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Step by Step Director David Bayne, and Carla Nunez. Photo: Julie Grant
Step by Step Director David Bayne, and Carla Nunez. Photo: Julie Grant

What NY reform means for Ogdensburg mental health care

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Advocates for people with mental illness in rural New York are concerned about the changes announced recently by the state. The New York State Office of Mental Health plans to close 65 inpatient beds at the St. Lawrence Psychiatric Center in Ogdensburg.

North Country residents who need long-term hospitalization could be sent to Syracuse or Utica for care, to what the state is calling "Regional Centers of Excellence."

The Office of Mental Health says the state will provide more money for outpatient services in the North Country.

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Reported by

Julie Grant
Reporter and Producer

You might never have noticed Ford Street in downtown Ogdensburg before, but it's a little intimidating. There are lots of tired-looking people just hanging around. Some are sitting at a picnic table outside, smoking. Inside is Step by Step, a drop-in center for people with mental illness. It's in a strip mall, and looks like a furniture store, there are so many couches and comfy-looking chairs. Except no store has this many people just sitting around – sleeping, knitting, or watching The Price is Right.

Executive Director David Bayne says the drop-in center is a place where people can relax, and be themselves.

"There's no mandated programming here. There's no mandates. Some people might come for five minutes, some people might stay all day."

Bayne grew up in the North Country, and was part of starting Step by Step in the 1990s. He says at that time, the state was moving people out of the mental health hospitals, and into new outpatient services.

With his long blond hair and army shorts, Bayne looks casual. But after twenty years, he's serious about the center's work.

"It's kind of self-help model. We don't have any clinicians; we don't have any social workers. What we share is what we've gone through ourselves, and we help people understand that recovery is possible."

Bayne says the drop-in center offers life skills training, computers, even Wii. It also serves free meals twice a week.

As he's talking, an angry-looking middle aged woman beelines toward Bayne.

"I'm going crazy, Dave. I swear, I want to sign myself into the hospital," she says.

"Okay. But we're not going to do that today," Bayne replies.

Her face softens.

Carla Nunez is 48. She's turned into a completely different person than the one who walked up here a minute ago. She's friendly and charming.

Nunez came from the tropics to Brooklyn with her family as a teenager. Soon after she was diagnosed with schizophrenia. She's been in and out of mental health hospitals ever since.

Nunez proudly says she's been living on the outside for three years. But there are moments, like today, when she wants to go back.

"Because some days I hear other voices. Not as much as I used to. They attack me, and they go away and they come back and they attack me. And I drill sergeant them in my mind, I say 'Get out of my head.'"

People like Nunez gravitate toward Ogdensburg. It's a small town and relatively easy place to make a life. For those with long-term mental illness, there are places to live, programs like Step by Step, and specialists to help with medications and psychiatry.

People relax and watch The Price is Right at the Step by Step drop-in center in Ogdensburg. Photo: Julie Grant
People relax and watch The Price is Right at the Step by Step drop-in center in Ogdensburg. Photo: Julie Grant
Dave Bayne says the inpatient beds at the St. Lawrence Psychiatric Center play an important role in that continuum of care.

"If folks have a little bit of a psychotic break, or need a little bit of help, or have some anxiety, or depression, they can go in and get a short stay, and then they can go right back to home, or wherever they're living, or back to their life."

Bayne is worried that things won't work as well if the state follows through on plans to close the beds at the St. Lawrence Psych Center.

Ogdensburg would still have some inpatient services for the mentally ill. Claxton Hepburn Medical Center has a short-term inpatient clinic. Director Kim McKnight says their 28 beds will not be enough.

"I believe there probably is going to be more patients coming to the emergency room, more need for beds in our community."

McKnight is concerned about sending people who need long-term mental health care to Syracuse or Utica.

"It's going to be difficult for the patients that we serve, the families that we serve, because it will be hours away from here. Many of the people with persistent mental illness do not have a lot of rich resources. They're not going to be able to travel to see their families, or have the money to do that."

The state is aware of this concern. Kirsten Woodlock in the Acting Commissioner for Mental Health, and led the state's reform plan. She says New York will start what's called a concierge program for families of people in faraway mental health hospitals.

"The point of labeling that a concierge service was to say we need to have a whole part of our line of business that tries to engage families. We have to find a better way, just like the cancer treatment centers and the trauma care centers, whether that be dedicating particular social workers at our Regional Centers of Excellence that reach out and help families make travel arrangements, perhaps actually defray travel expenses, be able to provide a hospitality house for people to stay if they travel in."

Woodlock says the state also plans to redistribute some of the money it saves on inpatient beds toward outpatient services more widely throughout the North Country.

"Having them mostly located in Ogdensburg, doesn't address the needs of people who might be from Tupper Lake, or might be from Massena, or might be from Plattsburgh, or might be from the Keene Valley. Part of why the changes at the St. Lawrence Psych Center really begin in 2015, is to give us a chance to design what that structure should look like in the communities."

At the Step by Step center in Ogdensburg, director Dave Bayne says there could be a real benefit to trading some inpatient beds for better outpatient services. But he's leery. He remembers similar promises in the 1990s, when the state transitioned people out of mental health hospitals into outpatient programs, including his drop-in center.

"And shortly a few years into the project, money started to dwindle away, the promise kind of wasn't fulfilled. A few hospitals were closed. But community programs never saw the funding that was related to those closures."

That's the same concern that keeps the leader of the state's mental health office up at night. Within weeks of announcing the state's plan, Kirsten Woodlock resigned her position as Acting Commissioner, for personal reasons. Now she says one of her biggest worries about the reform plan is that the state won't be able to follow through.

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