Legislators Could Save Money by Halting New State Hospital

Taking care of mentally ill people in community settings not only reduces costs but can create more jobs, according to advocates
November 30, 2010 -- Before embarking on the construction of a $180 million state mental hospital in Junction City, legislators may want to heed the advice of Kevin Campbell.
Campbell can show that caring for people in the community can be done at half the cost, and create more jobs. He’s produced a chart showing the level of care costs at Oregon State Hospital, residential care and community settings.
“Our goal has been to move people into the community where costs are lower; that way we’ve been able to help more people with the same amount of money,” said Campbell, executive director of GOBHI, a Medicaid mental health plan in Hood River that serves 50,000 people in 14 counties, who shared his concerns with the Oregon Health Policy Board recently. “Their clinical outcomes may be just as good or even better when we wrap around services.”
Speaking on behalf of Oregon’s nine mental health organizations (MHOs), Campbell has the statistics to back up his claims. Those MHOs have more than doubled the number of children needing mental health services since October 2005 – reaching 1,200 statewide – while their budget -- $45 million in state and federal funds – has remained flat. Together, they’ve moved more than 300 children out of residential settings into the community. 
“We’ve contained costs for five years, cut the number of bed days by more than 50 percent, and gone from 600 children in residential care to less than 300, and went from zero children in the community to over 900 that we now serve with those dollars,” he said.
A strong mentoring program has been built where professionals work with children at home and in school, teaching them coping skills and de-escalating harmful situations. Therapeutic foster homes have sprung up along with more professional counselors to work with troubled youth.
In 2007, 90 percent of children received services in their communities, while the number of children admitted to psychiatric day treatment decreased by 25 percent, according to Bill Bouska, child and adolescent mental health services manager for the Department of Human Services. During that same time, the number of children admitted to psychiatric residential treatment also decreased by 34 percent, while the number of Medicaid-eligible children receiving services increased from an average of 11,500 per quarter in 2005 to an average of 13,0546 per quarter in 2008, he said. 
In September, the MHOs turned their attention to adults in the state mental hospital and residential care, rolling out the Aim-High program, intended to move 331 people into community settings by next June -- using $9.3 million that had been set aside to build more residential services.
By late November, 116 people had been moved – 62 from the state mental hospital – into lower levels of care. The MHOs are providing rental assistance, supported employment, transition planning assertive community treatment and exceptional needs coordination.  
“This is all about local solutions, Campbell said. “We believe that ought to have a single system regardless what age you are – and develop local alternatives to serve communities rather than shipping people across the state to some large facility where they get disconnected from their family, their community. It so disrupts peoples lives. Now we’re getting people to a more appropriate level of care. We’re bringing treatment to them rather than bringing the people to treatment.
 “We’re helping young people and families facing disabilities caused by mental illness by wrapping services around, taking care of their daily living needs so they can get a job and stay in the community,” he added. “We’re trying to stabilize people so they never have to go to the state hospital, to keep them closer to home, in a safe setting that’s not as restrictive as the state hospital and without having to go through the trauma.”
Campbell has proposed that legislators take the funds necessary to operate the 320-bed Junction City Hospital – estimated at $120 million – and spend half that money on Medicaid services, which would yield another $60 million in matching federal dollars and use the remainder on community services. In that way, he said, those dollars would generate 1,750 local jobs -- 250 more than the 1,500 jobs needed to run the Junction City hospital.  Otherwise, he said, Oregon stands to lose that extra $60 million in federal funds since matching dollars are not available for institutional settings with more than 16 beds.
“If we can treat people in a community it costs 40 cents of general fund money; in the state hospital it costs $1,” Campbell said. “Our key to success is demonstrating that we can keep these people in a managed care environment and they can get better. We don’t believe they belong in a state hospital for10 or 16 years.”
When the master plan was developed for the new hospital in Junction City, none of these system changes were in place. Now both children and adults are experiencing a different level of care – a different budget environment which negates the need for that hospital, he believes.
“It’s better to stop it now rather than invest that money,” he said. “Isn’t there a better way to spend those dollars on 320 Oregonians? We can spend a fraction of that money in the community and maybe serve 1,200 rather than 320 people.”
There’s also a growing fear that operating the Junction City hospital will come at the expense of community mental healthy because there won’t be enough money for both.
“Money can be spent more wisely in the community,” said Gina Nikkel, executive director of the Association of Oregon Community Mental Health Programs. “We don’t want to see another empty building like Wapato Jail built in Multnomah County that still stands empty because there’s not enough money to operate it.”

For a detailed look at the level of care costs click here.

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Good article. Should be required reading for all State Legislators and the incoming Governor.

Campbell is right. We can't afford old thinking in this fiscal environment. Bob Joondeph Disability Rights Oregon