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How Some Places Are Easing the Often-Fatal Transition From a Psych Ward

People with mental illness are far more likely to commit suicide in the months after a hospital stay.

(AP/Ted S. Warren)
When someone is released from a psychiatric hospital, they don't always have a family to go back to. Even when they do, most families are ill-equipped to handle complex mental health needs. 

It’s a precarious time and part of the reason the suicide rate is 14 times higher in the first 90 days after people are discharged from the psych ward. 

To ease the transition, Ohio is opening the state's first "step-down" mental health facility to essentially act as a halfway house for people just out of the hospital. It will be one of few in the nation.

"The average length of stay in a psychiatric hospital is seven days, and that's just not enough. Some medications take weeks before they go into full effect," says Dustin McKee, policy director at the Ohio chapter of the National Alliance on Mental Illness (NAMI), which is partially funding the $2 million facility.

The Adam-Amanda Mental Health Rehabilitation Center, which will be in Athens, is named after Adam Knapp and Amanda Baker, who took their own lives after struggling to get treatment in the state. The center will have 16 beds and prioritize patients suffering from the most severe mental illnesses as well as "the ones who most often fall through the cracks,” says McKee.

"Our main office line doubles as a help line. We hear from Ohio families about the inadequate system [and] the gaps in the continuum of care," he says.

An existing building owned by the state mental health board will be renovated to house the facility. NAMI contributed $100,000 to its construction, while the state put down $500,000. The rest is expected to come from GoFundMe donations. Once up and running, it's projected to cost just under $1 million a year to operate. 

Facilities like this are rare in the United States. The step-down model of care is popular among mental health advocates, but there's a dearth of information about how effective it is or even how many step-downs exist.

The Mississippi State Penitentiary has used step-down treatments for mentally ill inmates over the past several years. As a result, it has reported an 89 percent decrease in behavioral health incidents.

McKee eventually hopes to have six step-down facilities in Ohio, one for each of the six state hospitals, and to extend its services to mentally ill people who end up in the criminal justice system. There has been a stark decline in psychiatric beds in the last half century -- a trend that often forces police officers to bring people with mental illness to jail instead of a hospital.

To avoid that, NAMI of Ohio would look to replicate a diversion model from San Antonio's Center for Health Care Services. It trains law enforcement to detect signs of mental illness and reroute those people to the center for a short-term stay or even transitional housing. Since the center opened, its CEO, Leon Evans, says the population of the county jail has dropped by 20 percent and the homeless rate downtown has decreased by 80 percent.

The center in San Antonio isn't technically a step-down center, but it's often included in the same conversation among mental health advocates because it has the same goal: to save lives.

"When building these sorts of step-down facilities, it doesn’t have to be super expensive," says Evans. "They are generally much less expensive than general medical care. And we've saved thousands of lives in San Antonio."

By diverting the mentally ill away from county jails and emergency rooms, the center has also saved San Antonio money: $10 million a year to be exact.

Mattie covers all things health for Governing.

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