Local Mental Health Network Reweaving Ohio Valley’s Safety Net
GLEN DALE — Friday marked the one year anniversary of the opening of a 24-bed psychiatric unit at WVU Medicine Reynolds Memorial Hospital. It’s a milestone — even if it feels nearly eclipsed by the double whammy that COVID and the late 2019 closure of Ohio Valley Medical Center dealt to the region’s mental health system.
In fewer than two years, the system has gone from a well-oiled machine to a patchwork quilt of care to a revived outpatient/inpatient network that is still getting its sea legs. Two individuals whose work takes them deep into the heart of caring for the mentally ill shared their takes on where the local safety net is and where it needs to go.
One is Debbie Clark, the nurse who managed both OVMC’s shuttered Hillcrest and a companion facility for juveniles. She now manages Reynolds’ behavioral health unit. The other is Ohio County Sheriff Tom Howard who, like all West Virginia sheriffs, is mandated to get individuals whose mental illness is so severe they are suicidal or potentially dangerous to others safely into court-ordered care.
REWEAVING A SAFETY NET
“The day that they announced the (OVMC) closure was my bipolar day,” Clark said of initially being told Hillcrest and the Robert C. Byrd Childhood and Adolescent Center for Behavioral Health would remain open, a decision that was reversed in about an hour. “I went from ‘Yay!’ to ‘Oh, no!'”
Yet mental health professionals hit the ground running, she noted. In fewer than four months, OVMC’s psychiatrists had moved from downtown Wheeling to Marshall County’s Reynolds, opening an outpatient clinic there.
By July 2020, a 24-bed behavioral health unit opened on Reynolds’ fifth floor. It features single rooms designed to help keep those in need of more than outpatient care alive. An example? From slanted doors to the absence of door knobs and jutting hinges, there is nowhere to hang oneself.
On the ground floor, an expansion of the emergency department includes spaces designed with the same intent in mind. In those rooms, there are shields that can lock down over medical equipment that is attached to walls.
“I think we have a working mental healthcare system,” Clark said of a program designed to primarily serve Marshall, Ohio and Wetzel counties. “We are ready to roll (but) it’s been a little slow … Hillcrest was there so long. I don’t think the word has went to the streets as much as when we were in Wheeling.”
Clark noted Reynolds — which is part of the same West Virginia University medical system as Wheeling Hospital – is working extensively with the region’s entire outpatient network and with agencies that deal with the homeless to raise awareness. The hospital also launched a recent billboard campaign.
But, the need for billboards illustrates part of why the system isn’t quite standing firmly, she added. Clark believes stubborn invisibility and transportation issues related to the relocation contributed to deaths of despair – suicide and overdose — during COVID.
“We lost a lot of former patients. We grieved each and every one of them.”
Regarding transportation, Clark explained that Hillcrest was a walk-in option for some patients. “When they were having a down time or just wanted to get clean (from substance use), they knew where we were and they just came in,” Clark said.
Now, it’s difficult for patients without personal transportation to get there. Buses only travel as far south as McMechen, well short of the hospital’s location in Glen Dale. Clark said sheriff’s deputies have assisted with transportation as needed.
ARE WE THERE YET?
And, that’s a problem, according to Ohio County Sheriff Tom Howard.
Since the Hillcrest closure, his deputies have put so many miles on an unmarked van purchased to transport suicidal or potentially violent patients it is in need of a new transmission. In late July, he was collecting repair estimates and trying to determine if the vehicle can remain viable.
Howard acknowledges the first 24 hours of care for such high-risk patients has dramatically improved since the opening of the Reynolds unit. Deputies and patients are no longer camping out in Wheeling Hospital’s emergency department while waiting for court hearings or inpatient beds.
But, he said his department is still being taxed in a way it was not when the OVMC emergency room and Hillcrest provided a seamless transfer from non-criminal custody to inpatient care.
Reynolds is only a temporary holding place for some cases at this point, Howard explained. Individuals that are ultimately court-placed in temporary, inpatient care (a process called involuntary commitment) are sometimes too violent or critically ill to stay.
“We’re still traveling all over the state with mental hygiene,” Howard said of transporting such patients as far away as the Virginia border.
With the transport van broken down, he said patients are now traveling in the back of a cruiser with a uniformed officer at the wheel. He considers this inappropriate – not so much in a police de-escalation way as a humanity one.
“The deputies get training, but they are not medical professionals,” he said of a statewide push among sheriffs to move toward a system in which deputies are standing by if there is a danger of violence to self or others but individuals would be moved directly into the custody of mental health professionals rather than to that of police.
“It’s what is proper.”
Clark agrees changes need to be made, but believes the Reynolds unit is doing what it was designed to do. There is local inpatient care. And, some of the caseload that could swamp state hospitals such as William R. Sharpe, Jr. Hospital in Weston is being treated closer to home.
“We keep many of the involuntary patients,” Clark said, noting 40% of Reynolds’ caseload falls into this category.
So far, at least, she said the need for transport to other psychiatric hospitals has been more about the severity of cases rather than local capacity. She said that is true even though Reynolds has 24 beds – compared to the 40 that were in regular use at Hillcrest and the additional 26 juvenile beds that were part of the shuttered OVMC system.
“We’ve never had to turn anybody away (because of lack of beds),” Clark said. “We’ve been full a couple of times … I think our census will go up, but I still think that we’ll (have space.)”
She remains concerned, however, about the continuing lack of a local facility for inpatient juvenile care. Parents must now seek local outpatient care or transport their children to inpatient facilities such as Chestnut Ridge Hospital in Morgantown.
Like Howard, Clark said access to humane medical care is what is right for the community.
“You have to treat patients with dignity and respect because any one of us is one tragedy away from being here.”