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Harrisburg State Hospital Closing
Proposed Closing of Harrisburg State Hospital
Testimony 1-28-05
James Jordan, Executive Director
NAMI Pennsylvania
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here for Print Version
MISSION
NAMI Pennsylvania (The National Alliance for the Mentally Ill)
is a grass roots organization that advocates for persons with mental
illness and their families. We believe, based on scientific study,
that mental illnesses are a biological brain disorder. They are
diseases and like other diseases, treatment works. We work to educate
people in our communities so that they will understand and recognize
mental illness as a disease and separate the disease from the person.
We work to help people understand that they cannot know or interact
with the person based on their perception of the disease. Just as
we do not identify or stigmatize a person by relating to them as
“a cancer person or a diabetes person”, we should not
define a person by the label of their mental illness.
STIGMA
We believe that public dialogue on the proposed closing is a positive
activity and that better understanding and better decisions based
on community needs can be achieved. However, it is painful for families
and consumers to hear some of the comments that are being made regarding
the proposed closing of Harrisburg State Hospital. To that end it
is important that people understand that residents at Harrisburg
State Hospital are citizens, human beings who have diseases that
are being treated. They have done nothing “Bad” and
this is not a forensic unit. They are our neighbors, our co-workers,
people we interact with in our places of worship. They are our children,
spouses siblings and friends. They are not being unleashed on the
community. They are important members of our communities and they
have every right to a peaceful productive place in our communities.
Many will require support and special services as do persons with
other diseases and health problems. But all should be treated with
respect. We encourage community members to contact NAMI, the state
OMHSAS and other advocacy organizations like The Mental Health Association,
The Pennsylvania Psychiatric Society and the Pennsylvania Mental
Health Consumers Association, to learn about mental illness.
HISTORY
In the past, many people with a mental illness lived without hope.
We have benefited from advancements in treatment and in the use
and development of new medications. Consequently, many people with
a mental illness are able to lead productive lives, to work and
raise families. We support any activity that will help to continue
improvement in the quality of the lives of those who have a mental
illness. We view the proposed closing as an opportunity to significantly
improve our system of care in this part of the state.
Statement of Commitment
It is natural, whether you have a mental illness or are “normal”,
when your care is dependent on others, to have fear because of uncertainty
of how the quality of your life will be affected by proposed changes.
The state has promised that no person will be moved to an inadequate
placement and that they will work directly with families and consumers
to ensure that placement have the support and access to services
and that placements will be in safe environments. NAMI Pennsylvania
commits itself to working to ensure that these promises are honored.
WE SUPPORT THE CONCEPT OF COMMUNITY PLACEMENT. NAMI Pennsylvania
WILL SUPPORT THE PROPOSED CLOSING OF HARRISBURG STATE HOSPITAL.
BUT WE MUST BE ASSURED THAT THE SYSTEM THAT WILL REPLACE THE HOSPITAL
WILL BE BETTER THAN THAT CURRENTLY PROVIDED.
Our issues have to do with process, time frames and funding. We
applaud the State for it’s commitment to improve the quality
of life for our family members and we make a commitment to work
with the State to help insure that planning and implementation meet
the needs of consumers and family members. We would also like to
express our appreciation to the clinical, direct care and administrative
staff at Harrisburg State Hospital. Thank you for the care you continue
to provide to our family members. It is our sincere hope that opportunities
to capture your experience and expertise in community settings will
be possible.
The following discussion outlines our concerns and makes recommendations
to address these concerns. It is important for us, as advocates,
to ask these questions to insure that our members concerns are given
adequate consideration.
Time Frame
The proposed time frames for implementation are not realistic.
• We do not believe that adequate services can be put in place
with the time frame outlined by the state. Development and expansion
of services in communities will require financial information and
the completion of consumer, clinical and family assessments. The
county’s internal process for developing services in response
to available funds and information provided by the assessments must
be considered. In addition, once the RFP process is completed, services
must be developed, city and county codes must be addressed and regional
services must be developed and coordinated.
• We believe that the current community system has serious
program gaps. An assessment of services currently provided is needed.
