Hospitals & Asylums
By Tony Sanders
Mentalhealth Access Point (MAP) was founded in 1997 by a nurse named Diana McIntosh. MAP serves to connect people with mental health services. Dr. Collins is the medical director of MAP. Her husband Dr. Charles Collins is a child psychiatrist who is the director the Child Division. MAP is one of five divisions of Central Clinic – Court Clinic, MHAP, Adult Division, Child Division and the Young Child Institute. Central Clinic is led by Executive Director Dr. Walter Smitson. ACT is a program that provides ongoing case managers, who work as a team, to people paroled from prisons. Kathryn Van Fleet, who has worked at MAP since 2000 said,
“Although there is room for improvement Central Clinic does good work”.
Most of what MAP does is refer people to ongoing case managers from a dynamic portfolio of mental health agencies. For instance, Greater Cincinnati Behavioral Health (GCB) was founded when CRI merged with QCM. The MAP office is located on 311 Albert Sabin Way in the Cincinnati medical complex by the University of Cincinnati. People generally call 558-8888 to schedule an appointment. Although things have improved dramatically since MAP was founded in 1997 the objective, to be “the front door to mental health services” still needs to be achieved. MAP Medical Director Jackie Collins MD said,
“The purpose of MAP is to connect people who have just been released from jail or a psychiatric or are new to the community, to mental health services”.
The intake of involuntary psychiatric patients continues to be performed primarily by Mobile Crisis and Psychiatric Emergency Services (PES) although other psychiatric hospitals in the community also detain people under 72-hour hold warrants issued by the Probate Court and are enforced by special police officers. Mobile Crisis represents the financial interests of University Hospital although the organization is so entrenched in the police force that they have offices in two police precincts, as well as at the hospital. Residents call Mobile Crisis and the alleged mentally ill are kidnapped. Mobile Crisis and PES are a serious hazard to the civil rights of the community, a breech in the security of University Hospital a regionally renowned trauma hospital, and the current focus of mental health reform in Hamilton County.
The unnecessary hospitalizations cost society tens of thousands of dollars per patient. The more intelligent and sane the patients are, the longer they tend to be hospitalized. The genuinely mentally ill patients tend to be admitted voluntarily or without much ado by family, case managers or police and are speedily released, often before they can answer the all-important question in regards to severe mental illness, “What is your name?” Even more troubling, Mobile Crisis and PES are advertised by the Hamilton County Mental Health and Recovery Services Board at the very top of their homepage. The class A felons are treated as the A students. The public is being misled to abuse very expensive and undesirable hospital services while MAP, “the front door to mental health services”, is relegated to clean up their mess.
The state mental institution, Summit Behavioral Health, the focus of reform at the turn of the century, has been rebuilt. It is comprised of wards A-F, arranged in a circle it is confusing, newer, and looks betters. They provide stimulating activities, a fitness area, workshop rooms and occupational therapy. All in all it is a happier place since the renovation. Summit is not necessarily better than the general hospital psychiatric wards because they are short term. Summit takes more time. The mental illness jurisdiction of the Probate Court no longer uses a prosecutor and there is a new courtroom at Summit Behavioral Health that tries all people who are committed to a psychiatric hospital against their will, in Hamilton County.
Before the 1960s the elderly were warehoused in psychiatric hospitals. This generation the elderly, who cannot care for themselves and don’t have family to care for them, are cared for in nursing homes. Nursing home care is expensive and there are physical requirements. Pass R checks for mental health and MRDD treatment deny eligibility to people who might be agitated and cause disruption in a private home. Elderly people in need of nursing home care who have been mistakenly probated to psychiatric hospitals often have difficulty finding a nursing home. They can however take up residence in long-term care facilities that are qualified by the state. Assisted living is not monitored by the state but by the city. Some facilities have grandfathered smoking sections and allow smoking.
The Recovery Center is a peer and consumer run advocacy center next door to the Mental Health and Recovery Board that opened in 2007 after the Recovery Initiative folded in 2005 at around the time the Board relocated to its current location on Auburn Avenue. The Recovery Center has both peers and consumers as opposed to the consumer strategy of the Initiative. There is now a professional social worker. The Center serves an average of 30 clients at any given time, approximately 85 individuals per month. Graduates generally go on to careers, furthering their education or volunteering. Some return to the center for specific classes but the goal is to help clients move back into the community. The Center is funded by a grant from the Health Foundation of Greater Cincinnati and receives ongoing support from the Hamilton County Community Mental Health and Recovery Services Board.
