PORT ANGELES — A combination of Medicaid cuts, expanded health care access and a statewide shortage of psychiatric beds is causing financial anxiety for the largest mental health services provider on the North Olympic Peninsula.
Peninsula Behavioral Health (PBH), which serves about 3,000 Clallam County residents in the Port Angeles and Sequim areas, has received more than $1 million in unanticipated hospital bills since July 1, agency officials said.
The private, not-for-profit mental health and chemical dependency treatment organization has an annual operating budget of about $7 million.
“Statewide, there’s a huge upswing in the number of hospitalizations, and that’s been true here as well,” said Wendy Sisk, PBH clinical director.
“We haven’t hit the level that some communities have in terms of the upswing, but it’s a problem statewide that we’re seeing increases in psychiatric hospitalizations.”
PBH Development Coordinator Rebekah Miller said other agencies in the region are facing the same challenges as PBH.
“It’s statewide,” Miller said.
“The state has shifted all of the risk to the community mental health centers.”
Jefferson Healthcare
Jefferson Healthcare is working on a plan to create a mental health service facility at the hospital in Port Townsend.
The hospital received a $1.5 million grant from the state Department of Commerce for such a facility.
Jefferson Mental Health Services will play a significant role in the development of the new service at the Port Townsend hospital, Adam Marquis, executive director of Jefferson Mental Health Services, and Jefferson Healthcare CEO Mike Glenn have said.
Directors of Port Townsend’s Jefferson Mental Health Services and Forks’ West End Outreach Services were not immediately available for comment Friday.
Increased access
Previously undiagnosed mental health conditions are now being identified as more people have access to health care coverage through the Affordable Care Act, Sisk said.
PBH has added 800 new clients since health care expansion, yet Medicaid slashed its funding by 16 percent last July.
“We’re looking at another 7 percent [cut] coming in April, even though our costs are going through the roof,” Sisk said.
Community mental health centers receive a pool of Medicaid money based on an estimated number of eligible clients in their coverage area, regardless of actual demand.
The reimbursement is the same whether the client needs one appointment or a 78-day stay in a community psychiatric hospital.
Western State Hospital in Lakewood, one of the largest psychiatric centers west of the Mississippi, has been turning patients away because of staff shortages.
Those who are committed to psychiatric care through the Involuntary Treatment Act are supposed to be transferred to Western State after a three-week stay in a community psychiatric hospital.
“We have a number of allocated beds at the state hospital, and so long as we have capacity out there, we shouldn’t be billed at all for people’s time at the state hospital,” Sisk said.
As a result of the pinch at Western State, which allots seven beds to PBH, clients are having extended stays in community hospitals in Bremerton, Bellingham, Longview or Spokane.
“And we pay by the day for everyone who’s in a community hospital,” Sisk said.
The average cost to PBH for keeping a client in a community hospital is between $800 and $1,300 per day.
Meanwhile, a backlog at community psychiatric hospitals has resulted in some patients being released sooner than they would otherwise be sent home.
“We’re seeing people cycling back through in record numbers,” Sisk said.
Olympic Medical
While Olympic Medical Center does not have psychiatric beds per se, it does provide mental health services with psychiatric support from PBH, Miller said.
The expanded emergency room at OMC includes two rooms for patients who are experiencing behavioral crises.
The hospital in Port Angeles simply does not have the capacity to treat the volume of psychiatric patients enrolled at PBH, Miller said.
PBH expanded local access to urgent psychiatric care in December 2014 when it opened a six-bed respite center adjacent to its Port Angeles headquarters.
The Clallam County Respite Center allows clients to seek voluntary treatment for mental health crises in their own community.
The new facility served more than 200 clients in 2015, at least 118 of whom would have otherwise gone to a hospital, Miller said.
Thanks in large part to the respite center, PBH assisted 6,100 people in crisis last year, up from 3,500 in 2014.
“Philosophically, we really believe people deserve to keep treatment in their community,” Sisk said.
“We don’t want to send people to Bremerton or Longview or Bellingham. Whenever we can, we work with folks to develop a plan to help them stay in the community.”
Crisis clients arrive at PBH though several portals, including the OMC emergency room, law enforcement contacts and primary care physicians.
A designated mental health provider determines whether the person needs an involuntary commitment within 72 hours. About half of those in crisis are already enrolled at PBH.
PBH provides 24-hour residential care for clients who are the most ill and supportive housing for those who wouldn’t otherwise be able to be successful in the community, Sisk said.
“We really see people across the spectrum in crisis services,” she added.
“These are our neighbors. They’re our church congregation members. They’re our friends. They’re people we work with.”
As PBH officials lobby the state Legislature for community mental health funding, the organization is taking a hard look at the financial viability of some of its non-essential programs.
“We want to keep offering all these vital, critical-to-the-community services,” Miller said.
“But at some point,” Sisk added, ”you have to figure out what do we have to do vs. what’s the maximum we can do with the money that we have.”
PBH is “cranking up some steam” on grant writing and gearing up for its annual fundraiser May 6, Miller said.
“Thankfully, we’re very strong financially,” Miller said.
“We’ve been very conservative in that sense. But it’s like a family budget. When you’re hit with a hospital bill, a seventh of your income, that’s going to have an impact.”
For 24-hour access to a mental health professional, phone PBH at 360-457-0431.
A crisis line is available for those who are struggling with suicidal thoughts: 360-452-4500 or 800-843-4793.
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Reporter Rob Ollikainen can be reached at 360-452-2345, ext. 56450, or at rollikainen@peninsuladailynews.com.
