麻豆传媒

By Ned Parker
(Written under the direction of Professor Joel Kaplan)

"The voices say 'There is no hope for me. You're not going to meet your goals. Kill yourself,'" psychiatric patient Dan Kelley said. Kelly has checked into inpatient psychiatric wards twice in the last two months. Shorter hospital stays, strained community resources and shrinking state dollars have affected the lives of the mentally ill.

While staying at the Syracuse Rescue Mission Allliance, A. Corgel contemplated suicide.

He had a record of shooting up bleach and had injected himself once with feces. In 1996, he purposefully crashed his speeding bicycle, while riding downhill, and damaged the nerves in his legs and lower back.

When he threatened to inject himself with chemicals the May, Rescue Mission staff escorted him to the St. Joseph's Hospital Health Center. Corgel, who has both a borderline personality disorder and HIV, spent 17 days in the psychiatric ward, but his visit ended abruptly.

"When I felt ready to reveal some things, they told me I had to go," said Corgel, 27, who has been hospitalized more than 10 times since age 15.

He returned to the homeless shelter and Central New York Services' day treatment program for chemical addictions and mental illness.

At the clinic, Corgel attended group therapy and played pool. He hoped to find an apartment, but Central New York Services and other agencies carried three to 12-month waiting periods for housing.

"Basically, I'm still depressed and still feeling suicidal."

Corgel lives in New York state where a population of some 600,000 mentally ill residents have both public money and medical care. Between 1990 and 1997, New York slashed spending for its Office of Mental Health by 27 percent. Even though the state raised funding by 4 percent for the current fiscal year, the budget is 13 percent less than it was was four years ago.

At the same time, the average inpatient psychiatric stay at general hospitals in Onondaga County decreased from 13 days in 1993 to 9 days in 1997. Statewide, general hospital Medicaid psychiatric days dropped by 46 percent between September of 1996 and March of 1998.

Office of Mental Health spokesperson Roger Klingman attributed the state budget reductions to a more efficient health delivery system and additional Medicaid funding to cover general hospital psychiatric stays, outpatient visits and social services. New York has also invested money in alternatives to hospitalization, Klingman said.

"We've tried to develop a system where people can recover," said Dr. Thomas Cheney, operations director of the state-run Hutchings Psychiatric Center. "There is better medication than before, so that people can be placed in the community with the right type of support."

But the government dollars earmarked to compensate for the closing of 2,400 psychiatric beds and five psychiatric centers between 1994 and 1999 in the 1993 Community Mental Health Reinvestment Act never materialized.

The state legislature passed the reinvestment act in November of 1993 to strengthen community mental health services with an estimated $210 million over five years.

After the 1998-99 budget, however, the state has distributed only $164 million, or 22 percent less than what it pledged, while closing 990 more inpatient beds than had been planned.

Klingman, OMH's spokesperson, attributed the financial shortfall to Gov. George Pataki's effort to eliminate the reinvestment act and merge all state mental health spending under a block grant in the 1996 budget. Klingman said when the state legislature rejected the governor's proposal, reinvestment act money was restored at only 50 percent of its previous level. In reality, Pataki sliced reinvestment dollars by 31 percent his very first year in office.

The political world does not concern A. Corgel.

In September, Central New York Services' day treatment expelled Corgel for drug use, and he moved from the Rescue Mission shelter to an apartment on Syracuse's south side.

Corgel fits a profile in OMH statistics: he suffers from both a mental illness and a drug addiction. OMH diagnosed 12 percent of its inpatient population with psychological and substance abuse problems in 1996, a 10 percent increase over 10 years.

When the psychiatric ward discharged Corgel to the Rescue Mission on May 22, his medical report said: "His prognosis is extremely poor. Given his limited impulse control, the client may well show further self-injurious behavior or pseudo-seizures...
However it does not appear that further hospital stay would be moderate this...this prognosis must be regarded as quite guarded."

