The initial announcement of state plans to close Lakeshore Mental Health Institute sent shock waves throughout the community. The specter of its released patients lapsing into homelessness and ending up in jail seemed all too real based on the results of Lakeshore downsizings in the past.
But local mental health advocates and service providers are convinced that the state's plan will strengthen rather than weaken supports for the mentally ill and result in fewer of them "falling between the cracks."
Their belief is based on the commitment of Gov. Bill Haslam and the state's Mental Health Commissioner Doug Varney that all of the $20 million in state savings derived from Lakeshore's closing will be dedicated to more efficient, effective, and extensive treatments of East Tennessee's mentally ill.
Varney, who served for many years as president of Frontier Health in Johnson City before accepting Haslam's appointment to the state post, commands the utmost respect of his fellow mental health center officials throughout the area. "He's one of us, has a real passion for the population that we serve, and knows the needs as well as anyone," says Andy Black, president of the Helen Ross McNabb Center in Knoxville.
Varney's multifaceted plan for redeployment of the $20 million in Lakeshore savings aims at bolstering both inpatient and outpatient services throughout the region. Provision for Lakeshore's present residential population of about 90 patients falls into the following two categories:
About half of them are there for stays of fewer than 10 days, typically for treatment of episodic relapses into psychotic states often due to failure to adhere to medication regimens and/or intoxication. These patients will be routed instead to one of the area's three private mental hospitals (Peninsula in Knoxville, Ridgeview in Oak Ridge, and Woodridge in Johnson City) with whom the state is contracting at a rate of $450 per diem compared to the $900 cost at Lakeshore.
The other half of the Lakeshore residents whose placement poses greater challenges are those who've been there for more than a year and in some cases up to 30 years. The private hospitals aren't presently equipped to take care of these long-term patients, many of whom also suffer from physical disabilities including dementia and retardation. But Lakeshore's longtime director Lee Thomas insists that, "For every one of these folks we have a plan for making their placement successful." And Varney adds that "they will get some of the best placements we've ever had."
Other allocations from the $20 million aim at bolstering services or expanding capacities all along what mental health professionals refer to as the continuum of care. These include:
• $1.1 million for intensive support services at group homes such as the eight Helen Ross McNabb maintains in the Knoxville area with 53 residents.
• $2.2 million for a 15-bed expansion of what are known as Crisis Stabilization Units of which there are presently two, totaling 30 beds at Helen Ross McNabb in Knoxville and Frontier in Johnson City. According to Black, the CSU admits individuals in crisis for up to three days and successfully diverts more than 90 percent of them from what would have otherwise been longer-term hospital stays.
• $1.5 million for expansion of Medically Monitored Crisis Detox, which Black says is "desperately needed" to cope with substance-abuse emergencies.
The longtime director of the East Tennessee Mental Health Association, Ben Harrington, suggests that the combination of CSU and Crisis Detox expansions could obviate the need for a so-called Safety Center for substance abusers that Sheriff Jimmy Jones has been championing as an alternative to jail.
Harrington acknowledges that there's room for skepticism whether the reinvestment of Lakeshore savings in other East Tennessee mental health programs can be sustained over time amid other state budgetary claims. But he insists that, "If we reinvest as wisely as we're intending right now, I see big benefits. We will be building our capacity to serve more people when they need care and better than at Lakeshore."
And there's no doubting Varney's sincerity when he asserts that, "This is not a one-year deal; it's a mental health-care systems transformation. For the first time in my 35 years in the field, we're going to have a big chunk of additional resources, and we're going to put it into services that can transform mental health care in this region."
One obvious blow to the community will be the loss of Lakeshore's 350 jobs. But both Harrington and Varney voice optimism that most of its professionals will readily find work attending to the added caseloads at private hospitals and other expanded facilities and services.