Taken from the Green Bay Press Gazette which is located HERE.
Some of Brown County’s most vulnerable residents — low-income people who suffer from chronic mental illness — must wait months for essential psychiatric care because of limits to budgets and staffing.
These patients wait an average of three months to be seen for treatment at the county’s adult outpatient clinic in Green Bay, according to county Human Services officials. That’s two months longer than the wait should be, they say.
County Human Services Director Brian Shoup called the situation “a hole in the safety net,” and said the county is working to significantly cut the wait by filling a vacant position with a half-time psychiatrist or nurse practitioner who could prescribe medications and provide therapy, with additional nursing staff support.
“If you’re making people wait longer than 30 days, I can tell you that you’re not providing the best mental health care,” he said. “(Patients) are going to drop out (of the health-care system). They’re going to disappear. Or they’re going to relapse.”
The way the public health system treats mentally ill patients has changed over the past several decades, driven in large part by the closure of expensive government-run psychiatric hospitals. It reduced the numbers of patients in hospitals, sending many to nursing homes but leaving many without any place to go.
It also increased the demand for treatment at outpatient facilities like the Brown County Community Treatment Center, which opened in Green Bay in October 2009 to replace the county’s aging Mental Health Center. Because of changes in how mental health care is delivered, the center has fewer than half the number of inpatient beds its predecessor had, but sees more people on an outpatient basis.
Nationally, the number of people with serious mental health issues in state psychiatric hospitals has shrunk from 559,000 in 1955 to fewer than 70,000 today, according to the National Alliance on Mental Illness, a New York-based advocacy group. Brown County officials said they can’t compare the current wait for outpatient care with that from 10 or 20 years ago, but believe it is significantly longer now. Three months, they say, is not acceptable.
While officials said they want to hire an additional psychiatrist or nurse practitioner to provide outpatient services, they must get approval from elected officials — even though funding exists within the county budget. Then, they have to recruit someone qualified to do the job.
For someone unable to get mental health treatment, the problems can be significant — especially in cases of serious conditions such schizophrenia and a manic-depressive illness. Family problems, unemployment, arrests, homelessness and jail time all are greater risks to the mentally ill than to the general population.
Untreated, mental illness affects many people. It taxes people and institutions in the community in a number of ways, including:
• The neighborhood. When a mental condition prevents a parent from caring for children, the issue can burden a spouse, a parent, a schoolteacher or a daycare provider. Homelessness can alter perceptions of a neighborhood, and possibly harm property values.
• On the job. When a person misses work, burdens fall on co-workers and the employer.
A 2005 study by researchers at Harvard, the University of Michigan and the National Institute of Mental Health found that people with serious mental disorders — about 6 percent of the population — averaged 88.3 days per year when they could not carry out daily activities. The National Alliance on Mental Illness said bipolar disorder alone accounts for $17 billion in lost productivity.
• On the street. Untreated mental illness can strain police resources, pulling officers from neighborhood patrols to respond to a fight or disturbance. Some of those incidents are violent. Nationally, a study by the U.S. Conferences of Mayors found that 26 percent of homeless people suffer from “serious mental illness;” the percentage with other mental health issues likely exceeds one third.
• At tax time. If a patient lands in a private hospital because he or she couldn’t get treatment in the public health system, the cost can be higher by $200 per day, the National Alliance on Mental Illness estimates. In some cases, taxpayers foot those bills.
“Not getting people in to a prescriber in a timely way creates a vicious cycle,” said Shoup. “You end up treating people at the highest cost level.”
Another consequence: When the mentally ill go untreated, jails and shelters become surrogate hospitals, according to Mental Illness Policy Org, a New York-based think tank that focuses on mental health issues.
Patients who don’t receive appropriate treatment after a hospital stay, according to the organization, cycle “through an endless revolving door of admissions, jails and public shelters.” Instead of receiving the medications and counseling they need to get back on track, they may simply bounce from agency to agency.
At any given time at the Brown County Jail, 11 percent to 12 percent of inmates are on medication to treat a mental disorder, said Lt. Phil Steffen, jail supervisor. “Fox Pod” — the jail’s Special Needs Unit where jail inmates with mental health issues are housed — is one of the facility’s busiest, requiring a higher number of staff members.
“We started off with one officer in the pod,” Steffen said. “It didn’t take us long to realize we needed more.”
The issue exists elsewhere in the county justice system. Donald Zuidmulder, a circuit court judge for 15 years after two decades as the county’s district attorney, said a significant portion of the defendants he sees suffer from a mental health illness or addiction or both.
The wait to see a psychiatrist for the poor in Brown County is a function of limited numbers of staff who can perform a mentalhealth evaluation, officials said. The county last year handled its caseload with two full-time psychiatrists, plus a third who worked six hours per week.
Another doctor and two nurse practitioners provided part-time help under contract. But in terms of reducing the wait, supply did not meet demand.
In 2011, the county had more than 3,800 “active outpatients,” said Kevin Lunog, behavioral health services manager. Patients receive therapy from weekly to once every three weeks. Shoup said the most effective treatment nowadays combines medication and talk therapy — different than in previous decades, when therapists likely chose one or the other, and a patient was more likely to be hospitalized.
Increased wait times are also a consequence of the shift from inpatient to outpatient care. In previous decades, more of the county’s mental health clients received inpatient psychiatric treatment. The old Mental Health Center included an 88-bed psychiatric hospital. The center that succeeded it is set up for about 35.
“That’s reflective of the change in demand for type of care,” said Shoup. “People don’t need to be admitted. They need stabilization.”
When a county is serving so many patients, significant costs can be involved.
The county billed about $1.02 million for services provided by its outpatient clinic last year. More than half of that was paid by Medicaid and a Medicaid HMO; only 6 percent was covered by private insurance.
“If you’re poor and on Medicaid, the reimbursement rates are abysmal,” Shoup said. “The number of providers (who provide mental health care for Medicaid patients) has dwindled, but you can’t blame that on the providers.”
He praised the hospital systems in the Green Bay area for performing significant work on behalf of low-income patients, but said that those who can’t get private care end up at the county clinic. “The county,” he said, “is the provider of last resort.”
The potential costs to the county of improving service could be a sticking point, some local lawmakers said. Officials say they were pleased that human services spending was cut by about $5.5 million dollars compared with 2011 levels while increasing the number of caseworkers devoted to protecting children. Still, there is a concern that addressing the problem could require additional spending.
Members of the county’s Human Service Board recently indicated that they will support the addition of staff. But a willingness to show support, one said, might also be a hint that members worry that the County Board might oppose the hiring more people.
“If we get any static about this, I want to hear about it,” said Hollandtown Supervisor William Clancy, a member of the Human Services Board.