Looking to the future for local mental health services in Klamath County

From the Klamath Herald and News, January 14, 2014

The Klamath Youth Development Center has more changes on the horizon than a new name — changes which will spur improvements in mental health services in the coming months.

Since KYDC took over Klamath County mental health services on Aug. 1, the organization and its director, Stan Gilbert have been working to offer services to more patients, as well as working with a variety of other mental health stakeholders to update programs and generally improve the health of the community.

Ron Woita, the director of emergency services at Sky Lakes Medical Center, said he was excited to see community partners tackling the issues surrounding mental health.

Ron Woita, the director of emergency services at Sky Lakes Medical Center, said he was excited to see community partners tackling the issues surrounding mental health.

“It’s going to change,” Gilbert said of the future of mental health in the county.

Since KYDC took over mental health services for the county, the number of complaints about access to care has decreased; the number of psychiatric emergencies and hospitalizations due to mental health problems are down, as are wait times for appointments and assessment wait times for mental patients.

Those positive changes will continue, Gilbert said.

Goals for health care, including mental health, Gilbert said, are threefold: offer better care, at a lower cost and improve the overall health of the community.

To that end, KYDC plans to consolidate programs to be more efficient, and modernize other programs to best serve clients’ needs.

KYDC and other mental health agencies, including Sky Lakes, Lutheran Community Services, Cascade Comprehensive Care and law enforcement are working to create a mobile response team. They also are working to create an adolescent respite care facility similar to Phoenix Place, which is the county’s only residential mental health care facility.

Community partnerships

Ron Woita, director of emergency services at Sky Lakes, is excited about how partners are coming together to tackle mental health issues.

“I’ve never seen a community really come together to address an issue like this,” Woita said. In the short time since the county mental health transition, KYDC has overcome a lot of hurdles, he said.

“It’s impressive, it really is,” Woita said. “It’s truly a positive change — from all aspects.”

He’s seen what he hopes is an increased response to mental health cases in the hospital’s emergency room. Cases seem to have decreased over the last few months even despite the typically stressful holiday season.

Greater access to needed mental health care keeps people from going in to crisis mode, when they could end up in the hospital, Woita explained.

Bob Pickel, the director of Lutheran Community Services, which also offers mental and behavioral health services, said he is glad to be working with KYDC.

Overall, there has been an attitude change in the county toward mental health, said Bill Guest, the CEO of Cascade Health Alliance, the state-designated coordinated care organization, or CCO, that began overseeing Oregon Health Plan and Medicaid patients in the county last fall.

Down the road, Gilbert hopes that mental health services will be more integrated with medical care; both medical and mental health practitioners would agree that there is a great deal of overlap between the two areas, he said.

For serious health issues and chronic diseases especially, mental health problems can hinder treatment, Gilbert explained.

The demarcation of drug and alcohol health problems and mental health, for example, are very closely intertwined and often can affect an entire family, Gilbert said.

Scott Munson, the director of Cascade Comprehensive Care and a registered nurse, agreed that with mental health and other providers working together, cooperation is growing in importance.

Munson envisions a patient-centered medical home, which could be one-stop shopping for patients.

In the past, adults had to receive treatment from the county, youth from KYDC, and families, to a small extent, could get treatment together at Lutheran Community Services, but those walls and barriers are now gone after the transition, Munson said.

“We’ve broken all those down,” Guest agreed. “We are much more coordinated.”

However, the county is in need of more mental health practitioners, especially psychiatrists. “It’s a big problem,” Gilbert said.

To Woita, every little step forward is nothing but good for the community, and he’s glad to see a variety of groups being proactive in making changes.

That doesn’t mean, however, that changes will happen immediately, he said. It’s not a light switch you can just turn on, he explained; instead, it takes a lot of work to make mental health, and health care services more efficient, and offer better access in a more timely manner.

Still, he’s encouraged by the progress so far.

“It’s very promising,” Woita said.

Upcoming projects for mental health care services in Klamath County

Two projects that will have a significant impact on mental health services in Klamath County are the creation of a mobile crisis response team and a new adolescent respite care facility.

The projects represent a new era of collaboration between a variety of mental health stakeholders.

Stan Gilbert, the executive director of Klamath Youth Development Center, said the crisis response team will be able to respond to psychiatric emergencies, wherever they take place, such as in a home or school or even on the street.

KYDC and other mental health care providers are dependent on Sky Lakes Medical Center in those emergencies because patients have to be admitted to the emergency room, which is an expensive and time-consuming process and takes a high degree of work for the hospital staff, Gilbert explained.

A mobile team would be less costly, and it also would offer better care for patients by avoiding the added stressors of being transported and admitted to the hospital.

Ron Woita, the director of emergency services at Sky Lakes, said it is expensive to admit those mental patients because of federal regulations; the Emergency Medical Treatment and Labor Act (EMTALA) requires that anyone who comes in to the hospital needs to have a medical exam, Woita said, and they have to be medically cleared to a certain level for liability reasons, for one.

The staff also needs to make sure patients are healthy in general.

A patient admitted to the emergency room might need a CT scan, for example, Woita said, to ensure they are medically stable. The same is true for mental health patients.

Another change is the creation of a local adolescent respite care facility, similar to Phoenix Place for adults, said Bill Guest, the CEO of the county’s coordinated care organization Cascade Comprehensive Care.

Community partners are using money from a state transformation grant to launch the facility hopefully this summer, Guest said.

The CCO’s medical director Dr. Lawrence Cohen said he is “as excited as can be” about the prospect of such a facility, and about the crisis response team.

The care facility will serve mental health patients 17 years old and under, Cohen said. Those patients in need of longer care are now sent out of the county for that care as far as 300 miles away.

“We don’t have places for them to go,” he said.

Sometimes, in those advanced situations, local mental health practitioners will not see the children in those cases again for a long time, Gilbert said.

“A lot of times they go away and we don’t see them again for years,” Gilbert said.

The buy-in on both projects throughout the community is tremendous, including with law enforcement, Cohen said.

“We have so many things that we want to do all at once,” he said. “This is the tip of the iceberg.”