This is an archived article that was published on sltrib.com in 2006, and information in the article may be outdated. It is provided only for personal research purposes and may not be reprinted.
PROVO - In fall 2004, 4,000 Utahns battling mental illness were turned away by the state's public mental health clinics. A shift in Medicaid policy meant they were no longer eligible for government assistance.
Uninsured, they couldn't afford medications and had nowhere to turn for counseling. Some threatened suicide. Others lost jobs. At least one or two became homeless.
Many kept calling Juergen Korbanka, adult therapy director at Utah County's Wasatch Mental Health, which cut off 709 clients. He set out to create a "leaner, meaner psychotherapy machine."
The resulting Wellness Recovery Clinic is being hailed by state officials as the future for treating the working poor and mentally ill.
With a team of nine counselors and support staff, the clinic opened in July 2005 and relies heavily on group therapy to reach 449 uninsured clients - more than half Korbanka's former caseload, but with one-third the money.
"Whereas before we based treatment on what Medicaid would cover, now we're asking, what do patients need?" said Lisa-Michele Church, Utah's Human Services director.
Church is urging other county mental health clinics to adopt Korbanka's approach and will ask the Legislature for money to fund the expansion. This year lawmakers temporarily plugged the $7 million hole left by the Medicaid rule change with $1 million. Church wants that funding stream made permanent.
But she says she's not asking the state to "shoulder the burden alone."
Nearly half of the Wellness Recovery Clinic's $325,000 budget is funded through federal grants, county dollars and private donations. Pharmaceutical companies kick in some funding for medications and volunteers help keep the operation afloat.
To be admitted, patients must be uninsured and meet certain income guidelines, earning less than $29,000 annually for a family of four. Treatment is free, but limited to 45 to 60 days.
To cut down on paperwork, the clinic manages patient files electronically. And most of the counseling is done in groups, rather than one-on-one.
All this saves money, but also aims to improve care.
The group sessions run once a week, so a patient can miss one without suffering a gap in treatment, said Korbanka. "We can tell that patient to come to another group in three to five days rather than wait weeks or longer for a new appointment."
Groups also exert positive peer pressure, he said. "Sometimes therapists don't have as much clout as they would like because the client says, 'You don't know what it's like.' If a patient tells another patient to stay on his meds, that carries more weight.''
Years of research have shown group therapy to be as good as individual therapy for most disorders, though it's not recommended for severe illnesses, such as psychotic disorders and schizophrenia.
The Wellness Recovery Clinic caters to people with bipolar disorder, borderline personality disorder and depression and anxiety. Of the 449 clients served this year, 93 percent gained or maintained ground, said Korbanka.
That may not sound like much, given most people's desire for a cure. But for many of Korbanka's patients, it means the difference between holding down a job or being hospitalized, falling into poverty and relying on government supports.
"When we lost Medicaid, we didn't save money, we just shifted the expense onto hospitals and taxpayers," said Korbanka.
Korbanka refused to surrender, despite the political climate - a federal government bent on wringing more savings from Medicaid and widespread mistrust of behavioral therapy.
"It was hard. We're in the business of helping people," recalls Korbanka. "For every person with the stamina or anger to call, there were probably five or six more suffering in silence."
Carol, who asked that only her first name be used, is among those might have wound up institutionalized were it not for Korbanka's new clinic.
The 63-year-old suffers from chronic depression and a schizoid disorder. She describes life before therapy and medication as living in a "state of panic."
Still, it took her losing her 30-year marriage and her job to come to terms with her disease. Even now, it takes willpower and courage to show up for her therapy sessions, Carol said.
"No one wants a diagnosis. Everyone wants to be normal. But as one counselor told me, 'Normal is someone you don't know very well,' " she Carol. "I never thought someone like myself, who has a college education, was once wealthy and traveled the world, would end up on the dole and taking anti-psychotic medicines."