The metro-east soon will have fewer beds available for people suffering a mental health crisis, even as advocates say they need more inpatient beds for mentally ill patients in Madison and St. Clair counties.
In 2013, St. Elizabeth’s Hospital and Touchette Regional Hospital joined forces with Southern Illinois Healthcare Foundation to build a new 30-bed behavioral health services center. It is intended to expand Touchette’s ability to help mentally ill patients who arrive in the emergency room with a need for inpatient treatment. Currently, Touchette has 12 beds available for mental health services, so the new facility will more than double Touchette’s capability.
But overall, it appears to forecast a decrease in the total number of beds available for mental health treatment in the metro-east. At the moment, there are 35 beds at St. Elizabeth’s, 12 beds at Touchette, 100 beds at Gateway Regional Medical Center in Granite City and 20 beds at Alton Memorial Hospital. That’s a total of 167 beds in the metro-east.
But St. Elizabeth’s plans to close its ward when Touchette opens the new one. That’s a loss of 35 beds in St. Clair County, which also lost 39 beds when Kenneth Hall Regional Hospital closed in East St. Louis. Once St. Elizabeth’s closes and Touchette opens its new ward, there will be a total of 150 beds in the metro-east, or an overall loss of 17 beds.
The state approved applications for the new mental health facility in 2013, and St. Elizabeth’s is guaranteeing the $10 million construction loan for the new unit, which is located on the Touchette campus.
“The priority is providing quality care to our region, and the opening of the Regional Mental Health Center is the next step toward delivering this care,” read a statement from St. Elizabeth’s officials. “It is a new standard for community partnerships between health care entities while benefiting the region’s growing mental health needs.”
But the number of mental health beds is not sufficient, according to Jessica Gruneich, executive director of NAMI of Southwestern Illinois, the local chapter of the National Alliance on Mental Illness. Her brother suffers from a mental illness, and on more than one occasion he has been in an emergency room with no space for him to be admitted for treatment, she said.
“We’re talking about people’s lives on the line,” Gruneich said. “No one is an expert until it hits you and your family. You have this medical problem, and you believe you can get medical treatment for it, and you have no idea about the lack of community support until it hits you.”
Often the patient is sent away, to hospitals as far away as Chicago or even out of state. That can be difficult for families, separating the patient from their local support system. It’s a problem that exists across the region, advocates say — patients from Chicago are just as routinely sent down to the metro-east when their facilities are full.
“Mental illnesses are chronic, medical conditions just like diabetes,” Gruneich said. “It’s hard for us in the mental health advocacy community to communicate this: people think it’s a choice. There’s a lack of understanding about how these illnesses affect people. That’s why we have to fight for more education so more people can get the treatment they need.”
Jennifer Roth, executive director of the Madison County Mental Health Board, said of the six hospitals in Madison County, some do not have any inpatient psychiatric beds, some have limitations on their psychiatric services and some have no mental health facilities at all:
▪ St. Anthony’s in Alton and Anderson Hospital in Maryville have no psychiatric services.
▪ St. Clare’s Hospital in Alton has an outpatient service providing therapy and evaluation, as well as an adult day service for senior citizens with dementia and younger people with brain injuries.
▪ Alton Memorial’s 20 inpatient beds are designated solely for senior citizens.
▪ St. Joseph’s Hospital in Highland has no inpatient beds, but offers some outpatient therapy.
▪ Chestnut Health Systems has a crisis program for 16 people limited at a two-week stay, which cannot be accessed by anyone who tests positive for drugs.
“Whether there are sufficient beds in this county — region, if you include St. Clair County and the surrounding rural areas — I would definitely say no,” Roth said. “Lack of community psychiatric beds is a continuing problem even with the growth we have had in the past year at Gateway.”
Gateway Regional Medical Center has the largest ward in the metro-east by far with 100 beds. Of those, 18 are designated for children, 18 for adolescents, 18 for adult females, 23 for adult males and the remainder for older adults. About 40 percent of Gateway’s mental-health patients come from the emergency room, and the rest are transferred in from other hospitals sending their overflow to the metro-east, according to Gateway spokesman Erin Echelmeyer.
