Mental illness in Dutchess County

Co-written by: Adriana Belmonte & Tom Martin

According to Mental Health America, over 40 million Americans deal with some form of mental health concern.

In 2008, the Dutchess County Department of Health surveyed adults throughout Dutchess County and found that 13 percent of those surveyed had reported that they had experienced poor mental health on 14 or more of the previous 30 days. The New York State Prevention Agenda for 2017 is to bring the percentage down to 10.1 percent.

According to Dutchess County’s 2017 Executive Budget report, Dutchess County’s efforts in regards to mental health have been primarily focused in, “prevention, intervention, and diversion.”

The Dutchess County Department of Health released a Community Health Assessment for 2014 to 2017 and stated that from 2007 to 2011, there was an increase in the use of “Office of Mental Health (OMH)-licensed and funded services among Dutchess County residents 18 to 64 years of age, which grew at a faster rate than the statewide average.”

Dutchess County offers more mental health services than any other county in the state. For 10 years, Mental Health America of Dutchess County (MHADC) received a grant from the Department of Housing & Urban Development, which was used to help offset the cost of their homeless shelter. In the last three years, however, MHADC has only received $55,000. MHADC mainly runs through Medicaid, county and state contracts, and donations and grants.

MHADC offers options for outpatient treatment, including those on AOT. With 140 employees and an $8 million budget, MHADC has three locations throughout the county, but most of the staff is based in Poughkeepsie. Its biggest services are community education, care management, and a daytime homeless shelter in Poughkeepsie known as “The Living Room.” 45 case managers deal with approximately 2500 clients.

Maureen Murphy, Single Point of Access and AOT Coordinator for the Department of Behavioral & Community Health, said that she sees an even divide between men and women when it comes to mental health patients, and also sees how intertwined mental illness is with substance abuse. A 2014 report published by the Substance Abuse and Mental Health Services Administration (SAMHSA) found that an estimated 7.9 million adults had experienced a co-occurring mental illness and substance use disorder within 2014.

“They take the drugs to mask their illness,” she explained. “I don’t find many people that are just mentally ill.”

She explained how it is like a snowball effect. A struggling economy leads to job losses and devastation as a result. The unemployed become depressed about their situation and turn to drugs and alcohol to “solve their problems.” As a result, their addiction leads to their families leaving them.

The Center for Disease Control lists mental illness as a significant risk factor for prescription drug abuse. Suffering from addiction and subsequently undergoing the loss of a support group, homelessness becomes a serious threat. According to the National Coalition for the Homeless, an estimated 20 to 25 percent of those who are homeless suffer a severe mental illness.

“How do you deal with bad news?” she said. “Some people find alternative ways to wallow in their bad news, when you wallow, you’re looking for something to get you out of it. Anybody and everybody must learn coping skills.”

Andrew O’Grady, Executive Director of Mental Health America of Dutchess County, agreed that unemployment is a factor. “If your mental illness won’t allow you to work and be a contributing member of society, you end up poor without a job,” he said. “People who don’t seek treatment or don’t want treatment end up homeless.”

O’Grady and Lisa Cardinale, the Quality Improvement Coordinator at the Department of Behavioral and Community Health, both agree that the system is “fragmented” to begin with. “People tend to fall through the cracks,” O’Grady said.

The Dutchess County Department of Health reported in 2013 that the suicide mortality rate was at 9.3 per 100,000, the percentage of binge drinking in the last 30 days among adults was at 18.1 percent, and the number of drug-related hospitalizations was at 28.1 per 10,000.

Murphy finds that a “volcano erupts” in the forms of drug and alcohol. “If you don’t have a release, the volcano will erupt,” she said. “It all makes sense. They’re just trying to escape this world that, for them, is not so pretty.” The biggest drug problem in Dutchess County right now, she said, is opiate abuse.

“Doctor shopping” is when opiate addicts seek painkillers from different doctors so that way no one will catch on. That is where the I-STOP Prescription Monitoring Program (PMP) comes in. According to New York State Department of Health website, “As of 2013, most prescribers are required to consult the PMP registry,” when a prescription is requested of any schedule II or higher controlled substance.

According to the 2015 Dutchess County Health Substance Abuse Workgroup report, between 2009 and 2013, there were 285 accidental overdoses from illegal, prescription, and over the counter drugs. Within the same four years, the City of Poughkeepsie experienced rates approximately twice as high as the rest of Dutchess County.

The parking lot behind the living room referenced by Edmonstone

At her job at The Living Room, Tracy Edmonstone sees many mentally ill clients who are also heavily addicted to drugs. “We wonder: why has our society allowed this to happen?” she said. Edmonstone sees predators that come to the Living Room to try and pimp out the girls. “We had guys taking one girl out and she’s giving them [sic] in the parking lot over a cigarette,” Edmonstone said. “And she doesn’t know better or to stop because she’s mentally ill.”

“We have people who are clearly mentally unstable but when they go to the hospital, the doctors ask if the client if he wants to hurt himself or others,” Edmonstone explained. “When they say no, the hospital cannot keep them.”

Edmonstone finds it “heartbreaking” when the police arrive to the scene of someone in mental distress and are unable to do anything because the person is not violent. That is where the Mobile Crisis Team comes in.

Starting in April 2012, the Mobile Crisis Team operates as a state grant through Dutchess County and is comprised of contracting agencies, including Mental Health America, Lexington, and Astor. It also shares a partnership with Mid-Hudson Regional Hospital.

