DIAGNOSIS, CRITICAL: SERVICES EVOLVE AS NEEDS CHANGE

In the two decades since a mentally ill woman named Sylvia Seegrist
gunned down nine people at the Springfield Mall, killing three and
seriously injuring six, the Pennsylvania mental-health act, which
governs commitment procedures, has not changed.

But the modes of treatment for the mentally ill have changed,
especially since the closing of Haverford State Hospital in 1998.

About that time, Jonna DiStefano was named administrator of the
Delaware County Office of Behavioral Health, which includes mental
health and substance-abuse services.

"The hospital was closing, they were discharging people into the
community and HealthChoices was starting," DiStefano said, referring
toPennsylvania's mandatory managed-care program for Medicaid-eligible people.

Care for the mentally ill is now more community oriented in keeping
with the aim of consumer advocates whose lawsuits condemning
institutionalization helped precipitate the closing of Haverford State.

New medications and different types of treatment for the mentally ill
also have emerged in the last two decades.

"Our own awareness and our own education about mental illness,
substance abuse and the availability of medication is very, very
different than it was 20 or 30 years ago," said DiStefano.

With the advent of HealthChoices, which in Delaware County is
operated by Magellan Behavioral Health of Pennsylvania, came the
ability to serve more clients than in the past, she said. And the
need for services in Delaware County is great.

About 7,000 people are currently being served by Delaware County's
Office of Behavioral Health, which became the umbrella agency for
clients who are mentally ill or who have substance-abuse problems in
1997 because, according to DiStefano, they face some of the same
issues. That number reflects some duplication of clients who receive
more than one service.

"It is difficult to keep resources up to the capacity that seems to
be needed. More and more people need and want services," said
DiStefano. "There are just so many resources, and not just dollars --
even the capacity at the provider sites."

About 60 percent of mental-health clients in Delaware County also
have drug or alcohol diagnoses, she noted.

"There is a high proportion of clients with dual diagnoses," said the
54-year-old Media resident, who added that local providers have
expertise in both mental health and substance-abuse treatment.

Delaware County has outpatient services for drug and alcohol clients
at Northwestern Human Services in Sharon Hill and Crozer-Chester
Medical Center in Upland and inpatient facilities at Mirmont
Treatment Center in Middletown and the Keystone Center in Chester. It
has more than 30 contracts for drug and alcohol-treatment services.
Some are located outside of the county -- for example, for females
addicted to heroin.

Seven Delaware County residents were serving sentences in Norristown
State Hospital's forensic unit as of Oct. 26. Three who have
completed their sentences have been transferred to the civil unit for
treatment in the last year.

DiStefano, who has a master's degree in social psychology and has
worked in the behavioral-health field since 1973, feels violent
behavior among the mentally ill is the exception and no more
prevalent than in the non-mentally ill population.

She concedes that there are people in Delaware County in need of
mental health services who are not getting them.

"Those that fall through the cracks are the ones we are not aware of.
Our involvement is with the poor, the uninsured or the people on
Medicaid," maintained DiStefano.

The majority of clients enter the county mental-health system through
base units at Northwestern Human Services and Crozer-Chester Medical
Center. They can walk in to those facilities or be referred to them
through Magellan. The county also provides case workers for people
with private insurance.

"We get a lot of calls -- 'My son is 32, mentally ill, I don't know
what to do, insurance has run out.' We refer them to the base unit to
assess the person's needs," said DiStefano.

Clients in the Delaware County mental-health system who require
extended hospitalization are sent to Norristown State Hospital in
Montgomery County.

Currently there are 46 Delaware County residents at Norristown, three
shy of the cap set by the state.

"Each of the five southeastern counties has a bed cap. Because we
work as a region, we have some flexibility," said DiStefano, who
added that counties will share beds with a county in need, if they
are available.

Delaware County has contracted the Parents Involved Network and
community health advocate Carol Hussey to help clients and families
navigate the mental health system.

The county also contracts with Consumer Satisfaction Team Inc. of
Philadelphia, which provides a six-member team of consumers and
family members of consumers to review mental-health and drug and
alcohol programs at least once a year as required by HealthChoices.

"If there are any problems, the programs are responsible for
corrective action," said DiStefano.

The Consumer Satisfaction Team also interviews clients as they are
discharged from Norristown State Hospital and follows up with them
six months later to see how they are faring, said DiStefano.

"We are also becoming better at looking at outcome measures and
looking at evidence-based programs. People are actually progressing,"
DiStefano pointed out.