Area Hurts for Mental Health Beds and Bucks

When it comes to mental health care, the sheets have been shorted in Arkansas’ northwest corner.

Northwest Arkansas has no state-funded mental health facility. Without state support, a 24-bed mental health facility would lose $950,000 per year, according to a recent task force study.

That’s because of the disparity in mental health insurance coverage and problems with Medicaid and Medicare.

Medicare doesn’t cover prescriptions, and Medicaid doesn’t cover a lot of people, said David Williams, president and CEO of Ozark Guidance Center of Springdale.

Williams chaired the task force that is pushing for funding of Act 1589, which was passed by the state Legislature in 2001 but was not funded. It provides $11.5 million per year to subsidize mental health care services statewide. Northwest Arkansas would get an estimated $1.25 million of that — enough to possibly encourage area hospitals to provide beds specifically for the mentally ill.

Rarely is there space available for local psychiatric patients at the Arkansas State Hospital in Little Rock where 90 beds are dedicated to mental health care. Most of those beds go to patients in the Pulaski County area.

Northwest Arkansas is the largest metropolitan area in the state without adequate psychiatric acute care.

Northwest Arkansas’ only inpatient facility can’t handle Medicaid and Medicare patients.

Up to 12 patients receive care at Fayetteville’s Vista Health, a private mental health facility. Vista Health can’t accept Medicaid, so it typically only admits the insured.

“The problem is that whether people have the means to pay or not, we don’t have adequate psychiatric acute care capacity,” Williams said.

Highland Hall, a 20-bed psychiatric unit at Northwest Medical Center, closed in April. Forty percent of its patients during its last year were charitable cases — meaning that insurance didn’t exist and subsidy programs didn’t provide for those patients, Williams said. The lack of subsidy programs led to the $1 million annual loss and the unit’s closing.

“The hospitals are saying they can’t afford to go broke taking care of the mentally ill,” Williams said. “If we can offset those costs, we can provide that care again.”

Highland Hall’s closing, and another closed program at Sparks Regional Medical Center in Fort Smith that also reportedly lost $1 million its final year of operations, have left those suffering from acute mental illness with little to no help.

Some are housed in local jails — if they’ve committed a crime that law enforcement can use to justify the incarceration.

Some are on daily outpatient support from Ozark Guidance Center but are left on their own or with family members much of the time.

Some are housed in hospital intensive and cardiac care wards where they have continuous nursing supervision, but the environment — glassed-in rooms, constant stimulation, untrained staff and a lack of space — doesn’t promote their mental well-being. And consequently, beds for the physically ill are taken up by the mentally ill.

“It’s a miserable area for psychiatric patients,” said Michael Hollomon, medical director of psychiatric services for Washington Regional Generations and Transitions — two mental health facilities operated by Washington Regional Medical Center. “But there’s a high level of observation.”

Every hospital in the area participated in the task force formed by Washington County Judge Jerry Hunton that is recommending funding changes to the Arkansas Legislature. The Northwest Arkansas Mental Health/HIV Crisis Stabilization Task Force also made suggestions on providing more HIV services.

“The task force is exploring possible solutions to the lack of mental health beds in Northwest Arkansas,” said Ed Mirzabegian, chief operating officer for St. Mary’s Hospital in Rogers and a task force member. “It’s a challenging task, but it’s also encouraging that all the health care leaders of the area are working together to solve this problem.”

Hunton sent Arkansas legislators a copy of the report with a cover letter Jan. 24 asking for their support of what he called “some positive changes in state funding for community-based mental healthcare.” The report includes in its appendix a copy of a similar report prepared by Huckabee’s statewide task force on the issue.

“Education seems to overshadow everything else,” Hunton said about the legislative session. “We can’t just look at education and ignore all these other things.”

The annual expenditure of public funds for mental health services in the state is nearly $400 million, which provides services to about 60,000 people each year — of which nearly 5,000 are admitted to the state’s community mental health centers.

But Arkansas is still 49th in the number of state-operated psychiatric beds per 100,000 people, according to a report on the statewide status of mental health care services prepared for Gov. Mike Huckabee by a similar task force he formed.

Funding the Beds

The national average for the two-county area’s population (311,259 in 2000, according to the U.S. Bureau of the Census) is 40 to 60 beds for acute mental health care. The task force report recommends 36 beds for the area — 12 at Vista Health and the development of 24 new beds.

They suggest immediate development of a 12-bed psychiatric unit for acute care in one of the local hospitals, with another 12 beds to be added as funding becomes available. Remodeling and equipping a hospital ward for that purpose will cost an estimated $1 million.

The task force’s report commends Ozark Guidance Center for the intensive outpatient care it provides and the resulting lower-than-average number of needed beds. About 9,000 people were treated for mental health services at Ozark Guidance Center last year and 856 were hospitalized, Williams said. Eight of them went to the state hospital.

“Part of the silver lining here is we have the support here to keep the demand low, but when we need it, we really need it,” Williams said.

Medicaid won’t pay for psychiatric care in a freestanding psychiatric facility. Williams explained it’s a federal law intended to discourage Medicaid-only psychiatric hospitals.

“They wanted to prevent snake pits,” he said.

WRMC’s Hollomon wouldn’t say if the hospital would go for the $1 million estimated renovation cost and other considerations to open a 12-bed mental health unit for adults. Open space at the mostly abandoned WRMC facilities at North Street and North College Avenue in Fayetteville was mentioned by several members of the task force as a possible location for the needed bed space.

WRMC’s Generations 16-bed program for elderly patients with mental health care needs operates in the facility now. The hospital also operates Transitions — a 10-bed program in its Fayetteville City Hospital facility on South School Avenue.

“Washington Regional’s administration and board are interested in looking at community problems, but we have to look at the whole community,” Hollomon said. “They want to meet that need if they can, but they have to look at the whole community.”

Acute Care and Holding Cells

In addition to the lack of funding for acute psychiatric inpatient care, Northwest Arkansas’ mental health crisis has another element — dealing with the criminally accused who need mental evaluations and special care.

“We need more care in jail and more security in the hospital,” Williams said. “There’s not enough hospital beds for them. There’s no room in the jail. There are just no secure beds in Northwest Arkansas.”

Washington County Sheriff Steve Whitmill supports a couple of recommendations to change the way the legal system deals with the mentally ill who’ve committed crimes.

The task force suggests that getting mental evaluations of the accused completed in a timely manner might be achieved with 16 jail cells dedicated to such inmates from the four northwest counties. The task force also recommends that forensic evaluations be conducted locally rather than only in Little Rock.

The state Department of Human Services is considering the decentralization of its forensic evaluation and treatment services now conducted at the Arkansas State Hospital in Little Rock — when available. The proposal is in response to a federal court ruling that such evaluations and treatment be conducted in a timely manner.

“We don’t have to have a postmark of Little Rock to do the same evaluations,” Whitmill said.

It’s better for law enforcement and better for the person being held to get an evaluation immediately, Whitmill said.

He also supports the task force’s recommendation that crisis stabilization and intervention teams be established that would train and support at least 10 percent of the area’s law enforcement personnel in intervention and jail diversion options for the mentally ill. The plan is based on a similar program in Memphis.

“Some of those folks don’t need to go to jail — they need help,” Whitmill said.

A comment in the report compiled by the Governor’s Mental Health System Task Force sums up the problem: “Years of benign neglect of the public mental health system and the failure of many components of that system to change — to embrace new and better ways of providing care — have combined to bring us to the critical juncture we now face.”