Reconsider the ASH closure

Dear Editor:

Allentown State Hospital (ASH) has been in the forefront in several areas and has won numerous awards nationally and recognized internationally. It was the first hospital in the country eliminating seclusion and initiating a reduction in the use of mechanical restraints and 'prn' medications as chemical restraints. The hospital has been around for 98 years catering to not only the mental health but the total care of thousands of consumers in its catchment areas of Northampton, Lehigh, Carbon, Munroe and Pike counties. It is indeed sad to know that this hospital will not be around after December 31st, 2010.

Of course the state has initiated the CHIPPPS initiative for reintegrating consumers into the community and we fully support that as we also believe that consumers do deserve to live within the community and not behind locked doors of state mental hospitals. In the 1950s the doors of state hospitals were opened with the introduction of psychiatric medications with considerable reduction in the number of consumers from over 2000 to about 170 right before the announcement of the ASH closure in January 2010. However we wonder if the state is too over enthusiastic and premature in their announcement of the closure .

I would like to point to the state's own document on the DPW site about ASH closure and try to bring out certain things to the attention of the concerned citizens and legislative members

1). They have listed one of the reasons for the closure of the ASH as the ASH grounds that amounts to over 217 acres and the potential use for alternate uses. We have heard projected estimates of over $1million as tax revenues to the city of Allentown itself. Should this be even listed as one of the reasons for ASH closure?

2). The state has also reported in the above document that the link between violence and mental illness is promoted and exaggerated by the news and entertainment media. But we must not diminish or discount the very fact that there is definitely a potential for violence and suicide in a small segment of the mental health population and the need for community treatment providers to be more vigilant and watchful for this.

3). The state also reports on the DPW website that the rate of incarceration is less than 2 percent and the rate of homelessness is less than 1percent. I believe this is an underestimate as I work in the community in both Lehigh and Northampton county prisons and at any given time, there is more than 15 percent of the jail population identified as having some form of serious mental illness.

I would recommend the following to better this process of reintegrating consumers into the community and preventing violence, suicide and thus restoring and helping in the recovery of the unfortunate people stricken with serious mental illnesses.

1) The state needs to revise the mental health law that is now antiquated dating back to 1964. There are several pitfalls in the provision for outpatient commitment to force treatment for unwilling consumers. I know from personal experience of working in the community for than 20 years that the outpatient 305 commitments in the mental health act is only an exercise in paper. As it stands now, do you all realize that we need to actually do another hearing for those under outpatient commitment if they refuse treatment and we have to prove that they are a source of imminent harm to themselves or others within past 30 days.

We do not have to look elsewhere than our neighboring state of New York where they have the "Kendra's Law", which came out initially in 1999 and later revised in 2005. This is an aftermath of an unfortunate incident in New York City subway when a consumer with mental illness who was not compliant with outpatient treatment pushed someone onto the subway line. In New York State, the treatment providers can get a court order for implementing outpatient treatment approved by the "director of community services" if there is a strong potential for violence without treatment rather than waiting for any act of violence within 30 days of the hearing.

2) There is also a long delay in access to outpatient mental health treatment in the Lehigh Valley Area . Typically the consumers have to wait more than a month for even getting appointments for an initial evaluation at all the outpatient facilities. I understand the state is developing jail diversion programs but I work at both Northampton and Lehigh county prisons and once they are released they are also forced to wait the same time even to get appointments and medications risking a relapse of their mental illness and future incarcerations.

Again I believe that the New York State has a better system based on my experience of referring outpatients there and they are required by law to give outpatient appointments within 3 days of hospital discharges!

Therefore I believe that the Commonwealth of PA needs to revise the outdated Mental Health Act of 1964, develop new outpatient treatment laws to enforce treatment to consumers with a strong potential for violence, crime ,suicide or deterioration in their ability to care for themselves. We are definitely going to see an increase in crimes, prison populations and homelessness, if we are not proactive by taking the above measures. I plead to the Commonwealth and to the area legislatures and the concerned public to reconsider the ASH closure until such measures are in place and allow the ASH to continue with the fine work they have been doing all along for the last 98 years rather than sell the ASH property of 217 acres which is of prime real estate value and force the families of those patients being transferred to Wernersville and Clark Summit Sate Hospitals to travel more than one hour each way to visit their loved ones.

Thank you all

Alex Thomas MD,

Psychiatrist at ASH for 21 years and

Union steward for PDA

First Vice President of Pennsylvania

Doctors Alliance