Amid the national clamor about the need to address mental health issues, Mayo Clinic Health System-Franciscan Health Care in La Crosse will close its Inpatient Behavioral Health Unit temporarily in mid-June for lack of psychiatry services, hospital officials say.
The closure, formally called diversion, involves trying to find inpatient services at other facilities, including Gundersen Health System, and/or pursuing other avenues, such as the La Crosse County Human Services Department’s Integrated Support and Recovery Services.
“We remain committed to serving the needs of behavioral health patients in our community,” said Dr. Susan Halter, medical director of Mayo-Franciscan’s Behavioral Health Services.
“This is a challenging time for behavioral health services, not only here at Franciscan Healthcare but across the country,” Halter said. “We are working on a long-term plan for this unit.
“We greatly appreciate the support and cooperation we have received from local and regional behavioral health entities, who are working with us to accept these patients,” she said.
The shortage of psychiatric practitioners has become a gathering storm nationally and in many states for the past several years, according to health officials.
Wisconsin providers were able to cover only 21 percent of the need as of April 28, 2014, the most recent statistics available, according to the Henry J. Kaiser Family Health Foundation. The foundation’s tracking of Mental Health Care Health Professional Shortage Areas found that the Badger State has 103 such spots and would need an additional 212 practitioners to lift the designation.
Across the Mississippi River in Minnesota, just over 61 percent of the needs are being met, while 59 areas are deemed short, and 30 practitioners are needed, according to Kaiser. In Iowa, just under 61 percent of the needs are being met, 67 areas are short and 30 practitioners are needed.
Nearly 4,000 shortage areas exist nationwide, meeting about 51 percent of the needs and requiring 3,707 more practitioners to level the playing field.
The problem, however, goes beyond counting noses.
“I won’t argue that there isn’t a shortage,” said Kelly Barton, a clinical operations vice president at Gundersen Health System in La Crosse. “At Gundersen, we have been fortunate to recruit psychiatrists, psychologists and therapists.”
Beyond that, “we’re trying to focus on different models and integrate mental health more into primary care,” Barton said.
“We are trying to get to the root cause. We could hire more providers, but that would not solve the problem,” she said.
“We’re moving upstream to reach people before they reach the crisis point,” Barton said.
That approach requires tapping into agencies that are outside the health care system to help identify other issues that might be affecting mental health, she said.
A common theory is that some health difficulties, such as anxiety, stress and some medical conditions such as heart problems, are masking mental health issues that eventually surface.
Enlisting and supporting primary care personnel to identify such issues can pinpoint cases in which patients might need just a few sessions with a therapist or medication instead of long-term care or even hospitalization, Barton said.
In the past, mental health care models may have been more rigid, stipulating the same regimen for everyone, “when not every kind is for everybody,” she said.
Partnering with primary care physicians and community agencies to tailor care to patients is as important, or more so, as increasing practitioners, Barton said.
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“We are blessed in this community with assets,” she said, adding, “How do we partner to focus on how to better handle patients — that’s a solve.”
Treating those who need behavioral health care but can be accommodated on an outpatient basis frees up beds for others who really need hospitalization, she said.
Gundersen’s 3-year-old Inpatient Behavioral Health Hospital, which has a total of 34 beds on Gundersen’s La Crosse campus, averages 27 patients a day and “is full a good portion of the time,” she said.
“When you hear we are in diversion, it’s because we are full,” Barton said, adding that Gundersen usually tries to find behavioral health beds in Madison or Milwaukee.
“If we think a behavioral health bed will open in 24 hours or so, we will admit patients in a regular hospital bed so they can stay in town, where their families are there for support,” she said.
The need for diversion worries county officials because county programs may have to pick up the tab when no beds are available, said Matt Strittmater, director of the county Human Services Department’s Integrated Support and Recovery Services.
With waiting lists for care at Mayo-Franciscan and Gundersen, the county has an outpatient clinic for the uninsured, Strittmater said.
The clinic has experienced an uptick in patients, which Strittmater said “is cheaper and better care than going to the ER.”
When someone is uninsured but is hospitalized, the county pays for the care, he said.
“We have a contract with Mayo for that” and would hope Gundersen can accommodate patients if Mayo-Franciscan is unavailable, he said.
“We always have a fear when they are full,” because that means transferring people out of town, possibly to a state hospital if no other hospitals are available, Strittmater said.
While private insurance covers such a move, coverage through the state’s form of Medicaid in BadgerCare would not, and the county is billed, he said.
Problems are expected to worsen with the temporary closure of the Acute Psychiatry Inpatient Unit at the VA Medical Center in Tomah, as well as its Community Living Center for Veterans requiring Mental Health Recovery, Strittmater said.
At Mayo, physician recruiter Rhonda Smith said, “With our change in our provider recruitment model from site based to specialty focused, psychiatry and psychology was the first specialty to launch due to the high need for openings and difficulty in finding candidates.”
Mayo also plans a broader national recruitment campaign focusing on psychiatry openings throughout its system, Smith said.
A bill in the Wisconsin Legislature may ease the process of scrambling for accommodations, Strittmater said. The proposal would provide an electronic tracker for psychiatric beds, making it easier to find openings, he said.
But the health officials agree that the proactive approach is the best solution not only to the shortage of psychiatrists but also to ease the demand for beds and, in the long term, shore up the nation’s mental health.
“Why wait until somebody is so depressed they have to go to the emergency room?” Gundersen’s Barton said.