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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.

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(11) comments

NotToday

The amount of people being negatively affected by this prior to Mayo closing its unit was already staggering, so I can't imagine what will happen now. I was on the waiting list at Mayo for 9 months after my only psychiatrist retired. I forced an admission to Mayo Inpatient Psych, saying I would hurt myself if they sent me home, but walked out the next day with a psychiatrist and counselor. When my new psychiatrist retired and I couldn't get another at Mayo, I switched to Gundersen and have been on the waiting list there for 10 months. In the meantime, when my psychiatrist's retirement was official, all the refills on my bipolar medications became void and I had to get my PCP to refill them. He was willing to refill some of them, but not all of them and wasn't comfortable adjusting the doses when I told him I was feeling unstable. I was diagnosed about 11 years ago after my first breakdown and have been stable for almost 10 years without any major manic or depressive episodes, aside from when they were combined with postpartum, but I still had my original doctor who made sure to stay on top of my moods and adjust my medications until I made it through those very rough times, especially the severe depression that follows the manic episodes. A few months ago when I started suffering from mania that only worsened, I called both hospitals again and found out they were not even making appointments because they each had only 1 doctor on staff for inpatient and outpatient care and weren't making appointments with counselors either for the same reason. My primary referred me to psych 10 months ago and again a few months ago when I told him I needed help, but again no one was available to help me. Finally after being stable for 10 years, I had the worst manic episode of my life, which not only lasted a few weeks but was gradually getting worse over that time. My husband and I have been together for 8 years, so he has never seen me unstable. He has never seen me yell at anyone because I refuse to do that and instead wait until everyone is calm to talk things out. Obviously, based on the fact that I won't even yell during an argument, he had never seen me get violent toward myself or anyone else. The worst night of my life started with an argument that evolved into me screaming, pushing my husband, kicking at him, throwing a small chair across the room and I was delusional because I was convinced he was attacking me and I was defending myself, so I called the police. By the time they arrived, I wasn't sure anymore what happened and refused to talk to them. Even though my husband explained over and over that he has never seen me like this and I needed mental health care, when there is a domestic call, someone has to be arrested, so I was arrested and charged with disorderly conduct. After I was bailed out, I was under the impression I could have someone go in and get my medications while I waited in my neighbor's driveway, but when my oldest son when into get them, he argued with my husband and they both called the police. Because I was there and had sent my son in to get my medications, they told me I broke bond and I was arrested again, this time having to stay all night without taking my bipolar medications. When I was released, the no contact was lifted. Two days later, I had taken off to my dad's house to stay and my family got worried and called in a welfare check, not realizing I was in class and that was why I couldn't answer their calls. When I got to my vehicle, the police were there and after making sure I was okay, they told me I broke bond by going to my house to get my things and my car because they did not have the updated info, so I was arrested again and when I couldn't get a hold of my husband to bring the paperwork down, I had to stay another night without my medications. When they wouldn't let me try calling again like they had told me I could and that I would be staying until 1:30 the next afternoon, which is when intake court takes place, I ended up in the padded cell for trying to hurt myself. By the time they had me talk to mental health care workers, I was crying so hard I couldn't talk and they told the officers it was due to going without my medication. At intake court they basically said "oops, the no contact was dropped 2 days ago," and let me go. Again, after all this, I couldn't get into a psychiatrist at either facility and unless I actually slit my wrist or overdosed, not just threatened to, they couldn't get me a bed. Finally I found out I could see a mental health care team through the county, which consists of a nurse practioner who can prescribe medications and counselors. They have messed with my medications so much that while I am doing better as far as the mania and depression, my anxiety is worse than it has ever been after they cut my dose of anxiety medicine in half, the same dose I have been on for 10 years without increase, and stopped my ADD medications which led to me having to drop one of my classes so I wouldn't fail and ruin my high GPA. After reading the comments here, I finally realized why my doctor left Mayo...apparently he was one of the doctors the blogger mentioned was let go due to questionable prescribing practices, even though he had never prescribed me anything different than what I have been on for 10 years, no early refills, nothing questionable in my case. So while the blogger may have had complaints, I don't think they thought through the impact of their crusade that may have led to the loss of 3 psychiatrists at Mayo on their patients. I have had major problems with Mayo and vowed never to go back after they overmedicated my thyroid for months and caused me to be unable to get out of bed and eventually develop either rheumatoid arthritis or a form of lupus due to the underlying autoimmune thyroid disease triggering other autoimmune diseases in my body. I could no longer perform my duties as a medical transcriptionist and after 16 years, I was told I needed to find a new career, which is why I am back in school. Despite my vow never to go back to Mayo, I just had to switch back to them so I can make an appointment with a PCP at a Mayo Clinic in Minnesota so I can be referred to a psychiatrist there, possibly even my previous doctor. I did all of this before seeing this article and after reading it, I am afraid of what will happen in our area when there are so many patients in need of mental health care and now 2 major resources for these patients are closing their doors! The amount of people in jail due to behavior resulting from lack of mental health care has increased dramatically in the last year, and that was before Mayo and Tomah VA stopped seeing patients. The receptionists at both facilities told me they heard stories like mine multiple times daily and felt helpless because they can't help them and don't even have anything to recommend to them. If someone like me who has no criminal record or history of any kind of violence, even while unstable, can end up in jail due to lack of mental health care treatment, what is going to happen when the multitude of people who do become violent when unstable can't get the treatment they need, inpatient or outpatient? A dramatic increase in crime? What about all the people who are suicidal? If they can't get admitted to avoid hurting themselves, don't you think we will have a huge increase in suicide attempts or successful suicides, not just in our adult population, but in the high percentage of teenagers suffering through these issues if they can't be admitted to keep them safe and get them treatment to stabilize them? Nothing good is going to come out of losing so many psychiatrists and the closing of inpatient facilities. I was afraid of what was going to happen when we had such limited options, but I am now terrified of what will happen with our already limited options cut so dramatically. Hopefully I can get help in Minnesota, but pretty soon they will be unable to take patients anymore and our already severely limited options will be down to the couple providers at Gundersen, and that is only when they start making appointments again because after 10 months on the waiting list, they were still not even making appointments, just putting people on an unending waiting list. I am glad the blogger made a stand, but I wish she had thought through the consequences and/or found a way to weed out the questionable providers and monitor the others closely until new providers could be hired to avoid the tidal wave of crime and suicide that could possibly be coming due to lack of treatment options. Sad outlook.

