By Denise Richardson The Daily Star
---- — Bassett Medical Center in Cooperstown will close its 10-bed inpatient psychiatric unit, a step resulting from a national shortage of psychiatrists and support staff willing to work in rural areas, officials said Friday.
Plans are in the works for a local “Mobil Crisis Assessment Team” to be ready when the Bassett unit closes, said Otsego County community services director Susan Matt. The designated team, plus other services, are intended to provide support to patients within the community and reduce needs for hospitalization, she said.
Matt said mental health care agency officials from the state and four-county area, among other organizations, have been meeting since last autumn to arrange for the MCAT program and other provisions, ranging from peer counselors to a “crisis apartment” for adults. Officials met Friday, she said, and will meet Tuesday to continue discussing implementation of plans.
However, on Friday, the pending closure unit prompted concerns among law enforcement officials about increased demands from a rising number of mental health calls.
Oneonta Police Chief Dennis Nayor alerted the mayor and city manager that transporting patients to facilities outside the area, such as to Binghamton or Utica, will create “tremendous strain on our manpower and functioning,” Nayor said in a memorandum Friday.
“Some transports will require two officers and some days we may have to make more than one trip,” Nayor wrote. “We will obviously do the best we can to deal with the situation, but with the huge increase in mental health issues locally, this is the absolute last thing we need.”
The Oneonta Police Department has responded to 56 calls this year regarding mental health services, according to Lt. Douglas Brenner. Those cases resulted in 22 transports to Bassett Medical Center in Cooperstown, which is about two transports per week, he said.
In 2013, the department responded to 225 calls for service and transported patients to Bassett 77 times, said Brenner, who wrote to Nayor that he would contact Matt about services and options.
Otsego County Sheriff Richard Devlin said deputies are responding to more cases involving mental health issues, though he didn’t have numbers immediately available Friday afternoon.
“We have the same concerns as the police department,” Devlin said.
According to a media release issued Friday, Bassett Medical Center has notified the state Office of Mental Health that because of “severe provider shortages, it plans to discontinue its inpatient psychiatric services.” Approval of the closure plan is expected from the state in one to two weeks, the Bassett release said.
“We did not make the decision to discontinue inpatient psychiatry services lightly and regret having to take this action,” Dr. William F. Streck, Bassett president and chief executive officer, said in the release.
“However, it has been impossible to recruit psychiatrists and advanced practice clinicians who wish to participate in inpatient psychiatric care,” Streck said. “This problem is not unique to Bassett. The shortage of mental health providers is a state and nationwide issue.”
A 2013 survey by the Healthcare Association of New York State reported that 58 percent of hospitals and health systems reported a shortage of psychiatrists, and about a third of hospitals reduced services because of the shortage, with the rate at about 50 percent among rural hospitals, the survey said.
In December, Bassett notified the Office of Mental Health that it would cut its inpatient psychiatric unit from 20 to 10 beds because of staffing challenges.
“We have been sincere in our belief that as a result of discussions with the state about where Bassett fits into the state’s overall solution for mental health, we could collectively come up with a way to adequately support inpatient psychiatric services,” Streck said in the release. “However, that has not happened, and it is clear that the recruitment challenges to appropriately staff the unit are too big to overcome.”
With Office of Mental Health approval of the closure plan pending, patients in Bassett’s inpatient psychiatry unit will remain until they are ready for discharge, the release said. Patients needing longer-term services will be transferred to another psychiatric facility. Options include facilities in Binghamton, Schenectady and Utica.
Bassett’s emergency department still will be able to accept patients experiencing emergency mental health issues, the release said. However, patients needing hospitalization will be transferred to a facility able to accept them.
Bassett will continue to offer outpatient mental health care, the release said, and to pursue additional psychiatric services through Vital Access Provider funding and programs eligible under the pending Delivery System Reform Incentive Payment program.
In 2007, A.O. Fox Memorial Hospital in Oneonta closed its 28-bed psychiatric unit because of a shortage of psychiatrists and increased costs. Bassett opened its crisis unit in February 2008.
Under the Mobil Crisis Assessment Team system, three team members would be in Otsego County and one each in Delaware, Chenango and Schoharie counties, Matt said, and coverage would be flexible depending on needs in the area.
Otsego County won’t be paying for the MCAT and other local services, Matt said. The state Office of Mental Health has provided about $1.2 million annual to Otsego, Delaware, Chenango and Schoharie counties for services, she said, and the local programs are funded through that pool.
MCAT, which is part of the Neighborhood Center Inc. in Utica, was to start July 1 but will start sooner based on when the Bassett unit closes, Matt said. Health care officials found out Thursday that the Bassett unit would be closing, she said.
Matt acknowledged that law enforcement agencies, ambulances and other transporters will have to travel farther to take patients to hospitals, she said.
But with MCAT and the implementation of local services, she said, the goal is to identify needs early, make referrals to community-based resources and intervene before a development of a crisis. The Oneonta Police Department does “a great job” with mental health calls, according to Matt, who said she has talked with Brenner about “constant communication” options and resources.
Plans for more community-based services were being made whether the Bassett crisis unit remained viable or not, she said.
“We need to do more in our communities,” Matt said. “The goal is to help people early on so they don’t get to a point were they need hospitalization.”
Matt said the MCAT program already serves Oneida and Herkimer counties and has had successful rates of treating patients, intervention and preventing hospitalization.
With a transition from inpatient psychiatric care, Bassett will be able to re-allocate remaining resources and focus on expanding and strengthening its community and school-based outpatient mental health services, according to the release.
Bassett will try to place staff affected by the closure in other positions at Bassett Medical Center or connect staff with opportunities elsewhere within the Bassett Healthcare Network, the release said. If staff prefer, the organization can connect them with job transition services outside of Bassett.