Christiana Care to end key mental health services

By day, Anthony Alfano deftly crafts whipped lattes and machiatto frappes at Starbucks, all the while dreaming of opening his own café.

The 19-year-old loves experimenting in the kitchen, especially with baked goods, and wants to make it his life's work.

Two years ago, though, he wasn't sure he was going to make it to his 18th birthday.

At 17, he battled intense depression and considered harming himself. He realized he needed help. When the teen psychiatric treatment program at the Herman Rosenblum Child and Adolescent Center was recommended to him, he enrolled and called it home for about three months.

"Honestly, it saved my life," Alfano, of Newark, said.

Christiana Care Health System will close Rosenblum Center on Feb. 20, and progressively close its outpatient psychiatric services in a move company officials say is part of a plan to overhaul its behavioral health care services.

Parents, advocates and many medical professionals say the effects will be heart-wrenching and throw people living with issues ranging from bipolar disorder to post traumatic stress disorder into a potential tailspin.

"How can they do it," said one woman who uses the outpatient program, but asked that her name not be used. "There is such a high demand for psychologists … Christiana has so many programs they self-fund, like weight loss, yet they are going to do away with this. This is ludicrous."

She is among patients who received letters in January explaining the changes. She had just begun outpatient treatment with Christiana in January to help recover from the trauma from abuse she endured from age 4 into her late teens. She's been diagnosed with bipolar II disorder, Tourette's syndrome, depression and suffers from severe anxiety.

She said she was told by her doctor in the outpatient program that "going to the News Journal would not be good for our practice."

"There are patients who have it worse than me," she said. "Just like cancer, mental illness is not a choice. When you go to somebody you build a rapport with them. It is not easy to go to yet another psychologist and tell this story over and over again."

Hospital officials say the plan is to move psychologists, social workers and therapists who work for Christiana Care's outpatient psychiatric program and Rosenblum Center into their primary care practices to diagnose mental illness earlier and more effectively.

Some patients will have to find new behavioral health specialists because of the move; about 2,000 Delawareans rely on the two programs now.

The changes are expected to be completed by May, officials said.

The Rosenblum Center offers intensive three- to eight-week treatment for students between the ages of 12 and 18 who need help and guidance. Patients live at home while enrolled in the program and continue their school work at the center so they don't fall behind in their studies. About 15 to 20 students are treated at any one time.

Alfano said the program was different from what he expected. Though there was intensive, one-on-one counseling, he says it was a very welcoming and warm place.

"They cared about every single one of us that came in there. Even when we didn't care," he said of the staff.

"It broke my heart a little bit to hear it. I love the therapists and everyone that works in that facility."

Stu, a parent who declined to give his last name to protect his daughter's privacy, said he was floored when he heard she would be one of the last patients Rosenblum would serve. At 16, she has suffered severe anxiety, depression and post-traumatic stress. She said she's thought about killing herself.

"I knew I needed help," she said.

Many of his daughter's friends in the program, Stu said, have had to come back for weeks at a time for a "tune up" after their initial enrollment.

"Where's the tune up now," he said. His daughter tried getting help at the Rockford Center, a psychiatric hospital in Newark, but she said she felt scared and uncomfortable being with patients who may have had violent pasts or histories of serious drug abuse.

"I feel safe there. I know I'm not going to be judged," she said of Rosenblum. "They will make your cuts feel like they aren't there. They will make you want to love yourself."

Rosenblum is no longer taking new patients and Delawareans who utilize the adult services will be assessed on a one-on-one basis if they need continued treatment, hospital officials said.

Some patients will be referred to other community providers, such as Mid-Atlantic Behavioral Health, if they need additional support.

"Each one is going to have a care plan and transition plan that makes sense," said Dr. Linda Lang, Christiana Care's director of psychiatric services. "We are not going to leave anybody stranded."

The therapists will be embedded in about 15 primary care practices from Wilmington to Middletown. The model is not new by any means, Lang said. Mental health professionals have been integrated into other Christiana Care's programs to help diagnose mental health issues as patients are being treated for other diseases like cancer or substance abuse, she said.

"Christiana Care is very committed to growing our resources in behavioral health. We have been doing that and continuing to do that," said Christiana Care Chief Executive Office Dr. Janice Nevin.

Nevin said Christiana Care's behavioral health care transformation is in line with Delaware's innovation plan, which looks to change the way health care is offered and how it is paid for in the state.

The increased access to mental health care will be "significant" Nevin said. The health system is hiring two new psychiatrists and two nurse practitioners as they go through the transition.

Officials said Rosenblum and the outpatient program are funded predominantly through third-party reimbursement, including commercial insurers and Medicaid. This move is not intended to save dollars, but improve access to overall services, Nevin said.

"I do think that this is the way of the future," she said. "This model of providing mental health services in primary care practices has been shown to improve overall health. The goal is same-day access for any new issues that may come up, but there will be ongoing therapy sessions."

Typically in a primary care practice, a patient may open up about feeling depressed or anxiety, but they won't be able to get specific treatment or consultation on the spot, said Penny Vigneau, senior vice president of Christiana Care's Cardiovascular and Behavioral Health Services.

They may have to set up an appointment with another professional in a different practice. Under the new model, a behavioral health specialist would be, ideally, right down the hall and able to talk to the patient, she said.

"We really want to talk to you right then and there in the moment," Vigneau said. "Mental health really is part of total health. That's the team model we are trying to build."

Advocates have questions about the new model and what it could mean for patients and for providers.

Jim Lafferty, executive director of the Mental Health Association in Delaware, is concerned the information being given to patients of both Rosenblum and the outpatient adult services is confusing.

"Patients have to be real clear about what is going on. It's a bit easier to deal with change," he said. Otherwise, they will just feel like they are being left out there, Lafferty added.

Beth Krieger, an alcohol and drug addiction counselor who referred a lot of patients to Rosenblum, said it is "disturbing" to those in the mental health field that such programs are being cut because there are already limited services in Delaware.

"If we have a kid in crisis we are going to be out of luck," she said.

"Kids now are just under so much stress. It's just really distressing to a lot of parents to know that their child doesn't have that as a resource."

There are similar adolescent programs at the Rockford Center and MeadowWood Behavioral Health System in New Castle, but some parents say they do not compare to what Rosenblum offers.

In late January a former Rosenblum patient created a petition through www.change.org to lobby the Christiana Care board of directors to change their minds on closing the center.

As of Sunday night there were close to 1,000 supporters, jumping from about 124 on Thursday night. Comments range from "For some people this may be their ticket to a better life and I don't think that that should be taken away from them" to "My friend's life was changed for the better at this center."

"I am just in shock," said Julie, a parent whose 15-year-old daughter transitioned out of Rosenblum in January after being enrolled for about four weeks. She declined to give her last name to protect her daughter's privacy.

"She immediately bonded with other kids her age that had similar situations. It's more like a school environment. She felt very safe," Julie explained. "When she was in Rockford, it was very different. A lot of information wasn't shared with us. It was much more like she was in prison than she was in a therapy center."

Her daughter said she cried when she found out the program would no longer be offered.

"It's just kind of upsetting to me that other people won't get to experience the help that I had," Julie's daughter said.

"You just had a really good support system that you could rely on and trust. You just had people who were there for you."

Senior investigative reporter Cris Barrish contributed to this story. Jen Rini can be reached at (302) 324-2386 or jrini@delawareonline.com. Follow @JenRini on Twitter.