The Grays Harbor County Commissioners on Monday voted to take the first in a long series of steps designed to combine mental health and substance abuse services into a five-county behavioral health organization.
Tentatively titled “Great Rivers Behavioral Health Organization (BHO),” the five-county group would include Grays Harbor, Pacific, Cowlitz, Lewis and Wahkiakum counties.
The organization’s foundation springs from legislation passed in 2014.
The BHO will not be in place entirely until April 2016, and all of the legislative mandates will not be met until 2020. Changes between now and 2016 likely will be internal changes to department and county organization.
“We expect services to be exactly as available as they are today and then get better because we want to bring more providers to the county,” said Joan Brewster, Grays Harbor County Department of Health Services director. “The only thing that you’d notice (as a client) is likely a change in the name (…) but the same services will be available to you and in time, we hope more services.”
What the commissioners approved Monday was an interagency contract with Cowlitz County to make their services part of the Grays Harbor County regional support network.
Combining counties, services
At the time of legislation, Grays Harbor was the only county in the state with its own regional support network. Timberland RSN was comprised of Lewis, Pacific and Wahkiakum counties. Cowlitz was part of an RSN with Skamania and Clark counties, however, Cowlitz is a rural county requiring services be provided differently than the Clark and Skamania RSN, which fulfills the needs of Clark County, a much larger population base.
Residents enrolled in Medicaid and meeting other requirements set for RSNs will benefit from the behavioral health organizations. The county’s crisis response obligations, including the 24/7 crisis line available to all county residents, also will be part of the BHO.
Following approval by commissioners from both counties and the support of a task force charged with guiding the creation of BHOs, Monday’s signed agreement will make Cowlitz County part of the Grays Harbor RSN beginning July 1 for nine months. By April 2016, the Great Rivers BHO will be formed and both Grays Harbor and Cowlitz will become part of that organization.
The legislation mandating BHOs did so because RSNs only deal with mental health services. The regional support networks were comprised of counties combining to provide mental health services, and each county also maintained substance abuse services through a different organizational body within their own county government. Keeping the two separate was problematic — though mental health and substance abuse treatment costs about the same, Brewster says, the separate systems created a disparity in how much money was set aside to treat each issue.
“(The BHO) will treat all behavioral health as equal,” Brewster said. “When you hear the words ‘behavioral health,’ it really means a combination of mental illness and substance abuse disorders.”
Clark and Skamania’s BHO (Klickitat County is expected to join that BHO as well, Brewster said) will take the next step of the BHO process by combining mental health and substance abuse services with primary/physical health care, nearly immediately. The five-county BHO with Grays Harbor will take a slower, more measured approach, integrating primary/physical health care by 2020, as mandated by the 2014 legislation.
“It’s such large shift in how health services are provided that there are going to be quite a few steps to walk through to actually achieve the vision,” Brewster said. “It’s a great vision.”
Currently there is crossover between primary/physical health care and mental health and substance abuse treatment in the RSN system, but it’s limited, Brewster says. The BHO aims to fully integrate all three.
“We really support the idea of integration,” Brewster said. “Figuring out how to make that happen in practice will be somewhat of a challenge, but I think we’re all up for the challenge. We just need to figure out how to do it, and it hasn’t been easy.”
The three-county Timberland RSN is taking the lead on organizing the five-county BHO.
Local benefits and control
The Legislature was interested in creating BHOs as a cost-savings measure. Regional support network and most substance abuse funds are federally and state granted. Combining patients into one large group means greater savings for the health plan, and if each RSN is viewed as a health plan and grants are paying the costs, combining RSNs into a BHO means a larger patient pool and savings to the state and federal governments.
For Grays Harbor County, or any of the other four counties in the Great Rivers BHO, there will be no direct savings from combining the RSN into a BHO, but indirect savings could occur, Brewster said.
Currently, a strong relationship exists between mental health/substance abuse services and the county jail/criminal justice system. That relationship would be maintained and, hopefully, the cost savings from the BHO would come to the jail and criminal justice system in the distant future. Many individuals making the rounds through the criminal justice system, and eventually the jail, are those with substance abuse issues, Brewster noted.
“Where we would see the impact is if we can make our system stronger and make treatment more readily available at the right level and at the right time, then we might see less costs in some of these areas, like impact on the jail or impact on the courts,” she explained. “If we can accomplish more with our social service dollars, we may be able to reduce the strain on the county budget in law enforcement. And if we aren’t mindful of what’s going on in social services, we could increase the strain on the county budget vis-a-vis the jail or criminal justice system.”
The five counties working together through the same organization does not mean that any of the five counties will lose any of their locally provided services.
“The services you can get in Grays Harbor now will stay in Grays Harbor,” Brewster said. “One of the values that the planning group (members of all five counties working together) has is we care that services are available to our consumers locally, and that the local service system reflects our community.
“We don’t want it to be a bureaucracy that seems impersonal or far away and we want it to be meaningful right here where the care happens. Everyone involved is looking to preserve that sense that it is our local service systems that helps create a system of recovery.”
What’s currently available in Grays Harbor County will remain in the county. Residents will not have to travel to any of the other four counties if they don’t already have to travel out of the county for services. Additionally Brewster believes the BHO will make more services available within the county.
“We want to expand the ease with which people can access mental illness treatment and treatment for substance abuse disorders. More providers would be a good thing. We are also working, now and into the future, to increase the available support services in the community,” Brewster said. “We really believe that recovery is possible and that the focus of these services needs to be focused on recovery. To get recovery you need to have housing support, social support, financial support to pay for treatment, so we’re always looking for how we can expand the levels of care available so people are supported for recovery. We want services to get better and we think they can get better as we become a larger organization.”
Brewster believes the BHO will bring positive impacts to the county, and she says residents currently using the RSN have only good things to look forward to as the BHO becomes a reality.
“Residents will have access to the care they have today and we hope expanded access to care, and more coordinated and integrated care,” she said. “I would really like for people to feel reassured that this change will not harm them in any way.”
Funding, currently made available mostly through federal and state grants, will not change (though how those funds are dispersed could become tricky as services are integrated), and Brewster doesn’t believe the BHO will have any significant financial impact to the county’s coffers as it progresses.
No comments:
Post a Comment