In fact, more than 20 percent of Gateway’s emergency-room admissions are mental health patients, Echelmeyer said.
“There are many, many issues plaguing the mental health system that leads to a high ER utilization… and most of our local ERs are not equipped to handle someone with a serious mental illness,” Roth said.
Sulbrena Day, vice president of Touchette ancillary services, said the community needs assessment completed in advance of Touchette’s application to the state in 2013 highlighted mental disorders as one of the most common causes of disability in the area.
“Mental illness is on the rise, and we see it as a top priority for this region,” she said. “It touches every population, every level, every socioeconomic status.”
Touchette’s assessment estimated that while state and federal rates of serious psychological distress occur in about 3.3 percent of the general population each year, the rate in Touchette’s service area was 5.1 percent, or 2,925 people per year. Their service area includes much of St. Clair County, including East St. Louis.
Roth said prior to a recent increase in beds at Gateway Regional Medical Center, it was common for a person with a serious mental illness to wait in an emergency room for up to 48 hours or more waiting for a bed to open up somewhere in the state.
“This doesn’t even take into account the number of folks with a serious mental illness who are in jail,” Roth said.
Jails often keep someone who is a danger to himself or others in protective custody, sometimes up to 48 hours while searching for an inpatient space, she said. “The jails do the best they can, but they are not designed or intended to be mental health centers,” Roth said.
One-third of those living with mental illness end up with substance abuse issues, self-medicating with alcohol, prescription drugs or even heroin, according to NAMI. For those with a severe mental illness, as many as half self-medicate with substance abuse. The issues feed on each other, whether it is a person who suffers from depression caused by binge drinking, or a bipolar person who self-medicates with heroin.
But unless the primary diagnosis is mental illness rather than drug detoxification, the patient cannot be admitted to the behavioral health wards. Addicts who need detoxification instead are often given referrals to drug treatment centers, which may or may not have space for them.
Many mental health patients are uninsured, underinsured or on Medicaid. Roth said historically Medicaid rates have not covered the true cost of providing medical service, so prior to the Affordable Care Act, hospitals were leery of adding additional services and space for psychiatric beds. The ACA has allowed many more people with mental illness to access health insurance, she said, which means there has been more compensation and patients are more likely to seek care.
However, she said the state has closed some state-operated facilities across Illinois, and has not increased allocations to community providers. “The lack of funding for community providers limits their ability to serve the great numbers of folks requesting services,” she said.
But Gruneich said that closing mental health wards and cutting spending for treatment is not saving money in the long run. “In terms of dollars and cents, it’s definitely more cost-effective to fund clinics, group homes and medication than it is to fund prisons,” she said. “Those things cost the state and taxpayers less than prison does, and many people in prison are there because they slipped through the system. They went years without diagnosis, therapy or medication, and then something happened. If we could work on that, taxpayers in our state would save money, and also save lives.”
Day said Touchette is a “disproportionate share” hospital, which means a large number of its patients are uninsured or underinsured, and thus they receive additional support funds. “It has its challenges, but it’s not impossible to care for these individuals,” Day said. “It’s our mission, and we hold fast to our mission.”
Touchette officials are looking forward to opening their new facility, which more than doubles their previous capacity and will improve efficiency, Day said. Touchette’s focus will be on adults age 18 and older with any type of psychiatric diagnosis, including schizophrenia, psychotic disorders or severe depression. Younger patients will be seen on an outpatient basis, Day said.
“What we’re trying to do as a region is to improve access to mental health beds by having one location to coordinate the mental health services,” Day said.
The move comes at a time when St. Elizabeth’s is proceeding with its move from Belleville to a new $300 million, 144-bed hospital in O’Fallon, which will not include a mental health ward.
The new facility at Touchette is under construction and projected to be completed at the end of the year, with an opening date in January 2016. St. Elizabeth’s, Touchette and Southern Illinois Healthcare Foundation are working on a transitional plan for the new facility, Day said.
Contact reporter Elizabeth Donald at firstname.lastname@example.org or 618-239-2507.