No one wants to be crazy

Innovative and collaborative mental health services reach people across Southwest Washington

According to Eric Yakovich, chief executive officer for Cowlitz County Guidance Association (CCGA), one in four people will deal with some sort of mental illness every year. In Southwest Washington that represents 142,968 people. Unfortunately, said Yakovich, far less than half of those receive care. In addition, said Yakovich, mental illness is the number one cause of missed days at work in the world’s developed economies and causes billions in lost wages and lost productivity.

“There’s a stigma around mental illness – no one wants to be crazy,” said Yakovich. “And, since those with mental illness aren’t in a wheelchair, or have a cast, or have lost their hair, people think nothing is wrong. Nothing could be further from the truth.”

In an effort to bring consistency to care across the region, as well as achieve cost efficiencies, Clark, Cowlitz and Skamania counties have combined administration of the region’s public mental health services. The new entity, formed last October, is called Southwest Washington Behavioral Health (SWBH) regional support network (RSN). Pacific and Wahkiakum counties, part of the Timberland RSN, have a “memo of understanding” with SWBH, and work closely to promote best practices.

“When we come together as a group, we can leverage our individual strengths,” said Geoff Knapp, SWBH Communications Coordinator. “Erasing borders between counties improves transferability of people in need and availability of services.”

SWBH contracts with providers across the region, such as Lower Columbia Mental Health Center in Cowlitz County and Columbia River Mental Health Services in Clark County, to provide publically funded mental health care.

The complexity of needs

According to Connie Mom-Chhing, SWBH chief executive officer, one of the main challenges for providers of mental health care is the complexity of needs.

“Most individuals have multiple needs,” said Mom-Chhing. “It’s not just mental health – there’s also chemical dependency, primary care health needs and even a housing component.”

Mom-Chhing said that this complexity requires a holistic approach to treatment.

“We strongly feel we have to do a better job of working with partners to meet needs,” said Mom-Chhing. “If you don’t treat the whole individual, they will get worse and end up in the emergency room or jail.”

Falling through the cracks

An even larger challenge, said Yakovich, is that because the majority of mental health care funding comes through Medicaid, there is a significant number of people who need care but are not eligible. Yakovich said that the state’s increased focus on using Medicaid funding for mental health care meant that 4,000 people per year are no longer able to receive care in Cowlitz County, although the CCGA budget remained fairly static. Brad Alberts, SWBH chief operations officer, said that the state was due to recalculate the Medicaid reimbursement rate in March.

“We never know what our rate will really be – it could drop a million dollars in one month,” said Alberts.

Some services do exist for non-Medicaid-eligible patients. For example, the Lower Columbia Mental Health Center offers a free counseling clinic that is open five days a week for four hours a day and a homeless outreach program. But, Yakovich said, it’s not enough. The tragic school shooting in Connecticut, he said, provides a graphic example.

“Young men in their late teens and early twenties are expected to go to work,” said Yakovich. “If they don’t have income or insurance, there is not funding to provide treatment. That’s an additional tragedy that needs to be addressed.”

Lynn Samuels, executive director of Columbia River Mental Health Services, said that they have a process to constantly assess risk associated with the people they serve – but this process applies only to those in the system.

“How can we get more people in our system that aren’t now getting the care they need?” asked Samuels. “That’s what creates risk.”

Samuels also predicted that the lack of available treatment dollars for the “working poor” was going to become an even greater problem in the next fiscal year. She expects the state’s K-12 education funding mandate will mean cuts in state-only human services dollars. Alberts said that the SWBH has used reserve funding to sustain same levels of service despite cuts to state funding two years ago, but those reserves have been almost used up.

“Other RSNs had to reduce services because they didn’t have the depth of reserves we had,” said Alberts.

Managing risk

Samuels said the region’s mental health care providers are committed to the safety of clients, their family members, staff and the community at large. For example, Columbia River Mental Health Services participates with a suicide response work group put together by the sheriff’s department.

Yakovich and Mom-Chhing said that their organizations have placed therapists in schools and for the last several years have provided student threat assessments for students who have “crossed the line between poor behavior and becoming a threat.”

“We try to be proactive and engage kids in services ahead of time,” said Yakovich. “But services are voluntary…the key is to be welcoming and provide information that will help them realize services can be a benefit to them.”

The CCGA also provides a yearly 40-hour crisis intervention training course to first responders. Yakovich said that so far, they have trained more than 225 officers and first-responders in Cowlitz County.

Collaboration Is key

Knapp said that they are working on a service integration initiative, so that mental health, chemical dependency, and primary care providers can collaborate.

“We need to better integrate and coordinate our services to meet overall health needs,” said Knapp. “We can’t continue to treat people from a silo perspective.”

According to Yakovich, the region’s mental health care organizations have made great progress over the last few years, raising awareness of the benefits of mental health care.

“Mental health care is becoming viewed as part of primary care,” said Yakovich. “The reality is that treatment helps – it relieves illness and symptoms.”

Locally grown: Innovative programs in Clark County

Psycho-Social Rehab

Lynn Samuels, executive director of Columbia River Mental Health Services, said they have embarked on an exciting new Psycho-Social Rehab (PSR) program. She described PSR as an intensive day-program, focused on positively engaging people who need mental health care services. The program will provide support and structure, and prepare participants for moving on to more traditional outpatient services. The program opened last December, and currently has about 10 participants. Eventually, said Samuels, she expects to have availability for 30 to 40 participants.

Consumer Voices Are Born (CVAB)

This program, located in Vancouver, encourages self-determination and self-sufficiency for people in mental health and addictions recovery. The REACH center offers self-help classes, recovery groups, access to computers, volunteer opportunities, and social activities. The Val Ogden Center is a community of peers working together to achieve recovery goals in an environment similar to a typical workplace. Vancouver’s CVAB has assisted other peer-run associations in the state, and is building a network of similar centers across the state through a grant from the Substance Abuse and Mental Health Services Administration.

Child Wraparound Program

Eric Yakovich, chief executive officer for Cowlitz County Guidance Association (CCGA), said their Child Wraparound program is a promising service for children and families that are involved in multiple support systems. The program focuses on helping the family become the leader of their care, instead of simply being told what to do by several different agencies or entities. Yakovich said the program has shown outstanding outcome for children and family, in terms of behaviors and functionality, and is based on a national wraparound initiative (see www.nwi.pdx.edu/wraparoundbasics.shtml). Clark County also offers a child wraparound program, coordinated through Catholic Community Services.

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