'A real failure in the community:' County officials, residents search for mental health solutions
Centre Daily Times - 6/23/2019
Jun. 23--BOALSBURG -- When Chris and Peg Potalivo's daughter suffered injuries from a car crash as a young adult, they didn't know they would be plunged into a more than a decadelong ordeal trying to get her mental health services that also treated her drug and alcohol abuse.
But they say Centre County's lack of in-patient psychiatric facilities and drug treatment programs, combined with a counterproductive psychiatric warrant process have led to their daughter being unable to get the help she needs.
"There is a real failure in the community," Chris Potalivo said. "Our daughter, unlike the poor gentleman that was shot by the police ... by the time it got to (police) to react, it was too late. The damage had already been done."
The aftermath of the police shooting of Osaze Osagie, a 29-year-old State College resident who was diagnosed with autism and had a history of mental illness, has many county residents calling for a review of the local mental health system and how it played a role in Osagie's death.
During a community meeting following Centre County District Attorney Bernie Cantorna's release of the investigative report that determined police officers were justified in their use of deadly force on Osagie, Cantorna and state police Sgt. William Slaton blamed failures of the mental health system for Osagie's death.
At the conclusion of his report, Cantorna called for a task force to be created to examine potential improvements for the county and state mental health systems, including the mental health warrant process.
In response to these demands, Centre County is hosting a community conversation on mental health from 6:30 to 8:30 p.m. Thursday on the third floor of the Courthouse Annex in Bellefonte, which will include presentations from state and local officials, as well as an opportunity for the public to ask questions.
What is a 302 warrant?
In his report, Cantorna cited a 433% increase in mental health, or "302," warrants from fiscal year 2017 to 2018. Although the reasons for the increase are still unclear, Commissioner Mike Pipe said the county is working on collecting data to specifically look at 302s.
A warrant for a 302, which is an involuntary commitment, can be initiated by any petitioner who believes that a person is a danger to themselves, a danger to others or is unable to properly care for themselves, according to the county's mental health services guidebook. A delegate from Centre County Can Help then decides whether a warrant should be issued, then does so through the local police department, explained Michelle Henry, Centre County assistant administrator for Mental Health Services.
'A life-changing event'
For the Potalivos' daughter, the car crash she experienced as a young adult "was a life-changing event," Chris Potalivo said.
A bright student studying pre-med at Penn State, she suffered a blow to her academics following the accident. She experienced short-term memory loss and had to relearn basic skills, Peg Potalivo said. Later, she turned to alcohol and partying to cope with unhealthy relationships and loss of a sense of purpose -- but the substance abuse always masked mental health problems, her mom said.
While the Potalivos' daughter was living out of state, her mental health deteriorated to the point where an old college roommate contacted them to come get their daughter because she needed help, they said.
But their daughter, who lived with the couple on-and-off, eventually needed a more serious intervention. Last summer, the Potalivos had to call the police five times over the span of two weeks due to escalating psychological and behavioral problems.
They decided to initiate the "302" warrant process, which they thought would get their daughter into an inpatient psychiatric facility that would be able to treat both her addiction and underlying mental health problems.
But they were surprised to find that, after officers escorted their at times noncompliant daughter into a police car, she was transported to Mount Nittany Medical Center'sEmergency Department, waited for a few hours, was seen by a medical doctor and released early the next morning.
All people who comply with the 302 warrant process are escorted to an emergency room, Henry said, where they can stay up to five days. If the emergency room doctor determines that the individual's symptoms do not require an involuntary commitment, and the person chooses not to voluntarily commit, they are free to go.
The Potalivos said they feel their daughter should not have been let go, and that, given the intense process they participated in to initiate a 302 warrant, they should have received a call from the hospital that she was being discharged.
Cantorna told the CDT in May that Pennsylvania has some of the strictest mental health laws in the country. While other states allow prediction of future dangerousness based on recent behavior, Pennsylvania requires dangerousness to be proven through acts that occurred within the previous 30 days, according to an email from a mental health professional Cantorna cited.
"To require families to wait until that person is actually in a mental health crisis, off their medication, potentially suicidal and homicidal, puts them at risk, puts their families at risk (and) puts law enforcement at risk," Cantorna said in May.
Whether a person is committed voluntarily or involuntarily, the 302 process does not stop after hospitalization, Henry said.
"We know this person just went through this process, whether they're there on a voluntary or involuntary, it doesn't matter to us," she said. "We're going back and trying to engage them in services as an outpatient. That's a huge entry and opportunity for us to try to engage somebody in services."
But for people who don't quite meet the threshold for an in-patient commitment, services can oftentimes seem harder to come by.
'Improvements to be made'
The lack of mid-level care -- for people needing more than a weekly therapy appointment but not to the point of committal -- was a gap brought to the commissioners' attention at their June 11 meeting by Geoff Landers-Nolan, a state-licensed professional counselor living in Ferguson Township.
