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ENLARGE
Janet Holland, Douglas County mental health director, takes part in a Mental Health Advisory Board meeting Dec. 18 at the Fowler House in Roseburg. For the past couple of months the advisory board has focused on prioritizing the needs of mental health patients in Douglas County.
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ENLARGE
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Empty parking spots mark the closing of Mercy’s Behavioral Health Unit in Roseburg. The hospital closed the unit after losing more than $2 million on it last year. The BHU had been in the red for the last 10 years and could no longer sustain such losses, according to Mercy spokeswoman Kathleen Nickel.
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The recent closure of Mercy’s Behavioral Health Unit appears to be the latest casualty of a state mental health budget that’s been less than healthy of late, and the effects of the closure are being felt across the state.
The unit provided 18 acute care beds for adults with mental illnesses who needed inpatient treatment. On average, 30 percent of the patients in the unit were not from Douglas County, said Kathleen Nickel, Mercy’s communications director. With the unit’s closure, Mercy staffers now have to call hospitals up and down the Interstate 5 corridor whenever someone needs inpatient care, and the patients from out of the area who relied on the BHU beds are also left searching for treatment.
Douglas County and most other areas in the state also suffer from a lack of sub-acute care centers for people who don’t require stays at the state hospital but are not ready to be out on their own, said Jane-ellen Weidanz, director of public policy for the Oregon Association of Hospitals and Health Systems.
Mercy’s inpatient unit was running the highest deficit in the state before it closed in October, losing more than $2 million last year. It cost the hospital more than $1,300 a day to treat a patient in the unit in 2006, but the hospital was being reimbursed with state dollars only $851 per day. Mercy had to absorb the cost difference, and any additional costs if the patient stayed in the unit longer than the state’s five-day maximum. After 10 years of losing money, the hospital couldn’t afford to run the unit any longer, Nickel said.
The unit provided 18 acute care beds for adults with mental illnesses who needed inpatient treatment. On average, 30 percent of the patients in the unit were not from Douglas County, said Kathleen Nickel, Mercy’s communications director. With the unit’s closure, Mercy staffers now have to call hospitals up and down the Interstate 5 corridor whenever someone needs inpatient care, and the patients from out of the area who relied on the BHU beds are also left searching for treatment.
Douglas County and most other areas in the state also suffer from a lack of sub-acute care centers for people who don’t require stays at the state hospital but are not ready to be out on their own, said Jane-ellen Weidanz, director of public policy for the Oregon Association of Hospitals and Health Systems.
Mercy’s inpatient unit was running the highest deficit in the state before it closed in October, losing more than $2 million last year. It cost the hospital more than $1,300 a day to treat a patient in the unit in 2006, but the hospital was being reimbursed with state dollars only $851 per day. Mercy had to absorb the cost difference, and any additional costs if the patient stayed in the unit longer than the state’s five-day maximum. After 10 years of losing money, the hospital couldn’t afford to run the unit any longer, Nickel said.
The low reimbursement rates are not unique to Douglas County. Hospitals across the state are losing money because they are paid less than the costs of their services, said Weidanz.
“Mercy being forced to close BHU is an example of where the system is not dealing with the reality,” she said. “No hospital in Oregon is making, or even breaking even. All are in the hole by half a million to 2.25 or 2.75 million dollars.”
<b>STATE OF THE SYSTEM</b>
Here in Douglas County, communities are suffering from a lack of intermediate-level services, which could be used to help people before they need more intensive treatment at places like the state hospital.
The county has crisis teams for emergencies, and therapists and counselors for community outreach and preventive care, but no adult day treatment centers or other forms of intermediate care.
To address such problems and the state’s myriad other mental health needs, Oregon’s Department of Human Services would need to invest an additional $125 million per biennium for the next six to eight years, Weidanz said.
However, earlier this year when the 2007-2009 biennial budget was set, the Legislature awarded the state’s Addictions and Mental Health division just under $25 million in additional funding. Of that, only $2.5 million was allotted for acute services like those that were available at the BHU. As of July 2006, the state had more than 300 adult acute care beds, all of which were vying for a piece of that additional money.
For the next two years, the state has just over $600 million to spend on a range of mental health services. A little over $350 million will be spread across seven different areas that provide community mental health services, and about $230 million is set aside for the Oregon State Hospital.