Charles Robitaille, a social worker for the Mobile Crisis Team, said that with the county downsizing and closing Hudson River State Hospital, there was no longer county money for many services and many people ended up displaced. As a result, the state gave a grant to outreach people and link them to services.

The now-defunct Hudson River State Hospital

Amanda Ewanciw, a Licensed Mental Health Counselor who works on the Mobile Crisis Team, explained that the team is called in for any mental health crisis at any place- parks, businesses, schools, etc.

“The goal of the team rests on keeping people out of hospitals,” she said. “The hospital setting is not always the best avenue for treatment. We want people to be able to thrive, learn, and grow.”

Since the Mobile Crisis Team is a free community outreach program, they are only available for clients in Dutchess County, but occasionally work outside the county for linkage with other mental health resource organization.

The team provides transportation, linkage, and follow up calls for their clients, aiming to keep them from hospitalization. However, in cases of a 945 order, a client is mandated to go to the hospital because he or she is deemed an “imminent risk of hurting self or others.” This kind of order is done by the Community of Mental Health.

The Mobile Crisis Team works with clients of all ages, including children. The youngest child that Ewanciw has dealt with was only three years old. She stated there are different approaches when it comes to working with children, such as additional collaborative work with parents, school, Child Protective Services, etc.

Murphy spoke of an 11-year-old patient who was admitted to the emergency room after trying to kill herself because her boyfriend talked to another girl on social media. Another young patient of hers was caught shoplifting a bra and eventually revealed that it was a cry for help, as she was being abused. “Stealing the bra brought people into her world,” Murphy said. “Kids are tough but there’s always a reason.”

Since there are no beds for adolescent psychiatric patients at Mid-Hudson Regional Hospital, mentally ill children up to age 18 are housed at Astor Services for Children & Families.

While the most common mental illness among patients under 18 is depression, Ewanciw stated that with adults, she has “seen it all.” As a result, though, the Mobile Crisis Team has a “good working relationship” with schools, cops, and hospitals. Despite the good relationship, the team must always ask in advance if the client in question has access to a weapon.

To further achieve the Mobile Crisis Team’s goal of jail and hospital diversion, Dutchess County is in the process of finalizing renovations to the Mental Health Offices at 230 North Road, creating the new Crisis Stabilization and Wellness Center.

The Stabilization Center, the first of its kind in New York, is a multi-agency partnership that will serve as a “hub” for evaluation. “It’s a safe place for people to detox,” Ewanciw said. “People will be assessed and then a determination will be made whether to hospitalize them or to send them to stabilization.”

The Center will offer mental health assessments, respite, primary care, detox, as well as establishing and providing links and information regarding available community resources.

Murphy noted that alcohol withdrawal is the only kind of withdrawal that can be deadly, so having a safe place to detox is important. “When you come out, you’re looking for and chasing that original high,” she said. “It’s a vicious circle.”

The rear entrance to the upcoming Crisis Stabilization and Wellness Center

The Crisis Stabilization Center is set to open in February 2017 and will have mental health professionals, counselors, nurses, and social workers on staff. Patients can stay for up to 23 hours and 59 minutes at a time. “We literally do it all,” Ewanciw said.

According to National Alliance on Mental Illness, approximately 3 in every 100 people will experience psychosis during their lifetime. Psychosis is defined as “a symptom associated with several types of mental illness including schizophrenia, bipolar disorder, and certain types of major depressive disorder.”

“When you get depressed, you body hurts,” Murphy said. “If someone’s very depressed, they start to get nervous and then develop anxiety. The anxious thoughts become overwhelming.”

Mental health professionals use the DSM-5 as a diagnostic tool. Murphy often sees diagnoses of depression and anxiety together and has seen a rise in the prevalence of post-traumatic stress disorder (PTSD). “A lot of people are suffering,” she said.

While there are many people suffering as Murphy said, not all of these people are willing to take their medications. Assistant Outpatient Treatment (AOT) is a program that tries to fix this problem. It is the only program in the state of New York that can mandate a patient to take their medications. Mental health professionals go to court with evidence that the person is a danger to himself or to others and put in a 960 pickup order. “They start functioning again,” Murphy said. “Everything we do is based on safety. We’ve never lost an AOT case since it’s started.” In Dutchess County, there are approximately 25 people on AOT right now, but Murphy believes that number should be tripled.

The goal for everyone involved is to keep people out of hospitals. O’Grady believes that the Rose House model is a great way of maintaining that goal. The Dutchess Rose House is a 24/7 self-referred hospital diversion and crisis respite, located on Violet Avenue. Those over the age of 18 who are experiencing a mental crisis can refer themselves to the Rose House, described by O’Grady as a “relaxing, calm place void of any potential triggers.” Guests determine the length of their stay, which can range from 1–5 days with a possible two day extension. Once admitted, guests are provided on-site support and counseling. “It may not be a huge impact, but it certainly keeps people out of the hospital,” said O’Grady.

The Department of Behavioral & Community Health has organized trainings in the past for police officers and state troopers who come into contact with mentally ill people. According to the 2017 Dutchess County Executive Budget, nearly 50 percent of law enforcement throughout Dutchess County will have received Crisis Intervention Training (CIT) by the end of 2017.

Murphy empathizes with the plights of the mentally ill. “With what life does to you, it all makes sense,” she said. According to the NAMI state legislation policy report, New York state’s budget represents the state’s strongest investment in mental health services in many years. For residents of Dutchess County, this is seen as a step in the right direction.