Addressing mental health needs requires collaboration, creativity, and funding

Keeping up with the demand for mental health care is yet another challenge for the industry. As competition for funding grows ever more intense, communities are finding creative new ways to meet patient needs. However, some behavioral health systems are coming under scrutiny.

Finding respite in the Big Apple

New York City is doing its part by providing an alternative place to stay for those who may otherwise be in a hospital or mental health facility due to a crisis. Community Access, also known as Parachute NYC, is  a publicly funded mental health center on the Lower East Side of Manhattan. Known as a respite center, Parachute is one of four of its kind in the city (the others are located in Brooklyn, Queens, and the Bronx). Although there are no medical staff, medications, or rules for activities or curfews, there are trained staff who can provide support for those dealing with mental illness because they are recovering themselves.

Respite centers offer relief at a reduced cost compared to hospitals, and can help patients avoid a more serious mental health episode that would necessitate a hospital stay. In addition to being costly, psychiatric hospital bed availability has declined over the past few years. Patients who wish to seek mental health treatment outside of a hospital setting, such as by receiving counseling and medication, can run into issues of provider shortages. As of June 2014, there were 4,000 designated mental health professional shortage areas (HPSAs). Even obtaining medication from a primary care provider can be difficult, as there were 6,100 primary care HPSAs.

Although some need a more structured environment and medical oversight, Parachute provides some distance from what is happening in a guest’s personal life to allow them to process their problems. A guest must check in voluntarily, and is screened at check in to ensure that they do not need more intensive treatment, or medication. Guests are able to continue working and can come and go at any time during their stay.

Parachute was launched by the public health department, partially funded by a $17.6 million HHS grant. The program has a goal of saving $50 million in psychiatric hospital expenses. New York’s Medicaid program also plans to use federal waivers to pay for respite services as well as other community health services for some beneficiaries. Although the maximum stay length is currently 10 days, it will be shortened to a week to comply with Medicaid rules.

Kansas’ behavioral health system stretched to its limit

Kansas’ behavioral health system is under review by a 30-member committee. This review follows noted issues surrounding state psychiatric hospitals, which are under scrutiny for safety concerns, being overcrowded, and allegedly failing to properly care for patients. The committee raised concerns about a lack of support for community-based programs, as well as underfunding and a shortage of psychiatrists. It also noted that patients who typically would have been treated at a state hospital are now spending days in local emergency rooms. Following more meetings, the committee will finalize recommendations for reform of the state system in July.

West Virginia needs new options

According to a federal report, West Virginia needs to better manage placement of mentally disabled children instead of relying on state hospitals or treatment facilities. In 2005, it created a response plan that would place children with mental disabilities and mental health conditions in community settings whenever possible, but never actually implemented the changes. The Department of Justice (DOJ) found that child services agencies have wasted resources and created confusion in the care environment. According to the report, mentally ill children on Medicaid have been unnecessarily segregated or institutionalized when care could have been better provided in their home. Although it is within the government’s power to sue the state to compel compliance, federal officials seemed encouraged by discussions with state leaders.