CLEVELAND — With last week’s announcement that St. Vincent Charity Medical Center will close to inpatient care by mid-November, the future of its psychiatric emergency department, one of only two such facilities in the state, is anything but certain. For those that know the mental healthcare system painfully well, the potential void left by St. Vincent’s is simply immeasurable.
On Sept. 14, the Sisters of Charity Health System, which oversees St. Vincent, announced that it would be eliminating inpatient, surgical and emergency room care by mid-November, citing tectonic changes in the healthcare industry and declining patient volumes amid a shift to more telehealth services. St. Vincent, which has cared for the city’s sick and wounded since the late 1800s, would instead shift to ambulatory and outpatient care after losing money every year for roughly a decade.
According to a WARN noticed filed with the state, a total of 978 positions could potentially be affected by the dramatic scale down in services. St. Vincent officials tell News 5 that 268 of the 978 positions are considered PRNs, which refers to people who are only called into action when they are available and when an employer requires their services. A total of 264 of the potentially affected positions are part time employees while the remaining 446 positions that are to be potentially affected are full-time employees.
In addition to the potential job losses, the impact that St. Vincent’s closure to inpatient care could dramatically change the landscape when it comes to the availability of mental healthcare offerings in the county and broader region. St. Vincent has one of only two psychiatric emergency departments (PED) in the entire state. A PED differs from a traditional emergency room in that it offers specialized care and staffing, including psychiatric nurses and psychiatrists, for those that are in need of emergency mental health treatment.
Kathleen Moser, the executive assistant for Cleveland City Councilwoman Rebecca Maurer (Ward 12), drafted a memo upon hearing the news that St. Vincent would be scaling back its services. Moser’s brother, Vincent, was diagnosed with early onset schizophrenia at age 13 and received treatment at St. Vincent on several occasions, Moser said.
“I remember Councilwoman Maurer read [the announcement] it out loud off an email. I [thought], 'wait, what?'” Moser said. “It was a little unexpected. I immediately started thinking about the recourse of that in my head. My brother personally had been there several times. A lot of his friends in his community — everyone has done some time at St. Vincent.”
Vincent Moser, affectionately known as Vinny, was known for his humor and his affinity for music and computers. According to his online obituary, Vincent’s passions led him to produce electronic music under the name, ‘Vmo.’ He graduated from Strongsville in 2013. He also served as a member for the Strongsville Youth Commission, where he developed a love for serving others and helping his community.
In the nearly four years since his death from schizophrenia and substance abuse, his sister Kathleen and the rest of his family members have been actively raising awareness as to the plight of the mental healthcare system in Ohio and, more broadly, the country.
Losing something like St. Vincent’s psychiatric emergency department will only exacerbate the difficulties people have in obtaining mental healthcare, she said.
“To a lot of people it was a hospital closing, which is still not good, but understanding the gravity of what is going on here and the position that we are already in in the mental healthcare system is important for people to take note of,” Moser said. “When we don’t fund things intentionally, this is the result. People die. My brother was one of those people.”
Moser said someone in crisis is unable to walk into a number of facilities, including the diversion center, crisis unit or treatment facility and immediately be given a bed. Conversely, an agency can’t demand a bed at a treatment facility without the necessary medical clearance.
That’s where the psychiatric emergency department — and ERs in general — come into focus. In a traditional emergency room, someone experiencing a mental health crisis has to wait alongside those with other maladies like broken bones or illnesses. Once brought back to an exam room, the person suffering from mental illness is evaluated and, oftentimes, has to wait even more before being seen by a doctor. If the doctor determines the mentally ill patient needs to be admitted, the real wait begins: The wait for a bed.
If there are no beds available in a given area, the patient is either sent home or transferred to the next hospital that has been licensed by the state Mental Health and Addiction Services Board, where they wait for a bed to become available.
“The waiting periods between arrival and being seen; being seen and being written for admission; being written for admission and finding a bed somewhere, can be hours, at times days or weeks for a bed,” Moser said. “It’s in those times that people leave, people get lost in the system. It really causes a lot of suffering that doesn’t need to be happening.”
Psychiatric emergency departments offer numerous advantages for those facing a mental health crisis, including more specialized care and, if space is available, a quicker path toward receiving inpatient treatment.
Moser said the steps that follow treatment, including finding stable and safe housing for the mentally ill, are just as difficult, oftentimes leading to a vicious cycle of hospitalization, discharge, crisis and so on. That cycle can wear on the patient’s loved ones — as it did hers.
“The pain that he went through and the pain my family went through from when he was diagnosed at 13, getting that diagnosis, and until the day that he died, was just an absolute battle,” Moser said. “Some things are hard enough on their own and schizophrenia is one of those things. To be having to claw for resources… it adds a level of exhaustion and trauma that I would like to see changed for others."
There may be a chance, however, that the psychiatric emergency department at St. Vincent could operate as a standalone unit. Currently, St. Vincent officials are in conversation with state and federal officials about the possibility of opening the PED separate from the hospital itself. However, doing so would require numerous bureaucratic hoops to jump through, officials said.
Then there’s the question of how to fund it.
The ADAMHS Board of Cuyahoga County has been a longtime funder and partner of St. Vincent for inpatient and outpatient mental health and addiction treatment, as well as recovery and support services like the PED. If St. Vincent were to somehow receive approval to open a standalone psychiatric emergency room, the ADAMHS Board could vote to provide some level of funding. However, any funding decisions cannot be made until that approval has been secured and approved.
“St. Vincent is deeply engrained in our crisis continuum of care, and we know there will be some level of impact from the loss of these services,” Scott Osiecki, the CEO of the ADAMHS Board of Cuyahoga County, said in a statement. “At this time, ADAMHS Board staff are analyzing the impact that the loss of inpatient behavioral health services as well as the psychiatric emergency room will have on the community. We are considering the opening of MetroHealth’s new psychiatric hospital in that analysis. The ADAMHS Board will continue to work with St. Vincent and other partners to ensure that individuals in Cuyahoga County receive the behavioral health care that they need.”