On Monday, the state of Illinois plans to stop accepting new admissions to the Singer Mental Health Center. The Rockford facility is one of several closures planned by the governor’s office as part of a cost-cutting move. WNIJ’s Mike Moen reports on what’s being done to help the community transition to a new mental health care system.
To say that local providers are scrambling might be an under-statement. With the writing on the wall that Singer would be closing, officials began formulating plans on how best to serve patients who would otherwise rely on the facility. The deadline is fast approaching, and people like Phil Eaton are working feverishly to make sure there’s a safety net in place when Singer shuts its doors October 31st.
Eaton is CEO of the Rosecrance Health Network, a non-profit that specializes in substance abuse treatment. Rosecrance recently developed a mental health division, and is at the center of plans to ensure that local residents have a place to turn to in the event of a psychiatric crisis.
“The two major foundational pieces of the next steps, one is a community crisis triage center. And the other piece is connected to that. [It] would be a more robust system of crisis residential beds” Eaton said.
The triage center will be located in downtown Rockford. Rosecrance is renovating office space to be used for patient care. Eaton says it will not be your typical setting.
“One of the goals is to establish a more comfortable, accepting environment that someone can stabilize in. And that will be part in parcel of our triage center” Eaton said.
The type of atmosphere Eaton is describing fits in with the state’s desire to focus more on community-based care. Officials in Springfield say that played a key role in their decision to close Singer, and that it’s not just about saving money.
In addition to getting the triage center up and running by next month, Eaton says they’re still trying to find a location for the extra crisis beds provided by his organization.
Rosecrance is one of nearly a dozen providers in northwest Illinois awarded smaller contracts by the state to replace the services offered by Singer.
Robin Garvey is with the Northern Illinois chapter of the National Alliance on Mental Illness. She’s there’s mixed feelings about the process and the deadline the local community is trying to meet.
“We wish that Singer would remain open a bit longer, just as a back-up, so that we have a little bit of time to transition from one system to another. In the absence of that, we don’t have very much time to find out if this is going to work as they think it will” Garvey said.
Garvey’s organization isn’t taking a stance on the closing of Singer. She says avoiding psychiatric hospitalization is always a good thing, because she says it can be traumatic for the person being admitted. But she says there’s lingering concern about the fact that once Singer closes, there won’t be a state facility within 45 minutes of the Rockford area for extreme cases.
“We are very concerned that there will be some people who will fall through the cracks in the absence of a place like Singer that will take people who are difficult to place. People whose illness has caused them to behave in ways that are difficult to manage in a community hospital setting” Garvey said.
Garvey says that means those in need of state psychiatric care will have to be transferred to state hospitals in Elgin or Chicago. With the closing of the Tinley Park hospital, advocates say that creates concerns about the availability of beds. There are also concerns that given its history of falling behind on payments, the state will be slow in providing funding under the new contracts.
A spokeswoman for the Illinois Department of Human Services confirms that court-ordered patients will have to be sent out of the area. But she stresses that the overall level of care in the community will improve, with the goal of creating less dependency on institutional-based care.
In other parts of the region, preparations are being made to move on without Singer. In Rock Island, there’s the Robert Young Center for Mental Health, which is part of a larger health system. Dave Deopere is the center’s director. He says they received extra funding to beef up crisis intervention services in their emergency department. Deopere says while they’ve become less-reliant on Singer, they are looking forward to getting extra resources.
“We only sent 26 [patients} last year. However, those 26 patients were very combative in exacerbating an environment in our psychiatric unit that can be extremely disruptive” Deopere said.
As for the Rockford-area, Rosecrance officials say they plan to have their expanded services up and running by next month’s deadline. But they say the real test will come over the next 6 to 12 months, when they can get a sense of what’s working, and what isn’t working under the new system.
