Laurel sought counseling for her sons three years ago after discovering they’d been sexually abused by a family friend.
She wasn’t happy with the counselors they had until they were assigned to therapist Josh Lydon, but after Lydon left Compass Behavioral Health to start the independent company Roseburg Therapy, she said she ran into a barricade when she tried to keep him as their therapist.
(The News-Review is using pseudonyms for Laurel and her sons to protect the anonymity of sexual abuse victims.)
Laurel’s family has been through a lot. Her tone was flat as she described the problems they’ve gone through since the abuse was discovered.
Neil, 19, is depressed and on medications. Awhile back he was hospitalized after an episode in which he wanted to hurt himself and one of his brothers. Lydon is the only one that has been able to get him to talk, Laurel said.
Ben, 13, is out of control.
“He has not slept in his bed for two days, and I texted him yesterday, asking him if he was going to come home,” she said in an interview Tuesday.
The answer she received contained words too foul to be printed in the newspaper. But Ben has said he would like to resume seeing Lydon.
Laurel felt the boys’ previous therapists were too “wishy washy,” all talk and no substance. Lydon gives them real coping mechanisms, and he’s the only therapist the boys want to see, she said. She also said Compass appointments were scheduled a month apart, and her boys need to be seen more frequently. At Roseburg Therapy, they could be seen weekly.
But Laurel doesn’t have a lot of money. She’s divorced and she lost her livelihood after she was forced to close down her business, so her sons are on the Oregon Health Plan, the state’s Medicaid program. They’re members of the Umpqua Health Alliance, a coordinated care organization that manages care for most OHP patients in Douglas County. She said UHA denied their request to continue seeing Lydon because Roseburg Therapy is not “in-network,” meaning it’s not part of the organization’s network of providers. They’re appealing, and in the meantime, Lydon is treating them despite the uncertainty about whether he’ll get paid.
So is Laurel’s family’s experience typical, or is it an outlier? Some independent therapists outside of UHA’s network, including Lydon, told The News-Review that low-income mental health patients typically face month-long waits for appointments at in-network providers, and deal with frequent turnover of therapists. But UHA and Compass disagreed with that assessment. They said there are plenty of in-network providers to cover patients’ needs.
To put the issue in context, it helps to step back a few years.
Four years ago, the mental health system for low-income county residents was in crisis. The county government abruptly dropped its mental health program, giving 100 employees pink slips and giving up its mental health authority to the state. The state, along with local providers, scrambled to put together the Community Health Alliance, which limped along providing mental health services until 2016, when Adapt merged with it. The mental health program was re-branded as Compass Behavioral Health.
Since then, it has added providers, doubled the number of patients being served, and tripled the number of services provided each month, Adapt CEO Greg Brigham said. It’s also on the verge of signing an agreement with the Roseburg School District that will put counselors in 13 schools—a contract Lydon said he had hoped to win for his company.
According to Brigham, Compass is a real success story.
Compass recently started up a 24-hour-a-day mobile crisis unit for patients who are unable to care for themselves or are at imminent risk of harming themselves or someone else. People experiencing mental health problems that aren’t a crisis get a first appointment within two weeks, while those with more urgent needs are separated into two categories. The most serious, called “emergent” are seen within 24 hours 97 percent of the time. The next level, “urgent,” are seen within two days 89 percent of the time, Brigham said.
Statistics about how often existing Compass patients are seen or how high the therapists’ caseloads are weren’t available, but Brigham said the number of services provided indicates they’re being seen more frequently than in the past. He said caseloads would vary depending on how often individual patients needed to be seen.
There has been staff turnover at Compass, but overall, the number of providers has increased. Since November 2016, about 40 providers left, but 57 were hired, Brigham said. Compass services aren’t limited to individual therapy. They include psychiatric prescriptions and skills training—services many private therapy offices don’t offer.
“Now is every person getting every service they need, treatment on demand? I’m sure that there are times when we fall short, but there are limited resources, and I think they’re being used pretty efficiently here,” Brigham said.
Lydon doesn’t think so.
He served on the Compass youth and family team for two years and said his caseload there reached about 90 children — too many to give the level of service he thought they needed. Instead of regularly scheduling weekly appointments, he said he found himself performing a sort of triage to juggle who most needed to be seen quickly. Some, he said, fell through the cracks.
So Lydon opened Roseburg Therapy in March and brought in four therapists to work with him. About 70 of the organization’s 90 patients are UHA members. He said he needs to bring in more to earn enough money to retain his therapists. He said UHA won’t make Roseburg Therapy “in-network,” and has notified him it won’t pay for any more of its members to receive services there.
Lydon asserts that there are plenty of patients to go around, and additional therapists could ease any overcrowding at in-network providers, lowering wait times for patients and allowing them to be seen on a weekly, rather than a monthly basis.
“What I’m offering at the table is basically the providers. It’s not a provider issue, it’s just whether or not UHA as the payer, the predominant payer for most people’s health care in this county, will allow those providers to do their job. Right now they are not,” he said.
Family therapist Jody Howell worked at Valley View Counseling before joining Roseburg Therapy in April. Valley View is an in-network provider for UHA.
Howell said he felt overloaded at Valley View, where he said he was seeing about 45 patients a week, and he also hears from patients about long waits for care at in-network providers.
Howell said he spent years on committees at Valley View and when he worked for the state’s child welfare office before that. There were hours spent watching power point presentations at lunch meetings where people talked about how to improve mental health care in Douglas County, but nothing ever seemed to get done, he said.
He feels Roseburg Therapy is finally calling out the elephant in the room, saying clients would be better served by a bigger network.
“Look, here’s what you do. You just have another agency to handle more of the clients that you can’t. You share. You help the clients get their needs met now. That’s what you’re supposed to do,” he said.
Lydon is promoting a change.org petition stating that mental health services for OHP patients in Douglas county are “inadequate” and “inaccessible.” It had been signed by 106 people as of Friday afternoon.
Lydon also points to a 2017 Oregon Health Authority report on coordinated care organizations across the state, including UHA. It said most CCOs aren’t adequately monitoring whether their networks of providers have the capacity to “ensure timely access to all required services,” including mental health services. Another 2017 OHA report found that UHA was below benchmark on access to care generally (not just mental health care), and on followup after hospitalizations for mental illness.
Umpqua Health Alliance spokeswoman Kat Cooper, however, issued a written statement that said the organization has plenty of therapists available in its network already, and it routinely monitors them to ensure that even non-urgent mental health appointments are scheduled within two weeks. UHA contracts with 23 independent providers in addition to larger organizations such as Valley View Counseling and Adapt. UHA also operates two clinics on Harvard Avenue.
“Mr. Lydon has made repeated claims that he has spoken with several Umpqua Health Alliance members who are experiencing long wait times for appointments. We have asked him numerous times to provide us with these individuals’ names so that we can help connect them to services, but Mr. Lydon has thus far refused to do so,” the statement said. It also said members having difficulty accessing services should call 541-229-4842 to schedule an appointment.
Brigham said Compass has helped transform mental health services in Douglas County.
“I would say it’s probably very safe to say that there has never been better access to mental health services for mental health recipients than there is right now, ever in the history of this county, probably by a pretty good stretch,” he said.