Centre County residents feel ‘unintended consequences’ of a transitioning mental health system

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Mental Health on Centre

In Centre County, there has been a dramatic increase in “302” mental health warrants. In March 2019, 29-year-old State College resident Osaze Osagie was shot and killed while police officers attempted to serve one of those warrants, sparking controversy across the community. “Mental health on Centre,” an ongoing series from the Centre Daily Times, explores how the mental health system is helping or hurting community members.

After years of in-patient psychiatric treatment, 22-year-old State College resident Anya Lazarow says she’s more stable now than ever. Working at Good Day Cafe and living in a supportive setting, she’s able to manage and monitor her mental illness, but getting there didn’t happen overnight.

Accessing in-patient treatment for mental illness comes with a number of challenges. With only seven beds reserved for Centre County residents at a state hospital, those in need are met with lengthy waiting lists and — if a bed is secured — speedy treatment plans.

Eventually, the Lazarow family says they were able to “crack” the system, but navigating mental health resources came with a significant amount of effort, advocacy and — in the end — pure luck. Met with a “waiting list at every stage of the game,” Anya Lazarow’s father, Lewis Lazarow, said the system is not equipped to serve the significant number of people who need in-patient treatment. With Centre County taking a close look at its mental health system, officials say the system began to change after the deinstitutionalization of psychiatric patients which began in the 1950s and ‘60s.

While the effort to increase community-based care has allowed people like Anya to find a job and function in society, deinstitutionalization has made it harder to find in-patient treatment options. In 2017, Dominic Sisti, director of the Scattergood Program for Applied Ethics of Behavioral Health Care at the University of Pennsylvania told NPR that state hospitals thought individuals who were receiving psychiatric care “probably could do well in the community.” While the decision was “well-intended,” Sisti said that over time, there has been an evaporation of psychiatric therapeutic spaces. Because of this, there is now a lack of psychiatric beds.

Centre County is no exception to this trend, Michelle Henry, Centre County assistant administrator for mental health services, told the CDT in June. After the first state hospital closed in Philadelphia, others followed and Henry said this shift left a “very significant impact” on the mental health system.

“We have seen that in our tenure,” Henry told the CDT. “Those transitions, and it adds such an important piece to how we support individuals and the services that we provide. We move away from congregate settings and institutional to give people opportunities in the community.”

Still, residents have expressed concerns over the amount of individuals who need in-patient care in institutional settings, but are unable to access treatment due to red tape, waiting lists and a lack of availability — leaving some hopeless.

“There’s a lot of things that stand in the way of someone getting help,” said Lewis Lazarow.

One county, seven beds

The Lazarows moved to Centre County from New Jersey in July 2016 with the hope of securing care for Anya, who showed symptoms of mental illness at a young age, her father said.

Through blended case management services, they were able to schedule weekly appointments with a psychologist. In March 2017, her psychologist determined in-patient care was necessary.

If a Centre County resident needs in-patient psychiatric care, Mount Nittany Medical Center and The Meadows Psychiatric Center in Centre Hall are the first options to consider, Centre County Human Services Administrator Natalie Corman told the CDT. But at both facilities, beds are limited — 12 beds for psychiatric care at MNMC and 119 at The Meadows — and not reserved just for county residents.

Mount Nittany Medical Center has 12 beds for psychiatric care. Centre Daily Times, file

A 302 warrant can be issued for an involuntary commitment. Centre County has seen a 433% increase in 302 warrants from 2017-2018, according to a May report released by District Attorney Bernie Cantorna. According to Corman, the waitlist for long-term in-patient care can last as long as three months.

“When we were in the hospital in crisis, everybody agreed she really needed to go,” Lewis Lazarow said. “She needed to go somewhere. They didn’t have any beds at Mount Nittany.”

In an email, Corman said bed availability is determined by the county’s licensed treatment facilities.

“The length of stay can dictate the waiting list,” Corman wrote. “If it is immediate in-patient care, we can secure a bed within minutes to hours. For long-term in-patient care, the wait time can be up to three months for our state hospital. During that time, the individual is receiving treatment in hopes of improving their mental health and possibly work toward community based treatment.”

If extended in-patient treatment is deemed necessary and local options are unavailable, Danville State Hospital reserves seven beds — out of 161 — for Centre County residents, according to the county’s mental health resources services guide.

Anya Lazarow ended up at The Meadows, where she spent one month receiving in-patient treatment that consisted of group and one-on-one therapy sessions. She said she was able to monitor and manage her medication in a supportive environment.

After a month, she was transferred to a community residential rehabilitation program. On her first day at the CRR, Anya Lazarow met Osaze Osagie, the 29-year-old with a history of mental illness who was killed in a March police shooting in State College.

Supportive environments with quick transitions

CRRs are state-licensed programs for individuals who are diagnosed with schizophrenia, major mood disorder, psychotic disorder, schizoaffective disorder or borderline personality disorder, according to the county’s services guide. Centre County works with two CRR providers who provide a total of 27 beds for residential programs, Henry said in June.

While at the CRR, Anya Lazarow was able to learn skills that helped her better adjust to society in a supportive setting, but these residential programs have a time limit before residents have to transition elsewhere, she said.

Anya Lazarow packages a baked good for an order at Good Day Cafe on Aug. 8. Abby Drey adrey@centredaily.com

In an email, Corman said the average time to live in a CRR is two years.

“The wait list is based on priority, individual need and availability from the providers,” Corman wrote. “Some individuals can enter the program immediately while some could wait months, pending their need and choice on when to enter the program.”