This information was provided by the Illinois Department of Human Services:
-Singer MHC has a budgeted capacity of 76 civil beds (FY 12), but due to staff shortages the facility has been forced to reduce the daily capacity to 45 in order to ensure patient safety and quality of care. The average length of stay at Singer is 25.16 days.
-The Department of Human Services has awarded contracts to area providers to ensure a comprehensive range of services are available to patients who would have been served by Singer. The Department has purchased 4,000 community-based hospital inpatient psychiatric services (CHIPs) bed days.These services will be in place in time for the Singer closure.
Hospital Providers for CHIPs
- Swedish American Hospital, Rockford
- Rockford Memorial Hospital Rockford
- OSF St. Elizabeth’s, Ottawa
- Trinity Medical Center, Moline
- Provena Mercy Center, Aurors
Awarded Mental Health Providers for Enhanced Crisis response (aka EDAs) and Acute Community Service Providers (ACS)
- Ben Gordon Center, DeKalb
- Bridgeway, Inc, Galesburg
- FHN- FCC, Freeport
- North Central Behavioral Health, LaSalle
- Robert Young Center, Rock Island
- Rosecrance, Rockford
- Sinnissippi Center Inc., Dixon
- Stepping Stones, Rockford - Awarded for special services
Legal concerns beyond Singer
Last year, Illinois earned a D grade in an independent assessment by The National Alliance on Mental Illness(NAMI). Although this grade is an improvement over the F received in 2006, the D came before the final closure of Tinley Park MHC, Singer MHC and Chester MHC in southwestern Illinois.
NAMI’s state rankings are based in part on the status of unresolved Olmstead Lawsuits. These lawsuits, which address issues related to state compliance with the Americans with Disabilities Act (ADA), originated with a landmark 1999 Supreme Court case that clarified exactly how states must comply with Title IIof the ADA.
“The Olmstead decision confirmed that states must ensure that Medicaid-eligible persons do not experience discrimination,” reported the Center for Personal AssistanceServices(PAS). Eligible patients need to be deinstitutionalized and moved into “a more integrated (community) setting.” However the Olmstead decision also said “states should make ‘reasonable accommodations’ to their long-term care systems.”
PAS lists Illinois as a state with a long history of unresolved Olmstead Lawsuits. This means that along with California and New York, Illinois’ lawsuits are more frequent and often go unresolved for much longer than similar cases in other states. Most of these lawsuits end up settled out of court after languishing in the legal system for years.
In 2010, an Illinois Olmstead Lawsuit, Williams v. Quinn, resulted in a federal judge approving a settlement which called for the creation of community-based homes for some 4,300 people with mental illnesses who were currently living in large nursing homes. The US Department of Justice filed a "statement of interest" in that lawsuit, and took similar action in two other Illinois cases.
In Ligas v. Maram, the Department agreed with disability groups suing the state for more community-based housing, and in Hampe v. Hamos, young people with severe disabilities over the age of 21 were granted special status, allowing them to retain state funding so they could live in their own homes, instead of being moved to nursing homes or hospitals.
The delicate balance between meeting the mental health needs of clients, from in-patient care to community-based programs, has prompted some observers to raise the question as Singer prepares to close: How will Illinois ensure that Singer patients eligible for community integration will be served by existing resources and that those requiring long-term care will receive the services that they need?
Meanwhile, at the national level, Illinois’ move toward community-based care reflects a long-term trend.
States are looking at ways to reduce the mental health services for people who reside in mental health centers. Additionally, they want to reduce the mental health services offered by public hospitals. This “deinstitutionalization” creates a gap in services that makes room for the next step in this trend —transinstitutionalization, the transfer of institutionalized populations to community-based programs.
Transinstitutionalization shifts boundaries and demographics to increase mental health care in the face of reduced inpatient mental health care facilities. Normally, this means that “other forms of care, such as social welfare, criminal justice, or nursing home care…and shelters” will take up the slack.
*Jane Denison-Furness contributed to the last section of this report.