Catholic Health World

St. John expands access to mental health services in challenging economy

Session to cover facility's approach to filling funding, care gaps

By expanding the services it offers to high-functioning mental health patients, PeaceHealth St. John Medical Center of Longview, Wash., is generating enough revenue to improve care for people who have significant mental health needs but no means to pay for services.

"The model fits well (for our patient population) — there is more access to services," said Kyle Rahn, regional director of behavioral health for St. John. "We made a business decision that helps us to achieve our mission and maintain services for a population in need."

Rahn and two colleagues will explain the approach to cross-subsidizing services during a session at the June Catholic Health Assembly called "Meeting Mental Health Needs at Every Age." The other pre-senters are Claudine Walker, outpatient services manager, and Robert Axelrod, associate medical director, both of St. John Behavioral Health Services.

Funding down, needs up
St. John developed its approach as it was facing the type of budget challenges that are straining mental health providers that rely very heavily on government payers for their income. Since the recession, government budgets have been stretched thin, and many states are having to cut back their funding of mental health services.

"This continues to be an issue that (health care providers) that have a mission based on need have to tackle," said Rahn. "As state funds shrink, so does our ability to serve patients."

The government budget cuts come at a time when economic upheaval and rising joblessness are increasing personal and family stress levels and vulnerability to mental health concerns. According to information from the U.S. Substance Abuse and Mental Health Services Administration, economic turmoil can result in a host of negative health affects and can be "devastating to emotional and mental well-being."

Groups left out of system
In Washington state, governmental funds for mental health services are doled out by entities called Regional Support Networks. Those networks' changing policies in recent years have resulted in funding going primarily to Medicaid recipients. Services fell in line behind the funding source and Medicaid recipients had access to mental health services, Rahn said. But people outside the Medicaid system had difficulty accessing services, especially in a market like Longview, where mental health service providers are in short supply, said Rahn.

Two groups that have suffered with the cuts and the shift in focus to Medicaid-covered mental health services are impoverished people with very acute mental health needs and people who could benefit from episodic mental health services, Rahn said. The latter group includes both the working-class uninsured who make too much money to qualify for Medicaid and privately insured people.

Regarding the first group of severely mentally ill patients, Rahn said, "These are the indigent who are chronically mentally ill. They don't even apply for Medicaid — they lack the ability to even come up with the address needed to apply for Medicaid because they can't maintain housing. They're in a vicious cycle." In Washington, an address is required to obtain Medicaid services, he explained.

The second group, he said, are "folks who are functional, they have a job, but they have a situational problem like a divorce" that affects their mental well-being.

Both groups are of concern to health care providers, said Rahn. The indigent patients with acute needs tend to cycle through emergency departments, and there often is no place to send them for ongoing mental health care. The high-functioning group could benefit greatly from care, so that their concerns don't escalate and become full-fledged mental health conditions, Rahn said.

An expansion with legs
St. John was able to better address the needs of both the low-functioning and high-functioning groups through an expansion of services last year.

It opened the Peace of Mind clinic in the spring to serve high-functioning patients who may benefit from a brief period of outpatient therapy for a particular need, such as a depressive episode related to a problem at the workplace.

The Peace of Mind clinic is part of a continuum of mental health services within St. John's behavioral health department. The main hospital campus operates an inpatient mental health unit. An affiliated campus has an outpatient behavioral health clinic for adults — including those with serious, chronic mental illness — and A Child's Place, for children and adolescents. All of the locations that serve adults share staff.

The addition of Peace of Mind allows St. John to cluster patient services according to acuity of symptoms and severity of illness, a separation that Rahn said increases the comfort of some patients with less severe mental health issues. The hospital now treats the most severely mentally ill patients at its main campus and at the outpatient behavioral health clinic and its higher-functioning patients at Peace of Mind.

Misimpression about services
Rahn said some hospital staff and community members have criticized the patient segregation, falsely believing that it is based on ability to pay rather than clinical condition. His team is working to correct the critics' misimpression that the Peace of Mind clinic serves only privately insured clients.

While the clients served by Peace of Mind tend to have reliable means of reimbursement — often private insurance — the clinic does not discriminate based on a patient's payer source or inability to pay, he said.

Put another way, he said, a person's mental health function loosely corresponds to his or her ability to hold a high-level job, which in turn loosely corresponds to insurance status.

Few people who come to the Peace of Mind clinic are indigent because the clinic's patients are high-functioning individuals who tend to be able to keep their jobs during boughts of anxiety or depression and thus maintain insurance coverage or the ability to pay for their services, Rahn said. In contrast, individuals with severe mental illness often find it hard or impossible to hold down a job.

The Peace of Mind clinic is filling a vacuum in the market, and new, previously underserved patients are taking advantage of the nearby access to mental health services. St. John is using net revenue from its Peace of Mind clinic to invest in services for its very sick indigent patients who are served at the other locations. For instance, Rahn said, the increased revenue is enabling the behavioral health department to add new clinicians who will serve patients all along the continuum of mental health care. In this way, the Peace of Mind Clinic is allowing St. John to advance its mission of caring for the vulnerable and indigent.

The workshop covering this mental health care model is one of 15 innovation sessions at the Catholic Health Assembly taking place June 13 to 15 at the Hyatt Regency Denver. Information on the assembly is available at www.chausa.org/assembly.

Copyright © 2010 by the Catholic Health Association of the United States
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