It is important to know if available services are meeting needs.
This question must be answered before we can address the request
for increased demands within the service area.
• We believe that it will take at least two to three years
to design and implement a system that will meet the needs of consumers
in this area.
• Families and consumers must be given an answer to the question
what happens if placement is not completed by 2005 December 31.
• The current stated goal is to place 135 consumers into communities
in less than nine months. Using Dauphin County as an example, a
successful placement currently takes one year. It takes longer to
actually develop new housing. Dauphin County is expected to place
40 people in the community during this time period. We do not believe
a broad range of placement options and support can be developed
in a six to nine month period. We also think considerable work is
needed to prepare the community so that consumers are welcomed and
supported.
• Families play an intricate role as treatment team member.
In many situations families provide the safety net for many of the
consumers who are placed in the community.
• The plan calls for approximately one hundred consumers
to be moved either to Danville or Wernersville state hospital. Some
families will need assistance to meet with their loved ones. These
arrangements should be in place before consumers are moved to either
hospital.
FINANCIAL ISSUES
Critical to the success of this initiative is funding. We believe
that development of a new system while operating an existing system
will require additional funding. This additional funding will help
to preclude the rush to close buildings prior to the availability
of services. The following questions should be answered in the Governor’s
proposed budget:
• How will this initiative be funded?
• Will the total amount budgeted for Harrisburg State Hospital
be dedicated to services and support for consumers in the HSH service
area?
• Will funds that are transferred to Danville or Wernersville
State Hospitals follow consumers when they move to the community?
• What funding will be provided to address the new admissions
and waiting lists?
• What are the plans for handling revenues generated from
new use of the hospital building and grounds? We strongly recommend
that all funds generated from the sale or rental of HSH be dedicated
to provide services for persons with mental illness in the area
being served by the hospital.
• A long term viable system will need legislative support.
What efforts exist to secure legislative support?
• Support for programs in future years will be needed. What
are the plans and thinking on this issue. Again, legislative support
will be needed to insure continuation of these programs.
SERVICE AND PROGRAM ISSUES
• There is a need for acute care beds in the community. Contracts
must be developed by the state with private hospitals to insure
that beds will be available. This will help to stop a trend of closing
these units in favor of more profitable lines of service.
• There is a need for longer term care in a community setting.
The need is for care up to two years to be provided. This service
does not exist currently in communities. We believe that it should
be a regionally based program.
• Special attention must be given to aging consumers. There
are approximately 50 elderly consumers who have additional special
needs.
• Currently HSH has a waiting list that is approximately six
weeks. The admission rate is four to six persons per week. What
are the plans to handle the waiting list and the admissions?
• As of 1-27-05 there are twelve consumers in Dauphin County
jail who could be released to the community if housing were available.
How will this issue be addressed? What impact will placement have
on the County jail population?
• A mental health court should be established to help ensure
that persons placed in the community are diverted to treatment and
do not end up in jail for non violent crimes. The services of Mental
Health courts are dependent upon a strong community system for which
persons can be placed. Model Assertive Community Treatment programs
should be established to help the transition of these persons into
the community.
• Training for members of the criminal justice system including
police officers, deputy sheriffs and district justices is needed
to help insure appropriate treatment for consumers. NAMI offers
several programs on co-occurring disorders, stigma and mental illness
and community reintegration issues.
• Families need education to be supportive and effective members
of treatment teams. NAMI’s Family To Family 12 week program
should be offered on a voluntary basis to families at each of the
state hospitals twice a year.
• NAMI along with other organizations provide excellent training
for consumers to help prepare them to reenter communities. These
programs should be offered to all consumers as part of the reintegration
into communities’ process.
• Safe adequate housing must be developed. It is important
to families that proper development of housing options meet code
requirements and that family members not be placed in Personal Care
Homes (under existing PCH regulations). These are not acceptable
residential facilities.
• It is imperative that a cost shift not occur so that the
burden for acute psychiatric care be placed on community hospital
emergency rooms. Generally, emergency rooms are not the best place
for acute psychiatric care. This is an unfair burden on hospitals.
