Educating more doctors about behavioral health issues, helping people navigate the complex system of care, and aiding people without insurance — those are the three gaps locally in mental health care delivery that will be studied during the next six months.
In April, three task forces made up of 100 mental health professionals will make recommendations about how to fix the gaps and improve behavioral health care in El Paso County.
“We’re not going to be whining anymore; we’re not going to be pointing fingers anymore; we’re going to find solutions to these problems,” said Dr. Sara Qualls, professor of psychology and director of the gerontology center at the University of Colorado at Colorado Springs. “And that means having a business plan attached. We’re going to come up with solutions, and we’re going to come up with how to pay for them.”
The three gaps in care were identified during a daylong summit sponsored by Colorado Health Partnerships, a nonprofit seeking ways to collaborate within the county’s medical system. The group examined perceived gaps in the system — lack of inpatient beds for patients topping the list — and then voted on top priorities they wanted to study.
“This is a new approach,” said Executive Director Carol Bruce-Fritz. “We’re going to come up with sustainable solutions during the next six months that can help and that can be implemented immediately. That means a business plan. This isn’t just a wish list of what we want to do — this is going to be a roadmap of how to get there.”
The task forces will meet frequently to develop the plans of attack that will be presented in April.
Basically, service issues boiled down to one problem: lack of money for insurance.
Access to mental health care in Colorado Springs is difficult — but not impossible — for people with insurance. Without insurance, even with government-sponsored programs, it can be nearly impossible to find the right treatment in El Paso County. Colorado ranks nearly last in funding for mental health care, professionals say, and that leads to dismaying consequences.
Lack of insurance leads to another costly problem: longer stays in traditional hospitals as doctors try to find beds in psychiatric hospitals. Those extended stays typically run $10,000 a day, says Billie Ratliff, who works in Memorial Health System’s emergency department, identifying patients who need behavioral health assessments. She says her staff of 18 provides mental health assessments to about 500 patients a month.
Despite attempts at the federal level to fix the pay disparity between physical health and mental health, professionals working in the field are skeptical that improving the pay system would improve access to care. The Affordable Care Act requires mental health care to be covered at the same level of care as physical health, and that insurance plans must carry basic mental health coverage.
“We’ll have to see how that plays out,” said Nancy Braney, vice president for health services at AspenPointe, a nonprofit that provides inpatient and outpatient help for people with mental illness. “We just don’t know right now, and that’s one of the uncertainties.”
Even a more equitable payment system won’t fix all the access problems, she said.
“We also have a lack of psychiatrists here,” Braney said. “It’s a nationwide problem. Fewer people are going into the field now because of all the uncertainties over the payer system.”
Braney highlighted the second gap in behavioral health care in the Pikes Peak region: a lack of “prescribers” — doctors who understand psychiatric medications and can prescribe them to patients, following their progress and monitoring patients for side-effects.
Based on population and typical ratios, Colorado Springs should have around 64 psychiatrists, experts in dealing with mental illness and prescribing the right medications. Instead, the area has about 14. That leaves a big gap in the number of trained experts able to prescribe psychiatric medications. Primary care doctors could prescribe medicine, but few can track patients’ progress.
The two major problems lead to some alarming statistics: higher-than-average suicide rates and health care costs. For example, 8.2 percent of local adults report depression, compared with the state average of 7 percent. And 30 percent of teenagers report feeling hopeless for two weeks at a time.
“That’s pretty dramatic,” Qualls said. “It’s pretty startling. You should be worried. When you add in substance abuse and suicide, it’s very alarming. Denver, a much bigger city, has a lower teen suicide rate. This is something we need to address.”
Making it easier for families to navigate systems of care — especially as the industry is in flux, waiting to see how the federal mandates play out — could stem the tide of depression, substance abuse and suicide in El Paso County, Qualls said.
“This is one of the problems identified through the survey we gave you,” she said. “We think there’s a real need here — a need to develop ways to help families get into behavioral health care, ways to help them cope with their family problems and issues.”
In a survey of providers, advocates and mental health experts, access to psychiatric beds was highlighted as a problem for geriatric patients, teenagers and adults. Colorado Springs has around 219 beds, which should be enough for the local population, Qualls said.
“But is it? We have people coming here from outside the region, because there aren’t enough beds statewide. They’re about 2,000 beds short statewide,” she said. “And you have to ask if it’s the right bed for the right patient at the right facility. We have a shortage of geriatric psychiatric beds; we have a shortage of places for children.”
The access issue becomes more acute at the inpatient level, Braney adds.
“Inpatient care is just a pressure point,” she said. “The system has access barriers all the way through it, because we can’t help people before it gets to the critical point, before they need inpatient treatment.”
Developing ways to navigate the system could ease the tension at the inpatient level, she said, by getting people help, medicine and assistance before they reach a crisis level.
“That’s something we have to work on,” Braney said. “We’re always reacting to the immediate crisis, but we need to focus on wellness, on prevention.”