. We might not like it, but it is the least offensive choice available to us at the moment. I'm not willing to flood the streets with the mentally ill under the hope that superman will see the emergency and come to rescue; The 1980s proved that takes too long to work.

    BTW, I included links for those not fluent in this field. Jack and I could jabber in abbreviations all day to ourselves.

  • Very interesting links - thanks for posting!

    As I read the information on health homes, I can already see difficulties with implementation. Integration of services is a wonderful idea and one that I support, but day-to-day challenges will interfere with communication. Most practitioners that I know, regardless of discipline, understand and agree with the idea of "working as a team", but are already so overwhelmed and, as a result, do not communicate well with each other. Many providers still do not have EMR or have partial EMR (e.g. hospitals whose CPEPs and inpatient units have it, but outpatient departments do not - essentially, the same institution has two separate charting systems) - so sharing of records "in house" will be affected. Given that many outpatient clinics lack support staff, turf battles will develop over who will xerox/fax/mail needed records. Psychiatrists will consider this beneath them and therapists will also resist, stating that they are not secretaries. In my experience, it is rare for a primary care physician to return calls or honor a request for paperwork. Many case managers do not return messages and call only when they need paperwork/information for audits. The same goes for inpatient social workers, many of whom call only the day prior to discharge, and only then because they are required to get the aftecare appointment within five days. Then there is the perennial problem of high staff turnover and limited time due to overwhelming caseloads, pressure to meet quotas, onerous paperwork, etc. Inpatient units are under so much pressure to discharge quickly that patients often receive poor aftercare planning - I can't tell you how many times I've seen a high-risk patient not receive services such as ACT or AOT because the application processes are so time-consuming and it becomes easier to simply send the patient back a standard outpatient clinic and hope for the best. Most patients who wind up at a state hospital have many unmet needs, yet know their rights and often decline services that would likely help them "remain healthy" (e.g. patients who never get annual physicals, patients who disengage from services, MICA patients who "hide out" in outpatient mental health clinics because they know they can still use and will never be tested for drug/alcohol use, patients who routinely stop taking medication, etc.). I don't mean to sound so cynical, because believe it or not, I actually am optimistic that positive change can occur. I've just seen so many allegedly new ideas trotted out over the years, only to fail and then be replaced by yet another new idea, only to fail and then...

    Whynot, I enjoy exchanging posts with you on this topic, as I think that administrators/policy makers/researchers and direct practitioners, despite wanting the same things, are often disconnected from one another. By improving communication amongst ourselves, we can keep fresh in our minds the perspectives of each other.

  • This article in the Eagle makes it sound as if the war is won, when in reality there is just a lull in the fighting.

    It is important to remember that in addition to the various lawsuits and mandates, the timing of the events puts the state in a budget bind.

    As you are aware, The Grand Plan is to use the savings from closing the hospital beds in order to improve community services. I think I love civil liberties and hate institutions with the same zeal as most, however, our present system isn't drive too much by feelings.

    It is driven by money and court processes. When it is all said and done, community services aren't a heck of a lot cheaper (1) and can't just be activated at a moments notice (2).

    The former (1) causes the state to not be very motivated unless the court system mandates action.

    The latter (2) means that advocates take the approach of requiring OMH to create these services while it continues to operate the hospitals.

    When combined, you get lots of problems:

    a. The state does not have the money or wherewithal to do both.

    b. As soon as the state creates community services intended as discharge resources for hospital patients, they are quickly filled with people who are in the community who have long been in need of care in order to avoid becoming hospital patients (or incarcerated).

    Hence, it never seems to create services and beds for the hospital patients that are costing it the most in terms of $ and lawsuits. At best, it creates step-down beds for those who are in the CRs.

    A past attempt:

    http://www.omh.ny.gov/omhweb/rfp/2011/supported_housing/nyc/

    All of this causes splits over which groups are "most worthy" among the advocates. For example, using Olmstead, do they fight for those who are in the hospital, and haven't been in the community for years?

    Or, do they fight for services for those who are presently at risk of becoming a long term inpatient?

    For the moment, OMH has decided that the threat posed by the politicians is more formidable than the threats posed by Olmstead, MRT and MISCC.

    ...the advocates remain divided, or neutralized.

This discussion has been closed.