MENTAL HEALTH CARE CRUNCH: A TWO-PART SERIES
TODAY
• Those dealing with mental health crises find care options are limited.
• Local agencies respond: Southwest Behavioral Health plans to add services; free clinic explores adding services for the uninsured.
MONDAY
• Mental health courts try to reduce the number of mentally ill defendants cycling through the criminal justice system.
$4M in mental health services to be added
The number of people eligible for mental health services through Southwest Washington Behavioral Health Regional Support Network has grown by more than 30,000 since the Medicaid program expanded this year.
To keep up with that need, the network is looking to add $4 million in outpatient and specialty services in Clark, Cowlitz and Skamania counties, said Marc Bollinger, the network’s chief clinical officer.
Southwest Washington Behavioral Health administers and coordinates mental health care for regional Medicaid clients who have higher-level diagnoses and needs. The network contracts with area mental health organizations to provide those services.
As more people become eligible for those services, the amount of money the network receives from the state to provide those services increases, Bollinger said.
In June, the network asked mental health agencies to submit program ideas for funding consideration. Sixteen agencies across the three counties submitted 27 different program ideas, which included programs targeting the homeless population, children in trauma, hospital diversion and early intervention, among many others, Bollinger said.
The network is currently evaluating those ideas and will request formal proposals for selected programs. The network will draft contracts with the agencies, and the contracts will go to the network’s board for approval in November, Bollinger said.
“There should be a number of new services available to those in Clark County in January,” he said.
Southwest Washington Behavioral Health currently provides about $28 million in outpatient services.
— Marissa Harshman
Free Clinic may add mental health services
While Medicaid expansion has enabled more Clark County residents to gain access to mental health services, the Free Clinic of Southwest Washington is still seeing a number of uninsured patients seeking those services.
The Free Clinic doesn’t provide mental health services. Instead, the clinic typically reaches out to community partners, such as Lifeline Connections or Columbia River Mental Health, to provide outpatient services to its uninsured patients.
In the last year, the Free Clinic has made 171 referrals for mental health or substance abuse services, said Barbe West, executive director of the Free Clinic. But the additional Medicaid patients have complicated the situation, she said.
“They’re so challenged by all the Medicaid patients, and that is their priority, and they can’t really accommodate the people that are uninsured,” West said of the agencies.
In response, the Free Clinic is exploring an idea that would bring mental health services to the clinic.
The Free Clinic is working with Lifeline Connections on a proposal to bring a behavioral health interventionist to the clinic once a week, West said.
“It’s not going to resolve the ongoing needs of mental health,” she said. “It would be more like an intervention.”
But to get the idea off the ground, West has to secure grant money to fund the program. West has just begun the search, but she’s hopeful she’ll find the money.
“It’s an important approach in how we deliver care, not just us, but everybody,” she said.
— Marissa Harshman
By the Numbers
70,000
The number of Clark County Medicaid clients eligible for higher-level mental health services prior to the Jan. 1 Medicaid expansion.
99,000
The number of Clark County Medicaid clients currently eligible for higher-level mental health services.
86
The percentage of those who receive an initial appointment with a mental health provider within 10 days.
$4 million
The amount of new mental health outpatient and specialty services to be purchased by Southwest Washington Behavioral Health.
20
The average number of patients seeking behavioral health services in the PeaceHealth Southwest Medical Center emergency room each day.
12
The average number of patients seeking behavioral health services in the Legacy Salmon Creek Medical Center emergency room each day.
Gregory’s teenager was diagnosed with bipolar disorder six years ago.
In those six years, the family has made at least a dozen trips to hospital emergency departments. The teen’s first trip to the emergency department was because of an overdose. The subsequent trips were during times of heightened crisis when Gregory’s teenager would go from being a big-hearted, kind child to destroying furniture and threatening self-harm or to harm Gregory and his wife.
“We know it isn’t the appropriate place to get care, but where else do we go?” Gregory said. “Jail is also not the appropriate place, but those are the only two places families have.”
Gregory and his family live in Vancouver. The Columbian is not using his real name, at his request, to protect his family’s privacy as his teenager continues to seek mental health services in the community.
Gregory’s frustration is shared not only by other families, but also health care providers, emergency department staff and mental health service providers.
All acknowledge the mental health care system in Clark County and across the state has gaping holes. The service needs reach across the spectrum of mental health care: crisis services that give families an option other than emergency rooms or law enforcement intervention; inpatient beds that provide intensive treatment, counseling and medication management; qualified counselors and prescribers to provide treatment; and outpatient services to prevent more crisis situations.
In some ways, those voids have been compounded, local providers say, by this year’s Medicaid expansion, which added tens of thousands of adults to the health program for low-income people. That expansion also meant a dramatic increase in the number of people eligible for state-funded mental health services.