The state hospital is in desperate need of repair; by 2013 two new facilities will replace the aging building currently in Salem, adding about 300 beds to the hospital. Design and construction is set to begin in the next two years.
“Mercy being forced to close BHU is an example of where the system is not dealing with the reality,” she said. “No hospital in Oregon is making, or even breaking even. All are in the hole by half a million to 2.25 or 2.75 million dollars.”
<b>STATE OF THE SYSTEM</b>
Here in Douglas County, communities are suffering from a lack of intermediate-level services, which could be used to help people before they need more intensive treatment at places like the state hospital.
The county has crisis teams for emergencies, and therapists and counselors for community outreach and preventive care, but no adult day treatment centers or other forms of intermediate care.
To address such problems and the state’s myriad other mental health needs, Oregon’s Department of Human Services would need to invest an additional $125 million per biennium for the next six to eight years, Weidanz said.
However, earlier this year when the 2007-2009 biennial budget was set, the Legislature awarded the state’s Addictions and Mental Health division just under $25 million in additional funding. Of that, only $2.5 million was allotted for acute services like those that were available at the BHU. As of July 2006, the state had more than 300 adult acute care beds, all of which were vying for a piece of that additional money.
For the next two years, the state has just over $600 million to spend on a range of mental health services. A little over $350 million will be spread across seven different areas that provide community mental health services, and about $230 million is set aside for the Oregon State Hospital.
The state hospital is in desperate need of repair; by 2013 two new facilities will replace the aging building currently in Salem, adding about 300 beds to the hospital. Design and construction is set to begin in the next two years.
The following is the state mental health budget for the 2007-09 biennium.
<b>Community mental health </b> — $359,200,764 Community mental health is divided among the following areas of service: <b>Adult Outpatient </b> — $87,790,028 <b>Child & Adolescent Outpatient </b> — $15,702,501 <b>Regional Acute Care</b> — $31,950,527 <b>Community Crisis</b> — $25,183,388 <b>Residential </b> — $152,412,173 <b>Older Adult</b> — $16,537,900 <b>Other </b> — $29,624,247 (includes funding for local administration, start-up costs for new projects and seed funding to build places for mental health consumers to live) <b>Oregon State Hospital </b> — $234,678,274 <b>Blue Mountain Recovery Center </b> — $23,918,592 <b>Total budget</b> — $617,797,630 |
In 2011, a new 620-bed facility will open in Salem, and in 2013, a 360-bed building will open in Junction City. The total cost of the project reaches just over $450 million.
“We’re one of the only states in the country building a new facility, but keep in mind that most rebuilt theirs in the ’60s and ’70s,” Weidanz said. “And we didn’t do that. We just stopped investing money.”
Now that the condition of the state facility is being addressed, some people worry that community services will be neglected. But Erinn Kelley-Siel, Gov. Ted Kulongoski’s human services policy adviser, said the governor’s office has made it clear to the Legislature that rebuilding the state hospital alone will not correct the shortfalls in mental health care.
“Last legislative session I think that it was made incredibly clear that building a state hospital will not ensure better community care,” Kelley-Siel said. “We need to transition. We need care to prevent patients from ending up in the hospital in the first place.”
<b>CHANGING COURSE</b>
All state funds for mental health care in Douglas County are funneled through the region’s mental health organization, Jefferson Behavioral Health, which is based in Grants Pass. JBH disburses state funds to six area counties and sets reimbursement rates for all mental health services. The closure of Mercy’s BHU has sparked concern over how Jefferson Behavioral Health is managing state money.
“There is a lot of dissatisfaction throughout most of the region about the way Jefferson Behavioral Health works,” said state Rep. Susan Morgan. “I think there is very legitimate questions about how efficient they are and the level of service they provide. A lot of people are trying to figure out a better way to do it.”
“We’re one of the only states in the country building a new facility, but keep in mind that most rebuilt theirs in the ’60s and ’70s,” Weidanz said. “And we didn’t do that. We just stopped investing money.”
Now that the condition of the state facility is being addressed, some people worry that community services will be neglected. But Erinn Kelley-Siel, Gov. Ted Kulongoski’s human services policy adviser, said the governor’s office has made it clear to the Legislature that rebuilding the state hospital alone will not correct the shortfalls in mental health care.
