> ## Behavioral health center closes doors

> By BRYAN NOONAN
> bnoonan@lakecityreporter.com
> Lake City Reporter
> June 1, 2002

> The sanctuary known as the Cypress Center for Behavioral Health closed its doors this morning. Those suffering from schizophrenia, bipolar, major depression and other debilitating mental illness will no longer find treatment between the familiar walls inside Lake City Medical Center.

> "Leave it open," pleaded Deborah Walker, not fully understanding. Walker is a diagnosed paranoid schizophrenic living at Eastside Care Retirement Center off Defender Avenue. The center houses nearly 30 residents suffering similar delusions and hallucinations that come with the illness. "We need it because we need a hospital to go to," said Walker.

> A dozen assisted living facilities in Lake City are uncertain what they will do the next time one of their residents sinks into a psychotic episode. For the past 20 years, Lake City Medical Center's behavioral health unit was the place for them to go.

> "A lot of them will be in the jail, a lot of them will end up on the streets, a lot of them will be a menace to society," said Randy Kay, who works with residents at an undisclosed assisted living facility in Lake City. "Most of all, they'll be harmful to themselves or others."

> Lake City Medical Center is closing the center to open 20 beds for surgical needs. In the past year, the hospital has been aggressively recruiting new physicians to the area so it can compete with the growing healthcare demands in Columbia County.

> "What we're trying to do is convert psychiatric beds to medical surgical beds," said Lake City Medical Center CEO Garry Karsner. "We're trying to make the decision to meet the needs of the community."

> These needs are not helping the demons inside Walker's mind. At one point Walker said she spent a month straight in the Lake City Medical Center behavioral health unit. She said Dr. Umesh Mhatre, the director of the program since 1979, saved her life there. Then she pauses with her head cocked to its side.

> "I've got a chip in my ear and they can hear everything you're saying," Walker said. "The police can."

> Psych unit needed

> Hallucinations twist reality into fear, fear into panic. Caught in a bout of psychotic reasoning, paranoid schizophrenics often cannot tell the difference between right and wrong.

> "We need some kind of psych unit here in Lake City," said Daphine Kirby, Eastside Care owner. A resident peeked suspiciously into the office with his face cupped to the window while she spoke. "I can't believe the county wouldn't have something other than just Meridian."

> The doors leading into Meridian Behavioral Healthcare off U.S. 41 South are shielded behind white pillars and trimmed hedges. The tall ceilings inside were made to contain hallucinations. The 10-bed in-patient crisis stabilization unit is often filled with patients hearing voices or seeing faces that are not there.

> The center is funded by the state for indigent patients, and its small staff of nurses and psychiatrists is not licensed to treat severe medical problems, or "medically complex" patients in need of intravenous tubes or antibiotics to soothe them.

> "It's going to be a big mess," said Robert Gottschalk, administrator at The Plantation, off Sisters Welcome Road. That facility houses 35 residents, 95 percent of which are paranoid schizophrenics. "I don't think Meridian is equipped for what's about to happen."

> But there was a time when Meridian didn't have Lake City Medical Center to rescue patients.

> Betty Strayer is the vice president for the northern region of Meridian and oversees approximately 125 mentally ill residents from six counties in northern Florida. She said the center has to think back to the time when it was the only one of its kind in the county.

> "We have to find a way," Strayer said. "We have to find a resource somewhere."

> The closest resource now is about 50 miles away at Shands at Vista Hospital in Gainesville. If that center is full, there are hospitals in Jacksonville, Orange Park and Tallahassee. But, Strayer said each psychiatrist has a unique strategy for treating disorders and some of the patients will be taking medications their bodies are not used to. Consistency of treatment will likely be lost.

> But Strayer's biggest concern is simply treating the patients in a timely manner. Her biggest fear is not being able to contain them if they lash out with no place to go.

> "If they are out of control ‹ and we do get patients that are out of control ‹ we will manage them by putting them in a seclusion area temporarily, by calling law enforcement if we need to," Strayer said. "We may do a physical leather restraint, arms and legs, but that's the most we would do."

> Hearings end too

> On Friday, the last two patients inside the Cypress Center were released to other hospitals. Its days of treating schizophrenia, various dementias and affective disorders, including major depression and bipolar, are over. Twenty beds wait to be primped for surgical needs.

> The closure will end Circuit Judge Julian Collins' Thursday afternoon visits to the hospital for hearings on patients committed by outside parties. He was sent in to determine if they were incompetent and should be hospitalized involuntarily.

> "Time is going to tell what is going to happen, but I don't know how we are going to deal with the problem," Collins said. "I just don't know where these people are going to go."

> One reason the assisted living facilities in town are full is because of the "de-institutionalizing" of state mental health hospitals that took place in the early 1980s. Strayer said hundreds of patients were released into communities across Florida, right around the time Lake City Medical Center and Dr. Mhatre admitted the first patients into their new behavioral health unit.

> "Once you get in the state hospital, you stayed forever, most of the time," Strayer said. "Until the concept of de-instituionalization came along. That was the idea that it was inhumane to hold them in a state hospital if they could function in the community."

> Now history has come full circle. Gottschalk said The Plantation is not overcrowded, but the Macclenny State Hospital, which exclusively houses people with chronic mental illness, has 19 men waiting to be admitted. Some of Lake City's mentally ill may have found treatment there, but like the hospitals and centers in the region, there is no room for them.

> Looking at the residents outside her office window at Eastside Care Retirement Center, Kirby says the saddest part of the whole thing is that most of them don't realize the impact Cypress Center's closing may have on their lives.

> "They don't really understand," she said.