Integrate primary and mental health care, PAR says
The latest PAR report, “Public Mental Health Care in Louisiana,” evaluates the state’s system of public mental health care. The report provides an overview of the system and focuses on several issues that are barriers for those who seek treatment for mental illness. The analysis finds that the system is biased toward expensive institutional care and does not have the capacity to treat many of those with mental illness.
The most striking difference between Louisiana and most other states is the high level of spending for state mental hospitals that provide intermediate to long-term inpatient care. Nationwide, spending on mental health services in 2006 included 28 percent for state or county psychiatric hospitals, 70 percent for community-based care and 2 percent for administrative costs. For Louisiana, the split was 56 percent for state psychiatric hospitals, 30 percent for community-based care and 13 percent for administrative costs.
The public system that delivers care for persons with mental illness has evolved over the past 50 years from providing mostly inpatient hospital services to providing predominantly community-based care that allows more personal freedom for most patients. However, the current system is underfunded, fragmented and difficult for the patient (and often the provider) to navigate.
Persons with chronic mental illness frequently seek non-emergency care services in emergency rooms throughout the state, because they do not have private insurance or Medicaid coverage and cannot afford to pay. These patients would benefit from having the continuity of treatment available from a single, non-emergency source of routine primary and mental health care.
The recommendations made by this PAR report are pragmatic solutions that are within current reach of policymakers dealing with austere budgets. While acknowledging that the preferred solution would include a massive injection of much-needed funding for public mental health services, the analysis is grounded in the reality that there is little money available for that purpose. The state is in the midst of a budget crisis, and services, no matter how vital, are likely to shrink rather than expand.
The report makes the following recommendations:
Sustained funding should be provided to expand patient-centered medical homes for primary care and integrated behavioral health services, including replacement for the expiring Greater New Orleans Primary Care Access and Stabilization Grant.
Public systems of medical care and behavioral health care should be integrated through regional care networks modeled after a successful community-based pilot project in the Capital Area Human Services District.
The Louisiana Medicaid program should review and revise its method of paying for treatment of patients diagnosed with mental illness or behavioral problems in order to encourage physicians to integrate primary and mental health care services and treatment plans.
The Legislature should establish an ongoing appropriation for payment of primary care treatment for uninsured persons with co-existing medical and behavioral health problems.
The DHH Office of Mental Health should focus on decreasing institutional costs where possible, including (a) downsizing existing state psychiatric hospitals by reducing bed capacity, staffing or excess land and (b) reducing administrative costs. Any savings incurred should be transferred to community-based outpatient care.
Various collaborative models for integrating primary and behavioral health care could be applied throughout the state, improving both physical and behavioral treatment for persons diagnosed with mental illness, as well as expanding diagnostic and treatment capacity for both behavioral and physical health problems. Notwithstanding the difficult budget climate, the state should implement these proposals because they provide significant long-term savings by improving access and quality of care, thereby reducing hospitalizations and other expensive treatment.
For additional information or to obtain a copy of the report, go to www.la-par.org.