“Last legislative session I think that it was made incredibly clear that building a state hospital will not ensure better community care,” Kelley-Siel said. “We need to transition. We need care to prevent patients from ending up in the hospital in the first place.”
<b>CHANGING COURSE</b>
All state funds for mental health care in Douglas County are funneled through the region’s mental health organization, Jefferson Behavioral Health, which is based in Grants Pass. JBH disburses state funds to six area counties and sets reimbursement rates for all mental health services. The closure of Mercy’s BHU has sparked concern over how Jefferson Behavioral Health is managing state money.
“There is a lot of dissatisfaction throughout most of the region about the way Jefferson Behavioral Health works,” said state Rep. Susan Morgan. “I think there is very legitimate questions about how efficient they are and the level of service they provide. A lot of people are trying to figure out a better way to do it.”
The number of people treated through various Douglas County Mental Health services in 2006.
All numbers are unduplicated and based on the number of patients and not the number of visits. <b>By age (in years): </b> 0-17: 1,129 18-20: 168 21-59: 2,051 60+: 253 Total: 3,601 <b>By areas of the county:</b> South: 539 North: 361 West (Reedsport): 188 Roseburg: 2,389 Out of county: 56 Total: 3,533 <b>By type of service:</b> Medication services: 1,086 Community support (severe and persistent illness): 412 Treatment services (outpatient): 3,270 Total: 4,768 |
Various local organizations have voiced frustration with JBH over the past several years, said Janet Holland, the county’s mental health director. The county is always forced to fight to receive funding for services and has to sit back and watch while other counties receive extra dollars, she said. There is also uncertainty among local providers, who never know if JBH will reimburse them for their services, she said. When the county asked for additional funding for community services since JBH would no longer be paying for the beds at Mercy, Holland said the county was told there was no extra money to give.
Dave Bast, executive director for JBH, said the money is tied up in contracts with other counties that provide acute care beds, hospitals that Douglas County patients may be forced to use now that Mercy’s unit has closed.
Concerns surrounding JBH have prompted county commissioners to start looking for other organizations to support the county, Holland said. In order for Douglas County to withdraw from JBH, it would have to find another mental health organization to join. Usually state law requires that counties join a neighboring organization, but representatives for Lane County’s LaneCare told Holland that they cannot take on responsibility for another county at this time. Lane County is the only neighboring county that is not a part of JBH.
However, Greater Oregon Behavioral Health Inc., which serves counties in eastern Oregon and two counties in northwest Oregon, has said it will look into the possibility of adding Douglas County to its organization. The withdrawal from JBH is still in exploratory stages, Holland said, but it is something the county will be looking into and will pursue if possible.
“Douglas County should not be underserved just because Mercy had to cut down,” she said.
<b>COMMUNITY CARE</b>
Several state organizations have set goals to improve preventive care and provide more effective mental health treatment on both a local and a statewide level. For example, in 2004 the Governor’s Mental Health Task Force identified ways to improve the state mental health system, such as forming a cohesive “system of care,” or continuum of services.
A system of care approach gets mentally ill patients proper treatment at the appropriate time, and would ideally begin and end at the community level, Kelley-Siel, the governor’s adviser, said. Such a system would include preventive education in the schools, and outreach programs, therapy and counseling for people identified as having a mental illness or needing some kind of mental health treatment. Residential treatment, inpatient care units and adult foster homes would also be utilized in such an approach.
“I see it as a big, huge wheel that needs all its components,” Weidanz said. “You have to have all of the pieces.”
If patients need more extensive treatment, such as a stay at the state hospital, ideally the patient’s community service providers would welcome them back to the community with an outstretched hand and help with a recovery program that would treat them locally, Weidanz said. The state hospital should be seen as a final resort that few people would have to use.
“Someone pointed it out to me like this: Anybody who goes to the state hospital is a failure,” Weidanz said. “It means we didn’t step in and take care of them.”
<b>EFFICIENCY IS KEY</b>
Even though mental health care didn’t receive as much additional funding as many lobbyists believe it deserved, it is not something that will be forgotten. Oregon’s Community Mental Health Coalition, co-led by Weidanz, hopes to have a survey conducted before the 2009 legislative session to get an overall picture of the mental health care system, including areas that are being neglected.