tmkgls

To NotToday: You said, "I am glad the blogger made a stand, but I wish she had thought through the consequences and/or found a way to weed out the questionable providers and monitor the others closely until new providers could be hired to avoid the tidal wave of crime and suicide that could possibly be coming due to lack of treatment options."
First: HOW can a layman "monitor" those that work in healthcare? If you know, please let me know.
Second: After your search regarding your psychiatrist at Mayo which led you to ONE of my blog posts, did you read any of my other blog posts or my entire website? No, you didn't. Yes - I do know through stats of my sites. Furthermore, did it ever occur to you that the psychiatrist was being VERY careful with what was prescribed to you because that psychiatrist was under the proverbial microscope? Also, you say your two of your psychiatrists "retired". When have you ever heard of any doctor "retiring" in their 40s? The one in their 60s may have "retired",but not the one in their 40s! I AM sorry for all the problems you are having to deal with now, but do not place them on my shoulders. If MAYO would have had psychiatrists already in place to replace those that were "let go" or left, they wouldn't be shorthanded right now. Administration at Mayo has proved time and again that THEY do not know what they are doing. Mayo, through the years, has let down TOO MANY of their patients in myriad ways - especially the poor, the disabled, and most especially those who have the stigmatized label "mentally ill". MANY of their doctors, PAs, ANPs, and so forth, over-prescribe, order unnecessary tests, make too many misdiagnoses, and miss diagnoses altogether due to negligence - and more. BTW: I do know that my blogs and website spurred Mayo to "clean house". They certainly do not want a plethora of lawsuits so one by one they are "letting go" those they find that could be sued. Mayo, IMHO, cares more about "revenue" than they do their patients - unless the patient is wealthy. Also, IMHO, Mayo is a VERY dangerous health-system. What they did to me nearly caused my death and the ramifications of their ineptitude affects me negatively to this very day. I am now bedridden for most of every day and am basically now a shut-in. As to Gundersen - I don't know since I have never needed to see a psychiatrist there. The initial diagnosis of depression (made at Mayo) came from a completely INCONCLUSIVE multi-form test and what may have been only "situational depression", which would ONLY have needed therapy, turned into "treatment resistant clinical (chronic) depression" - therefore my constant depression of varying levels cannot be treated - because of the ineptitude of the Behavioral Health department at Mayo. In addition, my myriad health issues (most of which were CAUSED by Mayo's ineptitude and negligence) cannot be treated properly since Mayo has ignored repeated requests, with me using legal forms provided to me, for them to send copies of all my records to Gundersen. Regardless, if you need a place to go to be watched so you do not harm yourself in any way, there is the CARE Center at 4647 Mormon Coulee Road in La Crosse. (608-519-3080). If they are filled up, they will help you find a place to stay, although it may be outside the county of La Crosse. Concerning getting proper psychiatric care, you don't HAVE to go to Mayo or Gundersen. You may have to drive a couple hours, but you will find clinics that are not associated with either Mayo or Gundersen. The internet isn't just for "fun" - it is also a wonderful tool for research. Research for other clinics that DO care about patients. I truly want to thank you, however, for pointing out how inept the law enforcement is in La Crosse. Just like the clinics in La Crosse, one hand doesn't know what the other hand is doing.

