November 17, 2007

Adult mental-health unit at CVPH busier than ever


PLATTSBURGH — The Adult Mental Health Unit at CVPH Medical Center has seen a significant increase in patients over the past few years as it serves people from the tri-county area and beyond.

In 2006, the unit served 719 patients, an increase of more than 100 from the previous year and up 200 from 2004.

“Our numbers are consistently increasing,” said Gizelle Menard, unit director for the Adult Unit. “We’re seeing a lot more patients — and not just people from Clinton, Essex and Franklin counties.”


The 18-bed facility is nearly always at full capacity and nearly 180 patients were sent to other hospitals with mental-health units in 2006.

“It’s 160 miles to the closest facility, and that puts a heavy burden on the families,” said Mary Krakowski, director of mental health for CVPH, which includes both the Adult and the Adolescent and Child units.

“Family involvement is so important to our treatment plans,” she added, noting that the best scenario for patient treatment is to remain close to home, so family members can visit regularly and partake in treatment and educational opportunities.

“We want the family members to come in,” Menard added. “We have them participate in the treatment plans. Mental illness is a family illness. The family is vital for their support.”


The unit’s staff also works closely with agencies throughout the region to ensure a smooth transition from inpatient services to life at home following the hospital stay.

Patients 18 and older are typically admitted to the unit through the hospital’s Emergency Department or by referral to treat acute problems related to mental illness.

A patient may have gone off medication or need an adjustment to a prescription, and the inpatient setting allows the best opportunity to make adjustments safely when a patient is at risk.

The typical hospital stay is seven to 10 days, though people vary in their response to treatment.

The staff — including registered nurses, licensed practical nurses, mental-health technicians, unit clerks, social workers, licensed clinicians and psychiatrists — use a variety of techniques in treating patients.

“We use a group-focus program, as well as individual sessions and family intervention,” Menard said. “We also need to develop a clear follow-up plan to ensure a safe discharge.”


The unit has been at CVPH for more than 40 years and has moved several times over that period. In 2002, the hospital decided to tear down the former Nurses Quarters, which had housed the Adult Mental Health Unit for some time.

“In order not to lose the Mental Health Unit, we secured an area on 4 Main, which was the former prison unit,” Krakowski said. “We knew that space was decreasing from 22 to 18 beds, but we were moving over with the same staff and offering the same services.”

Jean Berggren, a former staff psychiatrist on the unit who left in 2006 and now works for the New York State Department of Corrections, told the Press-Republican she felt lack of space on the unit created a difficult working environment for the staff, although she said state regulations did prevent patient crowding.

She said there was little room for staff to prepare medications or meet for discussions and that the nurses had limited desk room with which to work.

Both Krakowski and Menard admit there is tighter spacing for staff in the new facility, but they also say that spacing is not impacting patient care and that the state’s Office of Mental Health has approved the facility on an annual basis.

Activities are conducted throughout the day to keep patients active and provide them with therapy options. The available space is used on a revolving schedule to accommodate the activities.

“We have an excellent staff who are dedicated to what they’re doing,” Krakowski said, adding that many have been on the job for decades. “It’s a team effort between the hospital, the staff and the patients and families.”

Hospital officials said they are considering moving and expanding the Adult Unit.

CVPH has an agreement with Meadowbrook Nursing to move its sixth-floor Nursing Home to the new Meadowbrook facility on the former Plattsburgh Air Force Base. That move would free the sixth floor for a much larger adult unit.


CVPH is faced with concerns over reimbursement rates that netted a $1.5 million loss in revenue in 2006 and an estimated shortfall of $2.2 million this year for its Mental Health units but administrators are trying to work with the state to offset those concerns.

“There was a meeting, but no commitments or decisions were made,” CVPH Director of Marketing and Public Relations Michael Hildebran said of recent discussions between the Office of Mental Health and CVPH officials.

“Both parties are committed to resolving the problem over the next 30 to 60 days, and we remain hopeful that things can be worked out.”

The hospital is also continually recruiting for new psychiatrists to replace four who were lost to private positions. The hospital would like to have at least two psychiatrists for each unit.

They are also looking into the possibility of using “physician extenders,” such as a psychiatric nurse practitioner or physician’s assistant, to replace the doctors who have moved into state or private positions.

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