Chris Pedoto, the Director of the Recovery Center, who unlike his predecessor has never been mentally ill, said,
“Things are getting better. Arts are helping to fight stigma and change lives. The Recovery Center has been involved in art shows and poetry readings. The foundation of recovery is a set of four goals – work, school, volunteer and enhance personal growth. Peer support is an important part of the recovery process”.
Recovery specialist Angela Ostholhoff said, “We use curricula largely designed and modified by consumer staff. The education units focus on detailed examinations of mental wellness – how to get it and maintain it.”
The calendar of the Recovery Center is filled with classes focusing on all aspects of mental wellness. A typical week at the Recovery Center will find such sessions as, Illness Management and Recovery, Physical Wellness, Creative Expression, Computer Skills, Website Design, Smoking Cessation, Education Skills, Anger Management, Empowerment, Claiming your Voice, Successful Employment, Spirituality and Book Club. Support groups address such issues as GLBT, schizophrenia, dual diagnosis, bi-polar, depression and weight management.
Diana McIntosh, the founder of MAP, is currently employed across the street from the Recovery Center at the Hamilton County Community Mental Health and Recovery Services Board, in the position of Vice President of Clinical Services. She has not responded to requests for an interview however a discussion with her Secretary, Sherry, places her at the center of all reforms needed by the mental health system. In the conversation with her secretary it was determined that the current stage of mental health reform is driven by conflicts of interest arising in two areas.
The first issue is that MAP should take over responsibility for responding to allegations of mental illness from the community. MAP should be the officers on the street calming family squabbles and giving shelter to people fleeing domestic abuse. To be effective MAP would want better access to emergency shelters and more agents prepared to respond to distress calls from the community. Mobile Crisis and PES are undermined by conflicts of interest arising from the profit motive of expensive inpatient treatment at the general hospital psychiatric ward and the unlimited grant of police power. While the police might maintain the social service offices, University Hospital clearly needs to abolish both Mobile Crisis and PES so they would have a normal psychiatric department.
The second issue is that the adjudication of people who contest allegations of mental illness by the Probate Court Magistrate at Summit Behavioral Health gives rise to two conflicts of interest. The first conflict of interest is that the liberty interests of the mentally ill are not being sufficiently represented by the court magistrate while the Board has the community resources to house them and the knowledge of mental illness to adjudicate them fairly. The second conflict of interest involves the subversion of the “free will” of the Probate Court. By engaging in a slave trade with medical doctors the security of wills and therefore life expectancy of the population is seriously damaged. This traffic in slavery is so disgraceful that it is not until they have shifted responsibility for the adjudication of mental illness to the Mental Health Board that the Court could be renamed the Justice of Peace.
Essentially Diana McIntosh needs to finish what she started so that MAP would really be the, “front door to mental health services”. As far as agencies in Hamilton County go the Mental Health and Recovery Services Board is nonviolent. The Board however bears their corruption at the very top of their website – Mobile Crisis and PES should not have contracts with the Board or University Hospital, let alone be advertised as the first responders and representatives of the Board to members of the community. The Board cannot remain apathetic about this slave door to the mental health system. MAP needs to given the streets they were destined for.
From her new position as Vice President of Clinical Services Diana McIntosh can go beyond her dream of 1997 to arrange for the Board to liberate the Justice of the Peace from his centuries old sentence to Probate Court. The people of Cincinnati and Hamilton County could live longer and healthier lives and lead the nation to achieve the democratic ideal of a free will.
Works Cited
Anthony J. Sanders v. Hamilton County Community Mental
Health and Recovery Services Board et al. Case No. 1:08-cv-220 April
10, 2008
Mental Health Service for the District of Columbia 24USC(4)III§225-h
Hospitalization of Mentally Ill National Returned from Foreign Countries 24USC(9)§321-329
National Association of Peer Support Specialists. Innovative Recovery Center Finds Peer Specialists Key to Success. copied April 5, 2008