Guilty til proven Innocent

I don't think Mayo does know how to run their unit. I think there is probably too many people being paid high salaries for standing around doing nothing while those at the bottom do all the work. Money being thrown away? Maybe they need to do some serious house cleaning of those standing around so they could afford to hire the Psychiatrists needed? Also I see they telling the media they are temporarily closing does this mean the employees will be let go or paid unemployment with a recall date? Maybe when they realized there was a problem they should have taken a "CONFIDENTIAL" survey of their employees to find out where the problems were and then dealt the issues. Instead they probably did like most upper management does and hold a group meeting and expect employees to spill their guts in front of everyone and risk future job harassment or worse yet termination. There are far more people in need of this service than can be treated by Gunderson and now what happens to them. I can tell you for a fact what happens.... if a person with issues walks into Gunderson say with a drug issue and does not have insurance to cover the bill they are sent back into the streets and told to ween themselves off or deal with it. Then La Crosse wonders why they have such a drug problem of people trying to self medicate. If Mayo closes this unit things in La Crosse are going to get much worse.
Mayo Healthcare has many other similar units at their other facilities that are making it so why not this one? The answer has to be something within this unit alone as mentioned above.
The La Crosse community needs this unit and I think Mayo should search elsewhere for their solutions. Closing this unit is NOT the answer for them or for the community of La Crosse!

LaxSw

Gundersen has it's head in the sand if they think they are doing well with mental health access in this community. It can take 6 months to a year to get in to see a psychiatrist for medication management. That is not good access to mental health resources. Mayo fell apart when they got rid of a few of their psychiatrists and several others went to Gundersen or left for other opportunities.

tmkgls

Mayo fell apart because they weren't watching what their psychiatrists AND therapists were up to until I let them know through my blogs and the website I put up when they summarily dismissed my grievance (which they DID receive citations for mishandling). Finally, they fired one - Larson, one just disappeared - Winter, and another transferred to Red Wing, MN - Proctor. The psych unit was filled to capacity almost all of the time because antidepressants were, and most likely still are, being prescribed to people that really don't need them (like they did to me), thereby messing with the patient's brains. After all, antidepressants (et al.) ARE "mind-altering" psychotropic DRUGS - so, of course, they are going to alter the behavior in a negative way for those that truly never needed any in the first place (like me - I am no longer on them and misdiagnoses Mayo psychiatrists made have been removed from my list of diagnoses - I also no longer go to any Mayo Clinic). As to any in Behavioral Health that "went to Gundersen" - WHAT was Gundersen thinking when they hired them? I will have to see WHO they hired! As to the time it takes to see a psychiatrist at Gundersen, I do not know. I will, however, take your word on it LaxSw.

Buddy

Valleygirl is correct. Mayo (in La Crosse) in patient psych. staff do not know how to treat mental health patients or the people and agencies that they deal with. Inept. Gundersen is far and away better in that dept. I have worked with both, not as a patient, but as a referring agent. Gundersen IS thriving.

lil evil

The fact that the VA has had to close it's Acute Psych unit does not bode well for the Veterans. The signature injury for the Iraq and Afghanistan vets is Traumatic Brain Injury from concussion blasts from roadside bombs; that coupled with PTSD and you have thousands of Veterans that will need care for decades to come as they grow older. Some people would like to let the Veterans get care in a civilian hospital but It would be wise to have a facility strictly for the Veterans and not cohort them with civilians as they have special and unique needs that do not translate well to the civilian population.

tower

Vally, I doubt the Gundersen unit is thriving. I think it means they are willing to take the losses.

ValleyGirl

Two behavioral health units in the same city that provide the same type of services...One is thriving and one is closing. Sounds like Gundersen knows how to run a business. The other, not so much. Sad that Mayo can't provide these services that are so important to so many people.

CJ

Likely sustaining a good amount in write offs also so a drag on bottom line......

Mack

Mental health? We have corporate prisons to fill!

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