Pubdate: Fri, 04 Nov 2005 Source: Delaware County Daily Times (PA) Copyright: 2005 The Daily Times Contact: http://www.delcotimes.com/ Details: http://www.mapinc.org/media/1284 Author: Patti Mengers DIAGNOSIS, CRITICAL: SERVICES EVOLVE AS NEEDS CHANGE In the two decades since a mentally ill woman named Sylvia Seegrist gunned down nine people at the Springfield Mall, killing three and seriously injuring six, the Pennsylvania mental-health act, which governs commitment procedures, has not changed. But the modes of treatment for the mentally ill have changed, especially since the closing of Haverford State Hospital in 1998. About that time, Jonna DiStefano was named administrator of the Delaware County Office of Behavioral Health, which includes mental health and substance-abuse services. "The hospital was closing, they were discharging people into the community and HealthChoices was starting," DiStefano said, referring toPennsylvania's mandatory managed-care program for Medicaid-eligible people. Care for the mentally ill is now more community oriented in keeping with the aim of consumer advocates whose lawsuits condemning institutionalization helped precipitate the closing of Haverford State. New medications and different types of treatment for the mentally ill also have emerged in the last two decades. "Our own awareness and our own education about mental illness, substance abuse and the availability of medication is very, very different than it was 20 or 30 years ago," said DiStefano. With the advent of HealthChoices, which in Delaware County is operated by Magellan Behavioral Health of Pennsylvania, came the ability to serve more clients than in the past, she said. And the need for services in Delaware County is great. About 7,000 people are currently being served by Delaware County's Office of Behavioral Health, which became the umbrella agency for clients who are mentally ill or who have substance-abuse problems in 1997 because, according to DiStefano, they face some of the same issues. That number reflects some duplication of clients who receive more than one service. "It is difficult to keep resources up to the capacity that seems to be needed. More and more people need and want services," said DiStefano. "There are just so many resources, and not just dollars -- even the capacity at the provider sites." About 60 percent of mental-health clients in Delaware County also have drug or alcohol diagnoses, she noted. "There is a high proportion of clients with dual diagnoses," said the 54-year-old Media resident, who added that local providers have expertise in both mental health and substance-abuse treatment. Delaware County has outpatient services for drug and alcohol clients at Northwestern Human Services in Sharon Hill and Crozer-Chester Medical Center in Upland and inpatient facilities at Mirmont Treatment Center in Middletown and the Keystone Center in Chester. It has more than 30 contracts for drug and alcohol-treatment services. Some are located outside of the county -- for example, for females addicted to heroin. Seven Delaware County residents were serving sentences in Norristown State Hospital's forensic unit as of Oct. 26. Three who have completed their sentences have been transferred to the civil unit for treatment in the last year. DiStefano, who has a master's degree in social psychology and has worked in the behavioral-health field since 1973, feels violent behavior among the mentally ill is the exception and no more prevalent than in the non-mentally ill population. She concedes that there are people in Delaware County in need of mental health services who are not getting them. "Those that fall through the cracks are the ones we are not aware of. Our involvement is with the poor, the uninsured or the people on Medicaid," maintained DiStefano. The majority of clients enter the county mental-health system through base units at Northwestern Human Services and Crozer-Chester Medical Center. They can walk in to those facilities or be referred to them through Magellan. The county also provides case workers for people with private insurance. "We get a lot of calls -- 'My son is 32, mentally ill, I don't know what to do, insurance has run out.' We refer them to the base unit to assess the person's needs," said DiStefano. Clients in the Delaware County mental-health system who require extended hospitalization are sent to Norristown State Hospital in Montgomery County. Currently there are 46 Delaware County residents at Norristown, three shy of the cap set by the state. "Each of the five southeastern counties has a bed cap. Because we work as a region, we have some flexibility," said DiStefano, who added that counties will share beds with a county in need, if they are available. Delaware County has contracted the Parents Involved Network and community health advocate Carol Hussey to help clients and families navigate the mental health system. The county also contracts with Consumer Satisfaction Team Inc. of Philadelphia, which provides a six-member team of consumers and family members of consumers to review mental-health and drug and alcohol programs at least once a year as required by HealthChoices. "If there are any problems, the programs are responsible for corrective action," said DiStefano. The Consumer Satisfaction Team also interviews clients as they are discharged from Norristown State Hospital and follows up with them six months later to see how they are faring, said DiStefano. "We are also becoming better at looking at outcome measures and looking at evidence-based programs. People are actually progressing," DiStefano pointed out. - --- MAP posted-by: Beth Wehrman