Local Utilization of State Mental Health Facilities

By Jenny Goode

          Community MHMR Centers are contractually bound to stay within an annual allocation for state hospital usage in each fiscal year.  For Betty Hardwick Center, that amount has seen gradual decreases over the years and presently equates to about $1.2 million of inpatient care at state mental health facilities each year.  These are not actual dollars provided to the Center; rather they are referred to as a “trust fund allocation” that is already dedicated to the operating budgets of the state hospital system.

          We average about 225 admissions from our geographic area (Taylor, Jones, Callahan, Shackelford and Stephens Counties) annually. Each admission results in a charge to our trust fund of $425. If you calculate the cost of admissions using our averages, that leaves us with about $3107 per day of actual bed days. That equals to less than 10 people per day.

          Locally, we refer persons with some form of insurance – Medicare, Medicaid, private insurance, VA benefits – to private inpatient facilities. For last year, that totaled around 176 referrals to hospitals in addition to our state hospital referrals. So, the state hospital beds are most often used for persons who are without any form of insurance, who are adults with Medicaid (federally excluded from most private inpatient hospitals) and/or those whose level of care requires extensive supervision not provided by some private inpatient hospitals.

          If we exceed our allocation by more than 110%, we are required to settle up with the Department of State Health Services to the 110% level, which means, we’d pay for anything over $1.3 million in usage. If we applied the level of utilization we had in FY05 to the current fiscal year, we would be responsible to pay back $389,658 out of our operating budget.

          Obviously, we could not afford to do that, nor are we willing to jeopardize the critical outpatient services we provide. So, we have implemented a number of practices to help our community manage the limited state hospital resources available to our residents –

          1. Our utilization management staff continually strives to maximize the treatment in shorter lengths of time in the state hospital. State hospitals are no longer the long term treatment facilities that many people remember. Our current average length of stay is below 30 days. We accomplish this by providing treatment information to the inpatient treatment team, initiating active discharge planning as soon as a person is admitted, and reviewing the clinical improvements during inpatient care to determine when our outpatient services can again meet a person’s need.

          2. We successfully divert many people to respite care, outpatient psychiatric medical treatment, counseling, case management and other supportive services in the community. We recognize there are many people who might benefit from inpatient care, but resources are not available to pay for treatment for all who would benefit. State funded inpatient care must be reserved for those most seriously at risk for imminent harm to themselves or others.

          3. We work with our community partners to address other social issues that often create crises in people’s lives. State hospitals are not designed to treat substance abuse. We partner with Abilene Regional Council on Drug and Alcohol Abuse (ARCADA) to facilitate substance abuse care. We partner with Hope Haven, Just People, Salvation Army and others to address homelessness and lack of employment that often leave people feeling hopeless. Certainly, all of our local nonprofits and social service agencies are critically important in meeting the needs of people with mental illness.

          State funds are not adequate to serve all who need and request care. Texas ranks near the bottom in the nation in per capita mental health funding. So, we have a great deal of work to do with limited funding. However, Betty Hardwick Center enjoys the support and cooperation of many local agencies in coordinating the mental health services in our community. With increased understanding about community services, joint efforts and commitment to ongoing improvement, our community will continue to meet the needs for those with mental illnesses.

Submitted by Jenny Goode LBSW, MS, CEO for Betty Hardwick Center.  Mental Health Matters is sponsored by the Mental Health Association, phone (325) 673-2300, e-mail mhaa@bitstreet.com.  Need help?  Call the Hope Line (325) 677-7773.