Use rates fall for behavioral health care

Analysts ask if more capacity or more outreach is needed

By Marissa Harshman, Columbian health reporter

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Clark County behavioral health service providers have a real puzzle on their hands.

While the number of Medicaid patients in Clark County continues to grow, the number receiving behavioral health services -- care for mental health and substance abuse -- is dropping. But, providers say, the need hasn't declined. If anything, it's increased.

"It's a real puzzler for us," said Steve Maynard, provider network manager for the Southwest Washington Behavioral Health Regional Support Network. "It's very complicated. At least we think it's complicated, because we really can't figure it out."

Since 2007, the rate of Medicaid patients' receiving behavioral health services in Clark County has steadily declined, according to the regional support network, which arranges mental health services for people on Medicaid.

The statewide rate fell in 2007 and went up in 2008, but has trended downward since then.

During the 2007 fiscal year, about 8.5 percent of Clark County Medicaid patients received services. In the 2011 fiscal year, the rate had dropped to 7.3 percent.

In 2012, the network served 7,662 Clark County adults and children on Medicaid.

For the last year, the network has been looking into the issue, trying to determine the cause, or causes, of the decline.

"One thing we think is, our providers are reaching maximum capacity as far as how many people they can serve," Maynard said.

The network is working with its partners to open new programs in order to increase capacity in Clark County. One apparent area of need is intensive services, Maynard said. People who need high-end treatment, such as those recently released from the hospital, are having difficulty connecting with services, he said.

The client population at Columbia River Mental Health Services in Vancouver, which contracts with the regional network, has also dropped.

Lynn Samuels, executive director of the nonprofit, thinks dwindling funding for community outreach is at least partly to blame. Tighter budgets mean service contracts no longer pay for outreach, she said.

Samuels also wonders if all the talk about funding cuts and eliminated services has made people believe the community doesn't have anything to offer.

In response, the nonprofit has created outreach teams to connect with primary care providers who serve the Medicaid population. The goal is to make sure providers are aware of the behavioral health services available, she said.

The nonprofit is also trying to make it easier for patients to get connected with services by offering same-day and walk-in appointments, Samuels said.

Outreach has effect

The nonprofit Children's Center in Vancouver, which provides mental health services to children and families, noticed a decline in referrals last year, said Pat Beckett, executive director. Since school started this fall, however, the referrals have returned to historic levels, she said.

The regional network reached out to schools in the county to help connect the schools with service providers, Maynard said. Those efforts appear to be paying off for the Children's Center, Beckett said.

The regional network and area nonprofits plan to continue community outreach efforts in hopes of reversing the current trend and meeting the growing need of Clark County Medicaid patients.

"I think the need is absolutely there," Samuels said. "I can't imagine that Clark County is that much healthier and wealthier than the rest of the state."

Marissa Harshman: 360-735-4546; http://twitter.com/col_health; http://facebook.com/reporterharshman; marissa.harshman@columbian.com.