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June 29, 2009 9:29 AM
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YOUR VIEW: PIETER JOOST VAN WATTUM AND RONALD ANGOFF Closing Riverview Cuts Critical Children's Care

Courant.com
YOUR VIEW: PIETER JOOST VAN WATTUM AND RONALD ANGOFF
Closing Riverview Cuts Critical Children's Care


June 2, 2009

The idea of closing Riverview psychiatric hospital in Middletown has been proposed by some lawmakers and the governor to save money. This is not a viable option.

Riverview Hospital is an accredited 88-bed hospital that provides mental health treatment for children, 5 to 18 years of age, with extreme emotional and behavioral difficulties. The children at Riverview have been diagnosed with illnesses such as schizophrenia, bipolar disorder and depression, and often pose a chronic danger to themselves or others.

As part of admission criteria, they have failed treatment in other acute inpatient settings. Riverview patients come from places such as Yale-New Haven Hospital, the Institute of Living, Connecticut Children's Medical Center and Natchaug Hospital. The opportunity for chronic stabilization, improvement or a cure, in many cases, is at this young age; otherwise, inevitably many will fill our prisons and hospitals as adults - becoming a much larger financial and emotional burden.

Because of the severity and chronicity of the illnesses, and sometimes the difficulty in finding a suitable placement upon discharge from Riverview, the average length of stay during 2008 was 154 days - as opposed to one to two weeks in acute hospital settings.

A recent report by the Agency for Healthcare Research and Quality summarizes the five most costly conditions for children up to 17 years old in 2006. The "highest expenditures were for care and treatment of mental disorders." The report also points out that the reimbursement for mental disorders was lowest from private insurers, and highest for out-of-pocket expense. At capacity, the daily cost of a bed at Riverview is about $1,800, comparable to the cost of a general hospital bed. The cost of a Riverview stay is partially reimbursed by Medicaid if the patient is insured by the HUSKY program. There is little to no reimbursement from private insurers.

Riverview is a highly sought after site for clinical training of child and adolescent psychiatrists from Yale and UConn, and child and adolescent psychologists from Yale. It provides training for licensed clinical social workers from colleges and universities in the Northeast. According to the surgeon general's 2000 report, we need at least 35,000 child and adolescent psychiatrists to meet the mental health needs of our nation's children - and we only have approximately 7,000 in the U.S. When we are striving to provide increased numbers of trainees, it would be counterproductive to terminate the Riverview program.

Instead of reducing medically necessary care of the most severely ill children in our state, lawmakers should consider requiring private insurers to reimburse for psychiatric care, to relieve the burden on taxpayers and private and public hospitals. These children and their families or caregivers rely on Riverview for lifesaving and life altering treatment.

We, the providers of children's mental health services in Connecticut, must speak loudly on the behalf of those who cannot. Riverview must not close. Community hospitals and treatment settings cannot give the care in our communities that Riverview has done so capably these past decades. Many children have been stabilized or improved by the unique and high level of care at this hospital, which is well regarded at the state and national levels. Sadly, anecdotal and out-of-context reports about state institutions make good press. These reports must not force the closure of Riverview's treatment programs, which community hospitals and other treatment settings have consistently been unable to provide.

We would be more prudent to explore ways to achieve cost savings and increase revenues without crippling children's mental health care in Connecticut. Balancing the budget in the short term at the expense of eliminating essential services to Connecticut's most vulnerable children for the long term, cannot be an option.

- Pieter Joost van Wattum, M.D., is president of the Connecticut Council of Child and Adolescent Psychiatry. Ronald Angoff, M.D., is president of the Connecticut Chapter of the American Academy of Pediatrics.

Copyright © 2009, The Hartford Courant

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