In Arkansas, Mental Health Treatment Bogged Down by Uninsured

Concerns over mental health services have spiked nationally since last month’s school massacre in Connecticut, but mental health professionals in Arkansas say dealing with the mentally ill comes down to one thing: insurance.

At any given time, about 5 percent of Arkansas’ population struggles with mental illness that is too serious to allow them to manage their own care, according to Tom Grunden, executive director of the Little Rock Community Mental Health Center.

Those who are insured have plenty of options, the professionals say. Those who are uninsured can’t be turned away by hospitals and publicly funded community mental health centers, but their treatment options are limited and they drain resources away from even the paying patients.

Hospitals are “the safety net for society right now,” said Barry Pipkin, CEO of The BridgeWay, a private psychiatric hospital in North Little Rock.

The chronically severely mentally ill are often without health insurance or Medicaid and, in crises, seek care at hospital emergency rooms or psychiatric hospitals like his, Pipkin said.

Out of the 20-25 patients who come in daily to be assessed for treatment at The BridgeWay, two or three fit that chronic, severe category, he said.

“Many of those patients are not paid for and they have many needs. … They require a lot of our medical care, a lot of our special care,” he said. “At a small hospital such as ours, it does put a burden on our resources.”

The BridgeWay can stabilize a patient in an emergency, but the chronically mentally ill typically need much more care than that. More than half of the people The BridgeWay treats for mental illness also struggle with substance abuse, so people often leave the hospital’s acute care only to return to unhealthy lifestyle patterns outside the hospital’s walls, Pipkin said.

Other long-term needs, such as for help finding work or housing, play into the problem, he said.

“Those patients are the neediest patients, and they’re long-term care patients. Sometimes those patients, in addition to their mental illness and addictive disease, have developmental issues. … They’re a very complicated patient who requires a lot of care,” Pipkin said. “There’s outpatient services out there, but these folks need more than that. If you don’t have a job, who’s going to feed you? Who’s going to shelter you? Those go beyond outpatient needs.”

A homeless shelter isn’t equipped to deal with severe mental and physical health issues, Pipkin said.

CEO Tom Petrizzo of Ozark Guidance in Springdale said his organization seeks out grants and other ways to subsidize the care the organization provides at no cost to the uninsured. Ozark Guidance is among the state’s 13 state-contracted community mental health centers.

Because Ozark Guidance receives about $2.7 million per year in state and federal funding, the organization is required to treat people with mental illness regardless of their ability to pay.

But that uncompensated care cost the nonprofit about $4 million in 2012, Petrizzo said. Ozark Guidance is primarily an outpatient behavioral health center, but it does offer some residential treatment.

Last year, almost 5,200 of Ozark’s 11,000 patients were on Medicaid, Petrizzo said.

About 1,700 more would be eligible for Medicaid coverage under the proposed Medicaid expansion to people with incomes of up to 138 percent of the federal poverty line.

“The main thing that would be helpful to us … would be the Medicaid extension, where states have the ability to increase the income eligibility level,” Petrizzo said.

“It would reduce our uncompensated care burden, we figure, by 20-25 percent. … There’s a certain limit to how much you can do with uncompensated care. If a person has Medicaid, it’s easier to provide care because it’s a payment source.”

More Problems

Treating people who are chronically mentally ill and don’t have insurance comes with an array of problems, said Tom Grunden, executive director of the Little Rock Community Mental Health Center.

For one, emergency room and inpatient treatment are expensive, Grunden said.

Further, such services pull people out of their support systems of family and friends and don’t build sustainable, ongoing treatment outside of a facility, he said.

“Mental illness is recurring,” but patients come, receive intervention, then disappear, even though preventive care is cheaper,” Grunden said. “Thus, [providers] don’t know when symptoms recur.”

Grunden, along with executive directors of other Arkansas community mental health centers, serves on the board of the nonprofit Mental Health Council of Arkansas.

The Mental Health Council of Arkansas is pushing for a different model.

They adovcate one that would keep clients more consistently out of inpatient treatment and, with the help of case managers, help them learn to manage their own mental health care consistently over time.

Then, “as people grow stable, the focus is on prevention, not acute treatment,” Grunden said.

Money Means Options

Due to state and federal mental health parity laws, people who are insured typically don’t have trouble finding treatment, providers said.

“I think the issue is: Do you have insurance?” Grunden said. “If not, you have a hill to climb.”

Petrizzo echoed that idea.

Community mental health providers tend to struggle to find psychiatrists to hire because there’s more money to be made in private practice, Petrizzo said.

Not enough psychiatrists means longer waits for outpatient treatment, he said. “There’s a shortage there to be able to serve those folks,” he said.

Medical schools aren’t producing enough psychiatrists to meet demand, Petrizzo said, and most psychiatrists aren’t interested in working for community health providers.

Therefore, the sector where there are more doctors, and where mainly paying clients are served, is private practice. Private practitioners can limit the charity care they offer.

So, what’s it like if you have money, insurance or both?

“You’ve got lots of choices,” Petrizzo said. “There’s all kinds of private practitioners.”

Mental Health Checklist

Symptoms that someone needs to be evaluated for mental health treatment, as explained by Lee Christenson, CEO of Springwoods Behavioral Health in Fayetteville:

  • Depression is interfering with the person’s quality of life, relationships and work;
  • A psychotic break is impairing someone’s good judgment in caring for himself;
  • He is abusing alcohol or drugs; and/or
  • He is suicidal or talking of harming others.

“We live in a stressful world. People have a lot of stresses and strains in their life. I think the pivot point of when people really need care is when depression persists over a period of time. There is help and there is hope and people can recover," said Christenson.