But the timeline doesn’t work for everyone, Anya Lazarow said. When she first arrived, she said transitioning elsewhere was discussed “almost immediately.”

“On the one hand, it’s right for a place like the CRR to have a goal for your moving out,” Lewis Lazarow said. “That’s the right thing to do, but there is a level of pressure that really kind of is a two years maximum and no more than that.”

While Anya Lazarow said it is good to set goals over the course of treatment, she thinks those goals should not create additional pressure. Finances can also play a factor when an individual is considering transitioning elsewhere, she said. While someone may be ready to move, they might not have the funds to be able to afford other housing.

“In turn, it doesn’t allow people to move into the CRR, and there’s a huge waiting list,” Anya Lazarow said.

Now, Anya Lazarow lives with three others at the Fairweather Lodge, a residential program overseen by Strawberry Fields in State College, a resource that provides comprehensive services and support for people with disabilities. The organization also oversees Good Day Cafe, where she works.

“I don’t see myself moving out of the Fairweather Lodge anytime soon,” Anya Lazarow said, adding that there is no time limit on how long an individual can stay there.

Anya Lazarow laughs with coworkers as they dry silverware at Good Day Cafe on Aug. 8. Abby Drey adrey@centredaily.com

Anya and Lewis Lazarow said they were thankful to receive treatment, especially so close to home; however, they do not think luck is the best foundation for a system to be built on.

“It couldn’t have worked out any better, and I chalk that up a lot to luck and just being in the right place at the right time, which nobody should have to be in ... to get those services,” Lewis Lazarow said. “I fully admit we were fortunate to have it work out that way, but in an ideal form, that’s the way that it should work.”

Balancing state regulations and resident frustrations

Under the Mental Health Procedures Act of 1966, the county is obligated to offer specific mental illness treatment services. Kellie Wayda, director of Western Operations for the state’s Department of Human Services’ Office of Mental Health and Substance Abuse, said MHPA requires counties to provide short-term mental health in-patient, partial hospitalization, out-patient and 24/7 emergency treatment options.

Over the years, the county’s mental health office has added out-patient mental health providers, expanded its supportive housing services, enhanced its targeted case management programs and is moving forward with a 24-7 crisis assessment center, Corman said.

Although the MHPA helped create a baseline for services, Corman said its policies haven’t been updated to fit “current times and treatment development.” Because some of its wording is outdated, some individuals and families can experience problems when trying to receive treatment, especially those in crisis.

In a response to questions from a June community conversation on mental health, the county wrote that limited bed availability and long waiting lists are reflective of the readiness and volume of trained staff, demand for service, responding to health care billing demands, budgeting services to include time that is not reimbursed from funding sources, a variety of licenses and required training to maintain services.

Receiving between $3.7 million to 4 million in state funding, Corman said it is “critical” for the county to comply with regulations and policies in order to provide the services it currently offers. In addition, Centre County participates in block grant funding, which allows the human services office to be “flexible” in its spending and allocation of resources. Through the block grant program, Corman said her office was able to enhance its human resources services by putting more money towards select operations. Additional funding also helped create the crisis assessment center.

Kellie Wayda from the Pennsylvania Department of Human Services Offices of Mental Health and Substance Abuse Service speaks to the full room at the board of commissioners community conversation about mental health services in Centre County on June 27. Abby Drey adrey@centredaily.com

Although county officials think the current mental health system can provide adequate care — serving 888 individuals — the board of commissioners and human services staff agreed there is work to be done after hearing residents’ testimonies.

For Mina Yindra, of Boggs Township, the system is so dire that she views prison as the only means of her son receiving treatment and assuring his safety.

She moved her son, who’s diagnosed with schizophrenia, to Centre County in February. Yindra said she tried to seek long-term care for her son at Danville, but no beds were available. After he was charged with a misdemeanor for theft of services, she believes getting arrested is his best hope for long-term, in-patient treatment.

“If he gets arrested, at least he’s safe,” Yindra said.

Mina Yindra speaks about her concerns during the Centre County Board of Commissioners hosted community conversation about mental health services in Centre County on June 27. Abby Drey adrey@centredaily.com

Vernon Davis, of State College, told officials during the community conversation the commissioners held on mental health in June that psychiatric wards in state prisons should not be the main providers of in-patient treatment for mental illness.

“We have traded one for the other,” Davis said. “We have traded the incarceration for the mental health.”

While some have suggested reallocating funds from correctional institutions and using them to create more in-patient psychiatric treatment facilities, funding isn’t always the best solution, officials say.

“It’s easy to say, ‘Let’s just put money into a problem,’ ” Commissioner Steve Dershem said, following the community conversation. “I think we need to look at the best place that those dollars could be spent. We have to look at the needs of a variety of different areas and figure out where those dollars are best distributed. It’s going to be a challenge.”

But both Yindra and the Lazarows think the county must be innovative in its efforts to create new programs and find ways to implement change. Within the current system, Lewis Lazarow said Centre County is never going to be able to enhance its services at a rate that is sufficient enough to care for the high number of people who need it — with or without additional funds.

It must be a collaboration between officials at local, state and national levels, Lewis Lazarow said. While isolating mental illness to specific facilities might not be the best route, he thinks there must be a way to establish efficient, better-equipped resources for such a prominent issue.

“We need to be forwarding something that’s going to be able to address something that’s not random, isolated or a rare circumstance,” Lewis Lazarow said, describing the prevalence of mental illness in society. “And we are neglecting our society if we’re not coming up with those solutions.”

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Marley Parish reports on local government for the Centre Daily Times. She grew up in Slippery Rock and graduated from Allegheny College.