Nov. 28, 2006
A change in the way Washington County handles urgent mental health care cases has reduced the number of emergency detentions of disturbed individuals, even while the need for mental health services and the portion of patients who are uninsured increase.
Since the new programs were implemented in July 2005, the county has had 103 less emergency detentions than the previous year, a drop of 29 percent. Juvenile emergency detentions for the same year went down by 52 percent, from 90 to just 43.
The county’s Comprehensive Community Services Agency previously leased space in St. Joseph’s Hospital in West Bend, where county personal operated a 17-bed mental health inpatient unit until July 2005. To augment the inpatient unit, CCSA provide 96 hours per week of mobile crisis prevention and a crisis hotline.
Since the new location of SynergyHealth St. Joseph’s opened in the town of Polk last year, the county contracts the hospital to care for patients who need to stay in supervised care. The switch has allowed the county to offer 24-hour mobile crisis care every day, reducing the number of patients it has to pay to be treated on an inpatient basis.
During July 2005 through June 2006, county monitored adult psychiatric admissions were halved from the previous year, from 818 to 403, a drop of 51 percent. Juvenile admissions fell 57 percent during the same period, according to Deb DuFour, program manager of the county’s acute care services.
The program was able to divert 156 adults from the hospital in its first year. By its second year, it diverted 529 cases — an increase of 135 percent.
“We’ve reduced our dependence on the hospital, and we’ve not increased the tax burden for the taxpayers,” DuFour said.
The numbers of cases have continued at the lowered levels. According to St. Joseph’s spokeswoman Janet Ford, the hospital’s behavior health unit admitted 411 patients from January 2006 through Sept. 30, about 50 percent of which were referred from the county.
The acute care services average around 400 calls each month, mostly concerning people who would normally end up in the hospital, in emergency care or the custody of law enforcement.
Washington County started the service as emergency responders for children it was counseling who lived at home. It was gradually expanded to respond to all children who were having problems at home or school. The program worked so well it was expanded to include adults in 1999.
Crisis staffers have at minimum a bachelors degree, and training and experience working mental health. They are dispatched to assess mood disorders, anxiety levels and suicidal thoughts, and find the best solution for the individual.
The workers work in a recovery-based model. They are practiced at diffusing conflict between families and their children or developmentally disabled relatives and assessing suicidal thoughts of people in jail.
Mary Martin, who runs the behavioral health unit at St. Joseph’s compared crisis workers to ambulance technicians who assess mental health needs. Acute care employees also assess self-admissions to the psychiatric ward at St. Joseph’s.
“I firmly believe the amount of education the county has done provided to our law enforce, to acute care facilities and to the public has really aided to this reduction in emergency detentions,” Martin said.
Sgt. Gus Unertl, a spokesman for the West Bend police, said the new approach had not necessarily reduced the number of mental health-related calls the department received, but had been very successful in reducing the need for taking patients to the inpatient unit.
“The people they have are good in terms of coming out to the scene and telling us what they think is appropriate placement,” Unertl said. “Hopefully in the long run we’re saving funds and saving time at the mental health unit.”
Unertl said not having to drive people down to the new inpatient unit at St. Joseph’s in the town of Polk saves West Bend police time. He also said police in places like Hartford and Jackson probably save time by not having to drive patients to West Bend, where the old unit was located.
Emergency detentions are also traumatic for the unstable individuals in custody, who are handcuffed, escorted to the hospital and held against their will for as long as 72 hours.
“Before people either stayed at home and suffered or they went to the hospital,” DuFour said. “Now the hospital is a very last resort where it used to be the only resort.”
DuFour said when a child is placed in emergency detention they must automatically be taken to one of the state’s Mental Health Institutes in either Winnebago or Madison, both more than an hour drive away. The county must bear the cost of two deputies for the transportation of the child, who is often quite frightened.
“Because we’ve had the ability with the mobile team, we’ve been able to work with families to develop some strategies to have the child stay in the home,” DuFour said. “Before we had that team, law enforcement would just have to take them away because they didn’t have the time to sit and work those things out.”
Carolyn Mangan-Casey, who runs outpatient counseling for CCSA, said attending to psychological predicaments at their climax is always a plus.
“Anytime you can meet with a person at the time of the issue and right there were they are it doesn’t have to escalate into a bigger thing,” Mangan-Casey said.
The county continued their move to a recovery model with the opening of the Calm Harbor crisis stabilization home in conjunction with the non-profit corporation Nova Services. At Calm Harbor patients who no longer need hospitalization can stay and receive the social support necessary to sustain their recovery.
DuFour said one of the eight beds at Calm Harbor is dedicated to residential intoxication monitoring. Crisis workers can now assess drug and alcohol cases and determine whether the person has a chronic addiction problem which needs hospitalization — or is simply drunk, which can cost the county “about $1,000 a day for someone to sleep it off in the hospital.”
“Let’s say law enforcement does happen upon someone who is intoxicated and can’t find any family,” DuFour said. “We’ll gather information and make an assessment — are they going to have withdrawl or are they just a kid who drank too much?”
DuFour said the county board showed vision when it approved the changes, giving the crisis service $1.2 million to run a staff of 18 rotating around the clock.
“We are very lucky to have a county board in a conservative county that is as supportive as they are,” DuFour said. “CCSA operated that mental heatlh unit for over 30 years, and to say we want to close this and do business completely different. They really see the importance in providing service for people with these services.”
Jim Strachota, director of CCSA, said when he went before the county’s finance committee, a majority of spending increases for his department were for acute crisis services. Strachota said in light of state budget freezes, the county had been fair in maintaining these vital services.
The real problem, he said, was becoming the influx of uninsured patients. At times, more than 50 percent of the people seeking mental health services do not have insurance — or are “under-insured.”
“I don’t believe you could carve out mental health out of health insurance and say you can’t provide that anymore,” Strachota said.
Strachota said the CCSA was investigating the rise in uninsured patients. He suspects some of the causes are cutbacks in services provided by private clinics and health insurance, growth in the county’s population as a whole and unemployment.
Washington County’s unemployment for October 2006 was about the same as last year at 3.5 percent. The city of West Bend’s, however, was sixth worst out of the state’s 28 cities at 5 percent, up from 4.5 percent in 2005.
“I think unemployment certainly does affect your mental health,” DuFour said. “If you can’t provide for your family or you’re considered about losing your housing, that’s going to increase the stress levels in your life, and it might cause you to start using drugs or alcohol more, or you’re not getting the right amount of sleep.”
DuFour said medication to control behavior and mood disorders are expensive, and the county works hard to make sure assistance programs help as many eligible patients as possible.
“If they’re not gettting that medication, they’re not getting all the help they can,” DuFour said.
Martin said the county does all it can to help uninsured or underinsured patients. She said mental health patients in crisis need treatment as seriously as a person with a broken leg or bursting appendix, and the hospital does not turn them away.