"Centre County is blessed to have a very high level of therapy practices and therapy practitioners," he said. "On the other end of the spectrum, we have in-patient mental health care -- psychiatric hospitalization, 24/7 supervision, care, medication monitoring, all that. In between those things I think there's a lot of improvements to be made."
The Potalivos said it was hard for their daughter to find a psychiatrist who took Medicare, and those who did were so overbooked that she couldn't be seen as frequently as she needed.
For his daughter, Chris Potalivo felt she needed an in-patient "dual diagnosis" treatment program that transitions the individual back into the community while still providing structure and services. So far, there are no inpatient programs in Centre County that also treat substance use disorders.
"The correct right treatment from everything I've researched is a weaning-off process, which is typically 30-60 days, immediately into a transition program, where they're living in the community but in a controlled environment. That works. That's not here," he said.
BEHIND OUR REPORTING
Why did we report this story?
In Centre County, there has been a dramatic increase in "302" mental health warrants from fiscal year 2017 to 2018. This year, 29-year-old State College resident Osaze Osagie was shot and killed while police officers attempted to serve one of those warrants, sparking controversy across the community and initiating a conversation about the state of the mental health system. For some families in Centre County, Osagie's death highlighted problems in the mental health system that they've experienced first-hand. We've talked to families who continue to struggle to navigate resources and services, along with Centre County officials and those working in health and human services fields.
This story is the start of an ongoing investigation into the gaps in the county's mental health system and potential solutions. We're looking for your input about where those gaps exist. Email firstname.lastname@example.org to share your tips, information and stories.
When people need in-patient services, they can stay one of two different ways in Centre County -- Mount Nittany Medical Center or The Meadows Psychiatric Center, said Natalie Corman, Centre County Human Services administrator. Mount Nittany has 12 beds in its psychiatric unit, while The Meadows has 119. Those beds, however, are not just for Centre County residents.
"Those are the beds that we operate out of, and we are like all other 67 counties who do this every day who are looking for hospitalization beds," Corman said. "As we talk about treatment and services, having individuals be here is huge for us. Sometimes it doesn't always happen, and they have to go elsewhere."
The Potalivos sent their daughter to a treatment program in Altoona called Pyramid, which has a transition program set up, but she wouldn't finish the program because it wasn't close to home, they said.
County seeks solutions
The gap in mid-level mental health care services is also something the county has identified as an area of needed improvement.
"Police talk about wanting to be able to have the opportunity to, when they engage with people who might not necessarily reach that 302 medical-type of procedure that has to happen ... they just really want to be able to give them some help and engage them in a way that provides for them, knowing that they have assisted them with meeting somebody who can meet their needs," Corman said. "That crisis assessment piece really came from discussions we have had with law enforcement."
To determine the best solution to fill those gaps, Henry led a team that has spent more than four years traveling to other counties, looking at examples of services and researching the best solution for Centre County.
The result was a proposal for a crisis diversion program -- which included both a residential and a crisis assessment piece. However, when the county asked for bids, no one applied. So they went back to the drawing board, and decided to try the proposal again, but this time with just the crisis assessment piece.
"It would basically just be another site for an assessment, and that's ultimately what we're looking for, just another option outside of the Emergency Department," Henry said. "And it would be a holistic assessment. That would be ideal for us, that they're looking at the whole person and all the parts, and potentially be linking services and support in the community."
At the June 11 board of commissioners meeting, Corman announced that the county received three bids from organizations willing to provide the crisis assessment service. Corman explained at the meetings the proposal was for a site-based program that would allow individuals in a mental health crisis to be seen on location by mental health professionals.
The services would be available for people of all ages, and funded through a Human Services block grant from the state, she said.
"That would be a game changer in terms of having another opportunity for diverting people from the ED and going into services," Pipe said.
Recognizing that the residential need still exists in the county, Henry said they'll keep working toward finding a solution.
"We'll still strive to get there, and I think we are pretty good at adapting to what we need to based on what we're responding to," she said. "We literally do this every day."
Part of what Pipe said he hopes the community meeting achieves is opening the conversation up to the community, and hearing suggestions about the kinds of service needs that exists and what the county can do to better meet those needs within its system.
"People are very interested in this right now, so we want to include people in the process and really have a very strong dialogue, answering questions," he said at the meeting.
However, as evidenced by the four-year process just to get to the bidding stage for the crisis assessment services, Pipe acknowledged that change doesn't always happen quickly. With about 90% of its mental health funding coming from the state, the county is bound by the parameters of what the state allows and the state's processes for acquiring more funding and new services.
But for families like the Potalivos, four years of waiting is a luxury they can't afford.
"Our daughter is still out there, still desperately needs someone," Chris Potalivo said. "It's not just going to fade into the background."
(c)2019 the Centre Daily Times (State College, Pa.)
Visit the Centre Daily Times (State College, Pa.) at www.centredaily.com
Distributed by Tribune Content Agency, LLC.