Improving health care for uninsured mentally ill

Half of the state's uninsured mentally ill residents have nowhere to go but the emergency room when they need help.

That's appropriate when they are suicidal, but not when they need refills on medications or a counseling session.

A group of agencies led by Intermountain Healthcare is trying to improve how the uninsured mentally ill and substance users get help. On Monday, the partners celebrated an 18-month project that tested whether they could find patients better care outside hospitals.

The alliance says it has been able to get them into therapy more quickly and reduce their hospital readmission rates.

"We are using our resources in a better way," said Delia Rochon, director of mental health initiatives in Intermountain's community benefit department. "We provide the most appropriate care in the best way that we could in a timely manner."

The 1,000 patients in the project are too few to say whether the $148,000 investment saved money in emergency rooms, she said. But she believes such a program would save money if implemented for the 35,000 uninsured mentally ill people in the state.

The project was funded by Intermountain Healthcare Foundation, American Express, Segal Family Foundation and Edward G. Callister Foundation.

Since January 2011, a patient advocate at LDS Hospital and Intermountain Medical Center has found treatment for willing patients who visit the ER with mental illness or substance abuse problems.

All but 9 percent said they wanted help, with the remainder saying they were too afraid, due to the stigma surrounding mental health and substance abuse therapy.

The money helped expand services at the Family Counseling Center, Valley Mental Health, Volunteers of America, Cornerstone Counseling Center and National Alliance on Mental Illness.

Before the project, the 1,000 patients would have waited six to eight weeks for their first appointment. Now, the wait is down to about a week. Part of the problem was turmoil at Valley Mental Health, which lost a contract with Salt Lake County to oversee mental health services. Some patients were left without care and clinics meant for the uninsured were full.

OptumHealth, which took control of the contract, has committed to keeping the wait to one week, Rochon said.

With increased access, more patients took advantage of services: 72 percent scheduled an appointment, compared to 23 percent when the wait was weeks-long.

And the number of emergency room or inpatient admissions dropped by half among the 202 patients who attended at least one therapy session, down to a total of 98 within a year of the initial referral to therapy.

Rochon said the money will run out at the end of the year, but the partners are committed to continuing the program. They are seeking funding, including from the Legislature.

"The way that we are providing behavioral health right now is unaffordable and unsustainable," she said. "All of us are engaged in finding ways we can provide better services in a cost-effective way."

Lana Stohl, director of the state Division of Substance Abuse and Mental Health, said in a statement: "In a time of limited resources, collaboration between public and private entities will ensure availability of valuable services to a wider circle of citizens." —

Who needed help?

The Family Counseling Center was one of the clinics that expanded services as part of an effort to improve care for uninsured mentally ill patients and substance users. The diagnoses for patients referred to the clinic by an Intermountain Healthcare patient advocate:

Mood Disorders: 63 percent

Anxiety Disorders: 34 percent

Substance Abuse: 10 percent

Psychotic Disorders: 7 percent

Other: 11 percent

The total adds up to more than 100 perent because some patients had multiple conditions.

Source: Intermountain Healthcare