Stacey Lindbergh

Reduced state and federal funding for residential and community-based psychiatric treatment has forced providers across the Palmetto State to re-evaluate and re-define their missions, according to Debbie Calcote, who is executive director of the Berkeley County Mental Health Center in Moncks Corner.

"Our mission has narrowed over the years," said Calcote, who has worked for the county mental health system since 1981. "There was a time when we offered a wider range of services such as counseling for marital discord and other issues. But our treatment at the center now focuses on people with serious mental health problems because we don’t have the resources to provide everything."

Reduced governmental support for community psychiatric providers has affected private, for-profit facilities, too, according to Marc Turner, who is COO at PBHS.

Private psychiatric facilities were virtually non-existent until the 1970s when state governments across the United States began closing state hospitals. South Carolina, which was the second state in the union to establish mental hospitals in 1822, now has only two state hospitals within its system.

There are fewer options for psychiatric treatment within the private sector, too. Many larger medical-surgical hospitals use to maintain psychiatric wings to treat mentally ill patients. But as these institutions struggled to run profitable enterprises in recent years, these units closed, too. Today, Medical Hospital of South Carolina is the only hospital that continues to maintain a psychiatric wing in Charleston.

Cherie Tolley

"Over the last five to seven to 10 years, there have been continual reductions in state services and the community-based services have had to fill in the gaps," Turner said. "(PBHS doesn’t) purport to be a substitute for a state hospital but I feel we’re an important resource for the community. We’re the only psychiatric facility outside of MUSC in the area. ... If we weren’t here, a lot of people would not get psychiatric care. Still, the need in the community is probably greater than what we can provide. We can’t be all things to all people but we tackle what we do well. Unfortunately, this means there are people who are under-served who would have formerly been served by the state hospital system."

Tolley said she was disappointed that the state legislature was unable to override Gov. Mark Sanford’s veto of a proposed cigarette tax earlier this year. The bill contained provisions to help fund community psychiatric services.

"We are one of the few freestanding psychiatric hospitals in the state but what we run into is that we cannot take adult Medicaid and it’s very difficult to get children’s Medicaid," Tolley said, noting that the bulk of PBHS’s income is paid through private managed-care health plans.

MUSC, on the other hand, is able to collect these federal monies because 1960s-era rules sanction adult Medicaid payments to medical-surgical hospitals that offer psychiatric services.

Despite its limited access to public dollars, PBHS is mandated to provide treatment to unfunded patients who seek admission. Consequently, Tolley’s facility often ends up writing off those expenses.

"We used to get some disproportionate share money to offset those costs but we lost that about two years ago," she said. "So freestanding psychiatric hospitals have really taken a hit over the years."

Daniel Island resident Stacey Lindbergh was recently named PBHS’s director of Community and Governmental Relations. (She has also been nominated to serve on the Berkeley County Mental Health Board.) Before her job change, she worked with the PBHS mobile evaluation unit, which travels to area hospital emergency rooms to assess patients for possible admission. She said area hospital emergency rooms are sometimes clogged with uninsured psychiatric patients who are awaiting placement in treatment facilities or state hospitals.

But placement at state facilities in Bryan or Anderson typically doesn’t happen overnight, Lindbergh said. In one case, a patient spent 17 days in an area emergency room until the state had an available bed.

Marc Turner

The shortage of state hospital vacancies affects PBHS patients, too, according to Tolley.

"The waiting list for getting into state hospitals from a psychiatric hospital is long and nobody from here can be admitted to a state facility if there’s someone waiting in an ER anywhere in South Carolina," she said. "So it can take an excess of 60 days to get them admitted while the average stay here is typically eight to 10 days. That’s not good care for the patients if they need services beyond our capacity to treat."

Groundbreaking medical research unlocked many secrets about mental illness over the past 20 years. Today, psychiatric professionals understand that biochemistry, heredity and brain trauma are major contributing factors and modern medications are helping patients manage their illnesses and their lives.

Nevertheless, Tolley thinks there is still a stigma surrounding psychiatric disorders that doesn’t exist with other medical conditions.

"If you’re spending Christmas with your family and you’ve been diagnosed with diabetes or high blood pressure during the past year, you wouldn’t have any problem talking about it," Tolley said. "But if you’ve been diagnosed with depression, it’s unlikely you’ll say, ‘Yeah, man, I started on some Zoloft and it’s great.’ Many people still have the feeling of somehow being defective and we in society still view people who have these issues as weak in some way."

These attitudes, coupled with the current shortage of psychiatric treatment options, oftentimes impede people from seeking help when they begin experiencing difficulties.

"It’s so important for people, particularly parents, to recognize the warning signs of mental illness," Tolley said. "Unfortunately, people often wait until they’re faced with a crisis. Nobody wants a family member or child to become an in-patient but if they get treatment early, they can prevent criminal charges or suicide. The key is prevention, not waiting."