By this fall, Corgel used drugs frequently, including, on one occasion, a two-day sleepless amphetamine binge. He had gouged a march on his forehead and dyed his hair from blond to black to worship Satan. He said he was happy to no longer be at the Rescue Mission.

A stable environment, not a shelter, is crucial to recovery, said John Warren, the executive director of Central New York Services. On one randomly selected day, 25 percent of the people requesting care at his organization's program for drug addiction and mental illness lived in shelters or on the street, Warren said. He added that another 41 percent of his client pool live in housing situations that they consider unstable.

Corgel and other mental health patients exist in a health care landscape that offers fewer resources that it did four years ago.

Hutchings Psychiatric Center, one of the largest providers of outpatient care to the mentally ill in Onodaga, has lost 27 percent of its staff in the last three years while its outpatient population has increase from 1,050 to 1,279. Some patients have gone through several therapists due to the dwindling staff size, said Dr. Sandra Tars, Hutchings' director of quality improvement.

Hutchings and Syracuse's Benjamin Rush Center have eliminated clinical day treatment programs where patients maintain daily contact with psychiatrists and social workers. Benjamin Rush cut its one day treatment program, known as partial hospitalization, in 1997 after insurance companies refused to reimburse the hospital for its clients, said Benjamin Rush's Director of Nursing Jean Shook.

Hutchings cut the same type of program in 1995. The following year, New York state inaugurated its "prepaid mental health plan," and Hutchings cut its two other clinical day treatment programs. Under the new medical plan, patients pay a lump sum for monthly services and direct their own medical and therapeutic care. Member Support, a drop-in club offers self-help groups and social activities to Hutchings patients, but lacks an on-site staff.

"The result is our service is a better one," said Hutchings' Cheney, "because we have moved away from defining services toward regulations."

By default, the two medical centers have left only one large-scale clinical day treatment program in Onodaga. Located at St. Joseph's, the program carries a three-to four-week waiting list, serves 215 people and estimates a demand of 600, said Kelly DeVaul, St. Joseph;s director of inpatient care.

State budget cuts have forced Onondaga's adult case management services to lay off six mental health case managers between 1995 and 1996. Consequently, case management serves 70 fewer clients.

Since 1992, the state has gradually erased all state dollars for community residences - apartments and group homes that require state inspections, treatment plans and staff support. Instead, OMH has decided to give patients' money for renting apartments, also known as supported housing, which this year will include 700 new beds primarily in New York City.

However, Mary Lee Walawender, who supervises community residences for Transitional Living Services, said the state has failed the mentally ill in not requiring yearly state certification and a strong case management system for the supported housing. People end up renting substandard apartments in unsafe neighborhoods, she said. Walawender predicted that the development of unregulated housing will eventually lead to a new wave of mentally ill living on the streets.

"We're reinventing the wheel," she said.

Care for the mentally ill was also undermined by the turnover of housing staff and case managers at non-profit community services. Not-for-profit mental health workers have not received a wage increase since 1991. This year, Pataki vetoed a section of the mental health budget that would have given mental health workers a 2.5 percent cost of living increase.

"It's very hard to keep good people," said Tina Cardwell, who supervises Central New York services' two community residences for mental health patients with substance abuse problems. "You can work for Builder's Square and make more money than you do here."

Hospital officials said that they see the effects of state cutbacks and shorter hospital stays in an accelerated return rate for inpatients. Last year, 41 percent of St. Joseph's 878 psychiatric patients were repeat visitors, DeVaul said.

"I think people leave the hospital more ill without the same care or transition period. They would have a pass to go out during the day. We no longer do that.

"We have to depend on community resources that have decreased."

In a pay-by-the month hotel room, Navy veteran D. Carello flushed his rusted toilet by pouring water in to the bowl. A brown Zyprexa vial and two other bottles laid by the Bible on his dresser, but Carello refused to take any of his pills. The medications made him sick, he said.

