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Closing of psych services at local center prompts talk of mental-health alternatives

This article first appeared in the St. Louis Beacon, May 25, 2010 - The Missouri Department of Mental Health is asking local groups to help figure out ways to find services for patients who no longer will get acute or emergency treatment at the Metropolitan St. Louis Psychiatric Center, 5351 Delmar Blvd.

Because of state budget cuts, the department is trimming the hospital's budget -- closing the emergency room and short-term inpatient unit. About 2,800 patients a year use the 50 acute psychiatric beds and emergency room services to be eliminated. Patients affected include those suffering from schizophrenia, bipolar disorder, depression and substance abuse.

The state had initially said it would phase out the services in June. But, on Monday, officials extended the deadline to September with the hope that other plans could be made to accommodate displaced patients.

The state has asked the St. Louis Regional Health Commission, says Robert Fruend, the commission's chief executive officer, to bring all the players to the table, including those in law enforcement and health care, to talk about a collaborative effort, but he acknowledged that finding answers won't be easy.

"There is a recognition that when the state stops providing acute care, there needs to be a plan," says Lauren Javois, a regional executive officer for the Department of Mental Health. "We contacted the Regional Health Commission to convene a planning process with community mental-health providers, along with hospitals and law enforcement people at the table as part of that process. It's a matter of figuring out how to redistribute services."

While the state had been involved in a planning process with community mental-health providers, Javois says, the difference now is that the "Regional Health Commission is helping to bring in other potential players, meaning hospitals that have psychiatric beds and law enforcement that has to deal with patients who get no services."

Meanwhile, Javois says the state is trying to keep the acute-care unit in place until September. "We will do our best to keep it open, but there will be stiff challenges," he says.

The issue is not a new one. In 2004 in Kansas City, 100 acute-care beds were eliminated from a mental-health facility there. Eventually, Truman Medical Center, now a private nonprofit hospital, stepped up to the plate. It asked the state for permission to lease space in the mental-health facility to provide the emergency psychiatric services that the state no longer funded. This shift eased the adverse impact of the state's cuts.

Missouri is backing away from funding such services because of the budget and federal Medicaid rules, says Marsha Morgan, chief operating officer for behavioral health at Truman Medical Center.

"Under current federal law, a (public) health facility that includes more than 50 percent psychiatric patients becomes an institution for mental disease, and the federal government doesn't allow you to bill under Medicaid if you're an institution for mental disease," she says.

Medicaid is the federal-state health insurance program for the needy. If the federal government doesn't pay for care, the Department of Mental Health has to rely completely on state money. Hospitals providing medical and surgical services, as well as mental-health services, such as Truman, can care for the mentally ill and get Medicaid reimbursements. The catch is to make sure fewer than half the beds are used for psychiatric patients.

"Truman Medical Center has more than 252 licensed beds, so adding 25 for emergency psychiatric care means we didn't come close to becoming a 50 percent psychiatric hospital," Morgan says. Truman has since contracted to operate even more beds for the mentally ill at the mental-health facility.

So how has Truman's services helped to address the state's elimination of some psychiatric services at the state facility? Morgan says the unit has a 96 percent occupancy rate, consisting of Medicare and Medicaid patients, along with about 25 percent of patients lacking insurance. Without Truman's psychiatric beds, she says, people would end up in emergency rooms.

"Everybody we admit is dangerous to themselves and others, not violently dangerous, but they aren't eating or sleeping. They're walking the streets naked. Without this service, there would be a pretty big hole in the community."

She stressed that no one-size-fits-all solution can be applied to every part of the state that's coping with cuts in mental-health funding.

"We're in really difficult financial times in Missouri. Everyone needs to be creative in addressing this issue. You (the St. Louis region) have a number of hospitals with psychiatric units, you have strong health centers, great hospitals."

Complimenting the Regional Health Commission and others for their effort, Mason says, "I know they're creative people and will come up with a great solution. What works in Kansas City may not work in St. Louis, but I know they will come up with something that's better than what you've got." 

Funding for health reporting is provided in part by the Missouri Foundation for Health, a philanthropic organization whose vision is to improve the health of the people in the communities it serves.

Robert Joiner has carved a niche in providing informed reporting about a range of medical issues. He won a Dennis A. Hunt Journalism Award for the Beacon’s "Worlds Apart" series on health-care disparities. His journalism experience includes working at the St. Louis American and the St. Louis Post-Dispatch, where he was a beat reporter, wire editor, editorial writer, columnist, and member of the Washington bureau.