It also reduces much needed emergency care within the communities.
PROCESS
Counties, mental health advocates, state hospital staff members
and staff from OMHSAS have worked to develop five year plans which
were intended to address the community needs in various service
areas throughout the state. This plan was set aside in the Harrisburg
State Hospital area with virtually no notice or consultation. NAMI
PA members in other service areas are concerned that they may be
engaged in planning activities that may be set aside. Our members
question if they too may be faced with similar unilateral decisions
regarding the hospitals and services in their areas.
Some of our family members have voiced concern because of the sudden
announcement made in the news release regarding decisions that were
made that will have a major impact on their loved ones. If families
are included in planning, better communications reducing fear and
uncertainty may be possible. We seek a true partnership where surprises
and decisions made without consultation are replaced with consultation
and joint planning.
Expression of these concerns should not be interpreted as a retreat
from our commitment to optimum care and treatment and maximizing
opportunities for full and productive lives for our family members.
Nor should it be taken as a signal of a lack of support and willingness
to work with OMHSAS. Rather, it is a statement of our firm commitment
to the concept of community access and placement and our insistence
on being a part of the decisions at each point that have an impact
on the lives of our family members. It is also a statement of our
insistence that this initiative be done correctly. From our perspective
that means a well integrated plan, adequate funding, and service
and program support developed in communities where our family members
will live.
In a spirit of cooperation, we encourage the state to work to understand
and accept our thoughts and commitment to partnership. Although
we will probably not agree on all issues, we are committed to working
in the best interest of our family members and we believe that the
state has the same commitment. It is a formula for success.
RECOMMENDATIONS
The following are a list of recommendations we believe will help
the state in its efforts to successfully close Harrisburg State
Hospital.
.
• OMHSAS must maintain a strong coordinating and oversight
role in the new systems that are developed.
• OMHSAS must work with counties to assure that a living wage
is paid to direct care workers. The impact of this one action will
have a major discernable impact on continuity and quality of care
provided in communities.
• OMHSAS should build standards statewide which provide guidelines
for minimum standards of equal care throughout the Commonwealth.
• OMHSAS should build uniform standards for access to medications
to insure continuity of care. Formularies at MCO’s should
be standardized so that even levels of care throughout the state
are available.
• OMHSAS should include in all contracts for either acute
or longer term care the insistence that state standards and practices
for the use of seclusion and restraints be employed.
• OMHSAS should partner with counties and advocates to educate
communities regarding the rights of persons with mental illness.
They should also educate the community regarding the benefits of
including persons with mental illness in their communities.
• Many state workers have developed expertise in caring for
persons with mental illness. Special efforts must be made to create
opportunities to work in communities without the loss of benefits
earned in the state.
• A system to track all persons moved from HSH should be implemented
as transfers are made. An annual report regarding the outcome of
these transfers should be presented to consumers and family members.
• We are requesting that an individualize plan be developed
to meet specific needs of each consumer at HSH. The plan should
include treatment continuity and recovery at its core.
• Geriatric consumers present a special challenge. A move
for any person can be traumatic. The impact is even greater for
aging persons. Special care must be given to minimize fear and uncertainty
to help ensure the move will be successfully completed.
• Access to treatment and access to psychiatrist must be maintained
at the same level that is currently available at HSH. We believe
there is a severe shortage of community psychiatric care in this
area.
• The state plan should insure that medications available
in the state hospitals are continued in the community settings.
• The promise by OMHSAS of transportation assistance for families
in need if they must travel to Danville or Wernersville State Hospitals
must be kept.
• Transportation for consumers may be needed to facilitate
access to services in each county.
• Many families will provide a home where their loved ones
will live. They will also spend countless hours driving and providing
other forms of support. In the cases where living arrangements are
provided, we recommend that respite care support is developed and
case management services be provided. We also recommend that some
financial remuneration be offered to assist these families. Excellent
models of family support exist for the MR community. These models
should serve as guides for the mental health community.
• Training and employment must be provided for all who are
eligible and able to work.
We appreciate the opportunity to express both our support and concerns
and we look forward to a system that provides a higher level of
care and support.
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