Released from jail in May, Carello -- a manic depressive -- wanted to enroll in an outpatient psychiatric program and find some decent housing. He had been incarcerated eight months for walking out on the 26th day of a 28-day drug rehabilitation program.

Carello cried to himself in jail and, on at least one occasion, was visited by the county's mental health workers. The County Mental Health Department said that it treats, on average, 39 percent of the Onondaga Justice Center's yearly jail population.

Twenty four percent of OMH's statewide inpatient population has spent time in the criminal justice system.

Before going to jail, Carello lived for five years in the streets, snorting cocaine and rummaging for food in garbage cans. He had even completed one drug treatment program and relapsed.

"I had psychiatric problems and I couldn't get them under control. I couldn't sleep," Carello said. "Cocaine was doing more for me than the psychotropic medicine."

But within a month and a half of leaving jail this May, Carello stopped taking his medications and lost interest in finding an apartment.

He did not expect great deal from his social worker, Onodaga intensive case manager David Heinemann, who usually visited him once a week. Carello described Hinman as "rushed" and always having to leave for his next appointment.

Carello mistrusted everyone.

"I'm not getting anywhere," he said.

Hinman, however, had to juggle 12 other clients. His organization, Onodaga Case Management, assists clients in gaining access to basic services and held a 90-person waiting list this summer, said agency director Deborah Donahue.

Nonetheless, Carello remained ambivalent toward any help. He said he would rather survive far away from everyone.

Sometime during the summer, Carello started drinking heavily. It helped calm him and kept him around people, he said.

When he threatened his friend Arthur in mid-August, Carello checked himself into a Syracuse hospital and was then committed to the Canandaigua Veterans Center. He has been hospitalized at Canadaigua for the last three months.

"I can't keep doing what I've been doing all my life," he said in November. "I'm here on this earth for a purpose."

When Daniel Kelley awoke, a rubber tube dangled from his groin and another sent fluid to his nose. He could not remember swallowing the 41 Depakote pills or when the doctors pumped his stomach, but he knew he wanted to screamed.

It was January, and Kelley, a month out of prison, had tried to kill himself.

Since the 1980s, Kelley has attended various inpatient and outpatient Hutchings Psychiatric Center programs. Kelley's relationship with Hutchings has endured three prison sentences: the first from 1991 to 1993 for lighting an apartment on fire; the second, a six month term in 1997 for violating his parole with a trip to Florida, an assassination threat and a refusal to pay rent at his group home.

Even when Kelley moved to Oswego County in April, he chose to continue therapy at Hutchings Oneida Street Clinic, although he could only afford to visit every two weeks. His therapist, David Donigan, who has a roster of 50 clients, said he always had time for Kelley.

In mid-June, three months after his second suicide attempt this year, Kelley felt depressed and wanted to talk to someone. Despite not having an appointment, he traveled from Fulton to Hutchings, but a busy schedule prevented Donigan from sitting down with him.

Instead, Kelley agreed to drink coffee and eat donuts with other patients and two staff members. He said he felt better after talking with the other people and left.

Before 1995, Kelley could drop in on his old Hutchings therapist, Linda Moore, with greater freedom.

"She would spend more time with me because she did not have many patients," Kelley said.

But over the last three years, Hutchings has lost 159 employees, 93 of whom worked in outpatient services.

"There are fewer staff around to do the same amount of work," said Ann Staniec, supervisor of Hutchings' rehabilitation services, "so you have to change the way you do business. Sometimes a different way is less one-on-one and more group care. Another way is providing less services."

Susan Seamon, a Hutchings substance abuse and rehabilitation counselor, said she now devotes less time to individual clients. When patients show up without an appointment, she is sometimes forced to turn them away. Saddled with a caseload that has increased for 25 to 35 over the last two years, Seamon said she no longer has the flexibility to adapt to unexpected client behavior.

"Some show up at 4 p.m. Wednesday for a 10 a.m. appointment on Tuesday, "she said. Their time is not our time.

"They have the time of the mentally ill."

Copyright 1998, used with permission from The Daily Orange.