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UNDER STRESS

Mental-health advocates seek solution to funding shortage

— The idea sounds reasonable enough: If a hospital housing Southern Oregon's only acute-care psychiatric ward is losing money on the task, why can't other hospitals in the region help out?

Rogue Valley Medical Center's 2 North unit faces deficits that could run as high as &

36;3 million per year, since state support for mental health fell by nearly 70 percent in 2004.

The Southern Oregon chapter of the National Alliance for the Mentally Ill recently challenged hospitals in Jackson and Josephine counties to pick up a share of the region's psychiatric care costs.

Speaking for NAMI-SO, Patricia Garoutte, the group's vice president, wrote a letter encouraging each hospital to set aside six to eight beds for psychiatric patients.

Without this help many (people with mental illness) are doomed to move from hospitals, to homelessness, to jails and prisons, and even some to take their own lives, the Grants Pass woman wrote.

— In a telephone interview Garoutte said she was troubled by the lack of concern for the region's mental health needs. Mental illness has been something you put under the table or in the closet, she said. Funds are cut and cut and cut.

Dramatic reductions in state support for mental health, coupled with several neighboring counties' decision to start their own mental health treatment centers rather than send patients to RVMC, set the stage for the current crisis, said Hank Collins, Jackson County's director of health and human services.

Two things happened simultaneously that led us to this point, Collins said.

Jackson County hospital administrators say the NAMI proposal is well-intentioned, but it won't solve Southern Oregon's mental health problems.

Hospitals that don't already have a mental health program are unlikely to create one from scratch at a time when they're struggling to control costs, said Mark Marchetti, chief executive officer at Ashland Community Hospital.

Marchetti said the issue isn't so much the availability of hospital beds, but the costs of creating, maintaining and staffing a secure site for people who can be a danger to themselves and others.

I can't imagine (any hospital) taking on inpatient mental health willingly when they didn't already (offer the service), Marchetti said.

It makes more sense to find a way to fund psychiatric care at one site, said Scott Kelly, vice president for planning, marketing and business development for Asante Health System. Asante is RVMC's parent company.

We have limited resources in Southern Oregon, Kelly said. Separate sites are not the answer.

Hospital managers agreed that funding the region's mental health services will be one of the biggest challenges the health care community will face in the coming year.

We've got to find a way that's better and more affordable, said John Schwartz, acting chief executive for Providence Medford Medical Center.

Kelly said it would be unrealistic for Three Rivers Community Hospital in Grants Pass to create its own psychiatric unit because Three Rivers is also owned by Asante Health System and works with RVMC to support 2 North.

RVMC has commissioned Seattle-based ECG Consulting to find ways for the mental health program to function more efficiently. Kelly said the consultant's report isn't due for another three weeks, but one of its recommendations will be to create an outpatient clinic for psychiatric patients.

The clinic would help physicians stay in touch with psychiatric patients who have been discharged from the hospital, and support their efforts to function on their own with fewer return visits to the hospital.

That would help reduce the pressure on 2 North. About 12 percent of the unit's mental health patients are readmitted to the hospital within 30 days of being released, said Scott Sonenshine, clinical manager of RVMC's behavioral health services.

Kelly said RVMC will not close its 2 North treatment center, as had been rumored, although the loss of tax support forced hospital managers to reduce the number of beds to 18 instead of 25 in June 2004.

We're not going to abandon the community, he said. Behavioral health is an important part of the services this community needs.

To understand how RVMC became Southern Oregon's psychiatric care center, it helps to know a little history. For many years patients with mental illness were treated at Dammasch State Hospital, outside Wilsonville. Patients from Southern Oregon often were housed briefly at RVMC before they were transported to Dammasch.

About 20 years ago state officials decided to change the way they treated mental illness and set about closing the big state hospital. Regional treatment centers were created, including one in Southern Oregon. RVMC was the logical choice because staff already had experience with mentally ill patients.

For most of 2 North's existence, state funds paid the bills for people who lacked insurance or the ability to pay. Nearby counties sent their mental health patients to RVMC and paid the hospital for their treatment.

The arrangement began to deteriorate when several counties decided to create their own mental health treatment centers. That meant fewer patients ' and reimbursements ' for RVMC.

The present crisis developed after the Legislative Emergency Board, faced with budget shortfalls late in 2003, eliminated mental health benefits for most people on the Oregon Health Plan ' who made up a large part of the 2 North population.

Tax support for 2 North fell from &

36;2.25 million to &

36;690,000 in one year. June 2004, RVMC decided to reduce the number of beds from 25 to 18.

With fewer beds, the unit is nearly always full, Sonenshine said.

We continue to provide pretty much the service we provided before, but we don't get paid for it, he said.

Southern Oregon's situation is far from unique. Sonenshine said other Oregon counties struggle with the same funding problems. Schwartz, the Providence executive, saw similar problems when he worked in Illinois; Marchetti, the Ashland hospital chief, saw the same thing when he worked in Ohio and Pennsylvania.

The need (for mental health care) is real, Marchetti said, but no one seems to come to grips with how to pay for it.

A new working group is trying to find an answer for Southern Oregon. Earlier this year, community leaders realized they needed to find some way to address problems in health care that affect everyone but can't be resolved by any single sector of the community. They formed the Jefferson Regional Health Alliance to look at, among other things, the region's approach to mental health.

The Alliance includes representatives from the hospitals, Jackson and Josephine counties, the business sector and education.

We knew the treatment of the severely mentally ill is a bigger issue than just patient beds, said Carlton Purvis of Medford, JRHA's president. We also know we have excellent mental health resources here.

Purvis, who has worked as a health system planner, said part of the problem lies in the fact that mental health is one of those things that communities don't naturally come together on.

We're not structured to do that, he said. We're structured for economic development and education, but in health care, the way the system has developed over the past 50 years, some services were assigned to government and it was assumed that hospitals and private physicians would take care of the rest.

We've just begun the dialog on mental health, Schwartz said, noting the group has met just twice. It's a huge, huge issue, but having said that, I believe it's a societal issue and a political issue. How high a priority in our society are people with mental illness?

UNDER STRESS"bkettler@mailtribune.com.

Kathy Middleton, a psychiatric nurse at Rogue Valley Medical Center?s 2 North unit, dispenses drugs from the unit?s locked medication room. Mail Tribune / Bob Pennell - Mail Tribune Bob Pennell