Lawrence Memorial Hospital's decision to close its psychiatric unit Sept. 1 hasn't been as disruptive as many feared, hospital officials say.
But some in the mental health field say it is too soon to know, while others say what the community really needs is a detoxification program for alcoholics and drug abusers.
"By all reports, the transition has been smooth," Janice Early-Weas, director of community relations at the hospital, said of the unit's closure.
Hospital officials closed the 15-bed unit after three of the four psychiatrists who referred patients to the program -- Sheldon Whitten-Vile, Estanislao Rimando and Joseph Douglas -- resigned from active practice this summer because of relocation, poor health and increased demands posed by their outpatient caseloads.
Advocates for people who are mentally ill worried that without the unit, many patients likely would end up in jail or in Osawatomie State Hospital.
"It's still too early to say that that's happening," said Dave Johnson, CEO at Bert Nash Community Mental Health Center in Lawrence.
Adults needing inpatient care now are referred to the psychiatric units run by hospitals in Topeka and suburban Kansas City, Mo.
Johnson said Bert Nash eventually would like to see the psychiatric unit reopen because "people get better quicker when they're hospitalized in their own communities."
Still, Bert Nash has several programs designed to keep its patients out of hospital settings.
"The number of people who need hospitalization is not huge," he said. "But when the need is there, the problems tend to be pretty serious."
'We don't have the numbers'
Lawrence psychiatrist John Whipple doubts the unit will be reopened.
"The model for inpatient care has changed -- it's not local anymore, it's regional," he said.
For an LMH-size psychiatric unit to succeed, he said, it would have to draw patients from throughout northeast Kansas. That would be difficult, Whipple said, since Shawnee Mission Medical Center and Stormont Vail Regional Health Care in Topeka -- both less than an hour away -- already have well-established units.
"I know most people don't think of Lawrence as being a small town, but, really, we don't have the numbers," said Whipple, medical director at LMH's nine-bed psychiatric unit that specializes in caring for the elderly.
Before the adult psychiatric unit closed, its operations were combined with the geriatric unit's. The geriatric unit remains open.
When the adult unit was open, Whipple said, "more than 60 percent" of its admissions involved young adults who had threatened suicide after episodes of drug or alcohol abuse.
Most of these patients' conditions, he said, can be safely monitored outside a psychiatric-unit setting; the rest can be taken to Topeka or Lenexa.
Early-Weas said hospital officials were considering setting aside a few beds for a unit where intoxicated patients would be monitored and their mental health needs would be evaluated.
"That's being talked about," she said.
A better idea, Whipple said, would be for the community to start a short-stay, inpatient detoxification program.
"There's a great need for something like that in Douglas County," he said. "We definitely have the numbers."
"I agree completely," said Bruce Beale, executive director at DCCCA, which runs several drug- and alcohol-rehabilitation programs in Lawrence -- all of them outpatient.
"I've had lengthy conversations with my governing board about this," Beale said, "and the consensus is that we'd be happy to do it as long as it's financially doable. The problem is that the state's broke. There's no money -- when there is, I'm sure going to try to be first in line to get a detox unit going."
The unit would cost between $300,000 and $500,000 annually, depending on the services offered.
Much of the adult psychiatric unit's costs were offset by the geriatric unit's Medicare receipts. But a detoxification unit would not be eligible for Medicare funding, Beale said.