By: Lindsay Wallace, Executive Director
We’ve been hearing from members some of the concerns they have regarding the new psychiatric facility that Strategic Behavioral Health (SBH) will be building in the Madison area. NAMI Dane County was briefed on the facility in November and I want to take the opportunity now to share with our members what we know so far.
It is our understanding that the new facility will offer a variety of inpatient and outpatient services to adults and children, as well as a 24/7 crisis assessment unit. However, we do not yet know the specific services that will be offered because negotiations are ongoing.
In discussions with SBH, we do know they will use the data from a study paid for in the 2018 Dane County budget to inform the specific services they will offer so as not to duplicate adequate existing mental health services in the community. The study will be complete in time for the 2018 budget session, and SBH does not expect to begin building until September or October 2018.
One concern of members that NAMI Dane County shares is that SBH is a for-profit company. There are questions around effective care coordination, quality of care, service to patients who are unable to pay, and staffing problems.
There are distinct differences between not-for-profit and for-profit psychiatric facilities but SBH says their approach to care delivery is the same; they ensure all referring/community professionals, consumers, caregivers, and families are involved in the consumer’s treatment and recovery plan every step of the way.
I have reached out to other NAMI affiliates across the country who have SBH facilities in their community to see what their experiences have been in regards to care coordination and quality of care. In each instance, I received positive feedback. Our hope is SBH will deliver on this promise in Dane County as well. It is, of course, something we will monitor closely.
When it comes to service to patients who are unable to pay, SBH said they provide services regardless of ability to pay. They are able to do so because of the individual mandate through the Affordable Care Act. Those who have coverage are charged higher costs for services, making it possible for SBH to not turn away uninsured and underinsured patients - a practice we understand non-profit facilities utilize as well. Of course, there are concerns around the sustainability of such a practice with current tax reform efforts that include a repeal of the individual mandate.
In further evaluating SBH’s capacity to effectively serve people with mental illness in Dane County, we will seek answers to the following questions:
Will SBH have discretion over who they accept for inpatient treatment or must they accept referrals sent to them by the county?
Will SBH be required to serve people who are court ordered into treatment?
Will the contract with SBH establish requirements for discharge planning and linkages with community services?
Will SBH have the capacity to treat the physical health needs of people they serve, including preventive health services such as smoking cessation?
Will SBH’s performance be assessed on measures such as clinical outcomes, screening for metabolic disorders, coordination of mental and physical healthcare services, use of aversive measures such as restraints and seclusion, screening and treatment for alcohol or substance use, number of patients discharged on multiple antipsychotics and justification, and how quickly patients are seen in the community after discharge?
Because SBH will receive Medicare and Medicaid funding, they are subject to the Inpatient Psychiatric Facility Quality Reporting (IPFQR) program, which includes many of the measures listed in the immediate bullet above.
Dane County has not been designated a provider shortage area by the federal government, however, there are concerns regarding staffing because of the poor cost of living adjustments the county has given to purchase of service providers. It is difficult for community providers to compete with compensation provided by for-profit companies, which could reduce the number of qualified mental health professionals at community-based providers.
NAMI Dane County has not yet taken an official position in support or opposition of the facility. We need more data and information before doing so. However, we are intrigued about the possibility of a new facility for a few key reasons.
First, the federal government has designated Dane County as a facility-based shortage area for mental health care. We know it is often difficult to find psychiatric beds in Madison, particularly if the hospital being referred to has any concerns about their ability to deal with a person’s potentially challenging behaviors.
More psychiatric beds, particularly more acute care beds, could reduce the number of people needing to go to Winnebago Mental Health Institute (WMHI). The trip to WMHI not only takes an inordinate amount of law enforcement time, but the trip to WMHI itself can be traumatizing.
Second, SBH plans to offer a 24/7 crisis assessment unit, which could potentially reduce the inappropriate incarceration of people experiencing symptoms of mental illness.
Finally, SBH will be putting up the capital to build the new facility, meaning county dollars will not be diverted from existing mental health care services to fund the project. The county has maintained current levels of funding for the mental health care system, however, they continue to face fiscal challenges. While the new facility would result in a significant cost savings to the county, it would mean we have little leverage in the kinds of services SBH plans to offer.
I will share updates with our members as I learn more and gather data. We plan to offer a public forum in late Spring, which is the earliest SBH could participate. They do not plan to break ground until June or July. Details regarding the forum will be sent in our March/April newsletter.
I welcome your thoughts and input, and am happy to answer any questions you may have. You can email me at email@example.com or call 608-249-7188.