Continuing day treatment and its enemies

State OMH is trying to close day centers down


The intelligentsia in the state Office of Mental Health want to do away with continuing day treatment programs and they're cutting back those budgets, but their thinking is wrong. John Allen, a division director who's supposed to look after consumer/survivor's interests for the state office, called them “smoking and rocking clubs.” That's calumny. I've been there and they don't do that and it's most disrespectful.

The day treatment center we have in Schenectady run by Ellis Hospital offers shelter, comfort and structure, one of the few places in town that welcome people coming out of a tailspin with their mental illness.

It's mistaken for the state OMH to change the rate structure and billing procedure and thereby emasculate the continuing treatment programs that have sustained our mentally ill relatives in the community for at least the past 15 years. The state office looked for a place to cut money from, got the recovery minded fundamentalists on its side, and went in with the knife.

Continuing day treatment is a licensed, authorized program of the state Office of Mental Health to give people just out of hospital or in outpatient status some structure to go about their lives with. They have hourly instruction and group therapy discussions led by social workers, They take two meals there, have help with transportation, get access to clinical services from Ellis next door. It's for people who may not be able to survive on their own without a maintenance dose of support to help them negotiate the world outside.

The bullies at OMH sweetened the pie last fall for rebellious doctors and social workers at the mental health clinics who complained loudly about their poor pay and low Medicaid and insurance rates. The clinicians got what they wanted at the expense of the day treatment folks and they made off with higher billing rates and better pay scales, as far as I can estimate.

Meanwhile, Rich Angehr, Ellis's day treatment manager, has to worry. He said the state tightened billing rates, in one respect by restructuring things—no longer letting them charge half a day for two hours' time with a client; and a full day for three hours. As a result the agency may have to take in fewer clients and cut back their hours. It could lead to layoffs if the state cuts deep enough, he pointed out.

Many clients in continuing day treatment are right out of hospital inpatient psychiatry where they went because they couldn't cope with life outside at that moment. Some of these illnesses are heavier than we can imagine, like schizophrenia. There are those with depressions so intense they're panicky, can't sleep, feel awful and have thoughts of killing themselves. So what are the state gurus up to?

Lest we forget—people who live with schizophrenia and bipolar disorder can get through life most of the time with medicine that works and community supports. Now and then, they relapse, they go back in the hospital, at their worst they don't know who they are or what they're about. How would you like to lose your identity, to wonder who you are, to know that you're not right mentally but you have to survive it all.

The hospital turns you out in a few days, gives you a ticket to see a counselor at the mental health clinic and they set you up with continuing day treatment. You find friends and people going through the same trauma and you're all working to come out of the fog. You go there three days a week typically, a few hours a day, you listen to what's going on in the groups that will help with practical situations like handling money, using the bus, getting along with people, staying off drugs, coping with trauma.

Commissioner Michael Hogan is equivocal about continuing treatment, not willing to close it down but ready to accept it doesn't fit in with the modern model. Hogan writes:“reductions in the reimbursement rate paid to providers of continuing day treatment programs will help balance the budget. While these don't mandate reductions in capacity, OMH will work with providers that wish to transition to more sustainable program models. We do not seek to dramatically reduce capacity for this program which is a dated model that, nonetheless, provides essential supervision in some communities.”

That means the future of the day treatment business is in trouble. Hogan and others want to replace it with something called PROS—personalized recovery oriented services—that flopped when proposed a few years ago. It has a short term, self help and peer oriented outlook, pulling various staff together. The idea is to handle people quickly and get them out the door. But that's where it fails to recognize reality.

Others in the reform camp talk of the desirability of “rehabilitative services to assist people in managing their own illnesses and restore functioning across a range of life domains, including independent living social and cognitive skills. More use should be made of capitation payments, case rates and other models where providers are charged with responsibility for the whole person or for all of his or her mental health care, writes the Bazelon Center in an issues paper.

Those drab-interior day treatment centers sure don't fit this vision of patients suddenly getting up out of their rocking chairs and gliding swiftly back to society. (Roy Neville)