Faced with increasing hospitalization costs, mental health officials are proposing another strategy to care for patients undergoing psychiatric crises in Stanislaus County.
Officials are talking with local hospitals about forming crisis teams to stabilize patients who are considering suicide or having psychotic symptoms. The units with staff able to prescribe medication would choose people with the best chances of being stabilized, so they can return home and not be admitted to Doctors Behavioral Health Center on Claus Road.
The county would focus more attention on managing the care of patients who are hospitalized and released from the behavioral center. By making sure they take their medication and keep their appointments, the county hopes to reduce the number of people who are hospitalized again.
A third goal is establishing a 16-bed psychiatric health facility, which would increase bed capacity in the county. The new facility would require a lower level of staffing by nurses, reducing the costs of patient care, officials said.
The care given at DBHC is expensive because it's the highest level of care, said Madelyn Schlaepfer, director of county Behavioral Health and Recovery Services. "There are people who can be treated just as well at the lower level of care," she said.
Stanislaus County supervisors will consider the plan Tuesday. The details were released Friday in the board's agenda packet.
The county is responsible for Medi-Cal recipients and the uninsured who need acute psychiatric care, and it is seeing an alarming rise in hospitalizations and related costs at the behavioral center, which is owned by the parent company of Doctors Medical Center.
The county's costs for patient care at DBHC and facilities outside the county were $1.5 million over budget in July and August and could exceed budget by $3 million through June 30, officials said last week. Officials expect the total costs will be $10.2 million this year, $5 million higher than the previous year.
Combination of factors
The rising costs are attributed to the spike in admissions, an increase in rates paid to hospitals and a larger percentage of uninsured patients, for which the county pays 100 percent of charges. According to a report, the county pays $1,031 per day for Medi-Cal patients and $2,484 for three days for the uninsured. The patients inside the center are stabilized until they're no longer a danger to themselves or others.
Behavioral Health and Recovery Services will draw down fund balances to cover the unexpected costs this year, but it can't keep doing that, Schlaepfer said.
Officials suspect the spike in people needing crisis treatment has ties to job losses, families losing their homes and insurance, drug abuse, and funding cuts that have eroded outpatient mental health services.
Schlaepfer said people with symptoms take up beds in hospital emergency rooms while they wait for evaluation and space at DBHC or centers outside the county. Officials believe hospitals could relieve pressure on their emergency rooms by participating in the crisis stabilization teams.
If approved, it's going to take months to implement the new approach. The plan calls for using Mental Health Services Act funding to create the crisis stabilization teams. The proposal will be submitted for public review in December.
Jack Waldorf, vice president of the county Mental Health Board, said the plan should help resolve the county's budget problem and improve outpatient care for people with disorders.
"There has been a perennial problem with the lack of after-care," he said. "The behavioral center hands off their patients to the county, but if they don't have insurance, it's left to (safety-net health clinics) to deal with the patients, and they have limited resources."
Behavioral Health and Recovery Services is asking supervisors to approve a request for proposals for design services for the psychiatric health facility. Staff recommends a remodel of the Stanislaus Recovery Center in Ceres for the 16-bed facility, estimated to cost $2.2 million.
To pay for the project, the county has funds from the 2007 sale of Stanislaus Behavioral Health Center, which was renamed DBHC after it changed hands.
With the development of the psychiatric health facility, the county still would budget for 15 beds at DBHC and nine beds outside the county for patients needing the higher level of care. The total patient care costs are estimated at $8.7 million per year, or $1.5 million less than the current expense.
The Board of Supervisors meets at 9 a.m. Tuesday in the basement chamber of Tenth Street Place, at 1010 10th St.
Bee staff writer Ken Carlson can be reached at firstname.lastname@example.org or (209) 578-2321.
The Stanislaus County Board of Supervisors will meet at 9 a.m. Tuesday in the basement chamber of Tenth Street Place, at 1010 10th St. It will consider the following items:
An annual report from the Mental Health Board
Approval of designs for the coroner and public administration project. The $6.2 million project calls for remodeling the former Medical Arts Building on 17th Street for a coroner's facility, sheriff's detention video visitation center and Health Services Agency medical records.
An agreement with the cities of Riverbank and Oakdale for providing Dial-a-Ride service to those communities