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New research shows depression leads reasons for mental health hospitalizations

Times-Tribune - 10/15/2019

Oct. 15--Pennsylvanians checked into hospitals for mental disorders at a rate of 312 a day last year, according to a research brief published last week.

In Northeast Pennsylvania, Luzerne County led with the greatest portion of its population hospitalized at a rate of 104.2 admissions per 10,000 residents, according to a brief by the Pennsylvania Health Care Cost Containment Council.

Compared to the rest of the state, Luzerne County had the 19th-highest rate and was notably higher than the state average of 88.8 admissions per 10,000 residents.

Lackawanna County was 30th with 93.6 admissions per 10,000 residents.

A hospital stay says that those patients need care beyond what they can get in less acute settings,

such as regular talk therapy sessions or drug regimens, said William Chase, Psy.D., a Keystone College psychology professor and director of the school's counseling center.

Depression was the leading cause for hospitalization in 44% of cases. Schizophrenia and bipolarity followed at about 20% each.

Patients stayed on average 12.3 days in psychiatric hospitals and 8.6 days in acute care hospitals.

While they might have spent more time in psychiatric hospitals, more than half of stays happened in acute care hospitals.

That just confirms what Moosic psychiatrist Dr. Matthew Berger already knows: The system to care for them, both private and public, is riddled with gaps.

It's common to find mental health patients waiting in an emergency room, he said.

"Which is clearly not an appropriate place for a psych patient who already might be depressed and anxious, and sitting in an ER is making them worse," he said.

They might wait up to several days to be admitted, he said, losing precious time amid what could be serious episodes in a place not adequately equipped to care for them.

"They're inundated with patients," he said of emergency rooms. "They just get crushed."

Northeast Pennsylvania could use 37 more psychiatrists who can prescribe medicine, as opposed to psychologists who use other forms of therapy, according to a 2014 study commissioned by what is now the Geisinger Commonwealth School of Medicine and the Luzerne Foundation.

That region includes Lackawanna, Luzerne, Monroe, Schuylkill, Susquehanna, Wayne and Wyoming counties.

The service gaps were not consistent county to county. At the low end, Lackawanna County lacked only one psychiatrist to adequately care for its population, while Luzerne and Monroe counties were short 13 doctors each, the study found.

The new data comes as Gov. Tom Wolf's administration looks to dramatically change how the state manages mental health care.

In August, the human services department announced it would close the White Haven State Center in Luzerne County and Polk State Center in Venango County over the next three years.

The campuses care for some of the most complicated mental illness cases that require extensive care.

The news triggered outrage among people who worry about what will happen to loved ones living there. Lawmakers reacted by proposing legislation that would block the closures.

The state Human Services Department argued that community-based care puts patients closer to their families and that patients reported a better quality of life.

History says breaking down institutions leads to problems in other areas, Chase said.

"You would see spikes in things like homelessness," he said. "In many cases, you're dumping individuals out into a system where there isn't necessarily a well-established set of alternative treatments."

Berger suspects readmission rates are also surprisingly high because insurance companies limit the time a patient can stay in an acute setting, meaning they get discharged without locking in a sustainable, long-term treatment plan, he said.

He also laments that there is an antiquated government framework that isn't proactive in helping people find stability in their illnesses.

Pennsylvania's regulations around mental health are dramatically outdated, he said, and involuntary commitment laws, unchanged for decades, don't kick in until a patient is in crisis.

"We need to look at some way of doing more preventative medicine rather than reacting to the crisis," he said.

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