“Everyone knows we need more money, but people don’t quite get how complicated the system is and how many players are involved,” Weidanz said. “If we do this analysis, we can get a framework.”
The survey will also help identify areas where money could be channeled in order to be as effective as possible with what funds are available, Weidanz said.
Being resourceful with mental health services money is something Douglas County has been successful at thus far, said Rep. Morgan. In the last legislative session, Morgan rallied for additional funding for community services. She hopes it’s something that will continue to be pushed for in the 2009 session, but in the meantime it’s up to the county to be as resourceful as possible.
“We’re looking at the population that needs services and trying to match up the funds to make the most efficient decisions,” Morgan said. “We’re looking at holes in the delivery system and looking for other resources and delivery methods to find where we need more (funding).”
• You can reach reporter Marissa Harshman at 957-4202 or by e-mail at mharshman@newsreview.info.
Dave Bast, executive director for JBH, said the money is tied up in contracts with other counties that provide acute care beds, hospitals that Douglas County patients may be forced to use now that Mercy’s unit has closed.
Concerns surrounding JBH have prompted county commissioners to start looking for other organizations to support the county, Holland said. In order for Douglas County to withdraw from JBH, it would have to find another mental health organization to join. Usually state law requires that counties join a neighboring organization, but representatives for Lane County’s LaneCare told Holland that they cannot take on responsibility for another county at this time. Lane County is the only neighboring county that is not a part of JBH.
However, Greater Oregon Behavioral Health Inc., which serves counties in eastern Oregon and two counties in northwest Oregon, has said it will look into the possibility of adding Douglas County to its organization. The withdrawal from JBH is still in exploratory stages, Holland said, but it is something the county will be looking into and will pursue if possible.
“Douglas County should not be underserved just because Mercy had to cut down,” she said.
<b>COMMUNITY CARE</b>
Several state organizations have set goals to improve preventive care and provide more effective mental health treatment on both a local and a statewide level. For example, in 2004 the Governor’s Mental Health Task Force identified ways to improve the state mental health system, such as forming a cohesive “system of care,” or continuum of services.
A system of care approach gets mentally ill patients proper treatment at the appropriate time, and would ideally begin and end at the community level, Kelley-Siel, the governor’s adviser, said. Such a system would include preventive education in the schools, and outreach programs, therapy and counseling for people identified as having a mental illness or needing some kind of mental health treatment. Residential treatment, inpatient care units and adult foster homes would also be utilized in such an approach.
“I see it as a big, huge wheel that needs all its components,” Weidanz said. “You have to have all of the pieces.”
If patients need more extensive treatment, such as a stay at the state hospital, ideally the patient’s community service providers would welcome them back to the community with an outstretched hand and help with a recovery program that would treat them locally, Weidanz said. The state hospital should be seen as a final resort that few people would have to use.
“Someone pointed it out to me like this: Anybody who goes to the state hospital is a failure,” Weidanz said. “It means we didn’t step in and take care of them.”
<b>EFFICIENCY IS KEY</b>
Even though mental health care didn’t receive as much additional funding as many lobbyists believe it deserved, it is not something that will be forgotten. Oregon’s Community Mental Health Coalition, co-led by Weidanz, hopes to have a survey conducted before the 2009 legislative session to get an overall picture of the mental health care system, including areas that are being neglected.
“Everyone knows we need more money, but people don’t quite get how complicated the system is and how many players are involved,” Weidanz said. “If we do this analysis, we can get a framework.”
The survey will also help identify areas where money could be channeled in order to be as effective as possible with what funds are available, Weidanz said.
Being resourceful with mental health services money is something Douglas County has been successful at thus far, said Rep. Morgan. In the last legislative session, Morgan rallied for additional funding for community services. She hopes it’s something that will continue to be pushed for in the 2009 session, but in the meantime it’s up to the county to be as resourceful as possible.
“We’re looking at the population that needs services and trying to match up the funds to make the most efficient decisions,” Morgan said. “We’re looking at holes in the delivery system and looking for other resources and delivery methods to find where we need more (funding).”
• You can reach reporter Marissa Harshman at 957-4202 or by e-mail at mharshman@newsreview.info.
