Burrell Behavioral Health employs nearly 900 at 27 locations in its 17-county service area. Tell me more about the mission of the not-for-profit organization. It has always been the same – to provide a continuum of care. When I was first starting to practice, people spent a good part of their lives in state hospitals. In 1979, we started our very first group home in the state for the seriously mentally ill. We had 11 residents and on the average they had spent 11 years of their lives in a state hospital. Back in those days, there was no coverage for mental health. You wound up getting nothing, until you got everything – meaning you got put in the hospital, when in fact you may not have needed to be. So our goal was very basic – to provide as much care as is needed, but no more than is needed.
Gov. Jay Nixon visited Burrell on March 4 to talk about the Medicaid expansion plan, citing a new report from the Missouri Department of Mental Health, which said Missouri hospitals currently receive more than $500 million annually in federal reimbursements. If approved, how would the proposed expansion effect Missouri’s mental health services? It will immediately create a much higher level of access as well as demand. People will be much more comfortable seeking care they know they can pay for. And, when you have an increase in demand, you have to be able to find the staff. This will be a challenge. It is increasingly difficult to recruit psychiatrists and psychiatric nurse practitioners. On the straight clinical therapy side, this is one of the values of our current integration with The School of Professional Psychology at the Forest Institute. It will assist us in making sure we are developing doctoral level positions in the pipeline that will be available for Burrell.
On the other side, what is the outlook if the Missouri General Assembly doesn’t approve Medicaid expansion? The hospitals have a much higher percentage of unreimbursed inpatient days on psych then they do for medical/surgical beds. In psych, about 23 percent don’t have a source of payment, and on medical/surgical beds, only 7 percent don’t have a source of payment. As of 2014, uncompensated days will no longer be paid to the hospitals. That money goes away because Medicaid expansion is intended to take care of that payment to the hospitals; however, if there is no Medicaid expansion, there are no reimbursements for those patients, period. For the state of Missouri, that is a $3.7 billion economic impact. Because there is such a higher percentage of uncompensated care on the psych beds than on medical/surgical beds, hospitals won’t have a whole lot of choice, but to, over time, decrease psych beds. In the alternative, they would have the unacceptable option of cutting a minimum of three medical/surgical beds to have the impact of cutting just one psych bed.
Springfield Police Chief Paul Williams said dealing with persons with severe illness puts a significant burden on the department’s time and resources. Do you think county jails have become the new community mental health units? If you need another level of security and the ability to watch over the person during a difficult period, the jail and the emergency rooms are the only things left. There is no doubt it will put a burden on law enforcement. If more and more people need to be taken to the emergency room because they are not in treatment, that puts a burden on the emergency room and the police are often involved as the first responder. We need to get people into treatment. But, if we are to maintain quality and appropriateness of care, there needs to be a way to pay for that treatment and Medicaid expansion is a big part of that.
Recently, a national conversation on gun control in America has shifted toward a discussion on mental illness and background checks. Do you think this line of questioning is merited? People with a mental illness are no more likely to be dangerous to another person than is the average person. There is no significant difference between the probability that you will harm someone than the probability that a person with a mental illness will harm someone; with one exception – they are far more likely to hurt themselves. Out of about 30,000 people killed by firearms last year, 62 percent were suicides. So, all this talk about people with a mental illness being dangerous for the general public is really not well founded in any data. I worry sometimes when I hear this talk that it inappropriately demonizes folks.[[In-content Ad]]
