{"id":1098,"date":"2012-04-13T15:45:50","date_gmt":"2012-04-13T19:45:50","guid":{"rendered":"http:\/\/emu.edu\/now\/crossroads-copy\/?p=1098"},"modified":"2012-07-18T10:55:52","modified_gmt":"2012-07-18T14:55:52","slug":"there-has-to-be-a-better-way","status":"publish","type":"post","link":"https:\/\/emu.edu\/now\/crossroads\/2012\/04\/13\/there-has-to-be-a-better-way\/","title":{"rendered":"There Has to be a Better Way"},"content":{"rendered":"
\"Tim

Tim Derstine \u201988, MD, medical director of Behavioral Health Services, Mount Nittany Medical Center in State College, Pennsylvania<\/p><\/div>\n

By Andrew Jenner ’04<\/strong><\/p>\n

Since the very beginning, the conviction that \u201cthere has to be a better way\u201d has been a guiding principle for the Mennonite mental healthcare institutions that were established as a response to the experience of conscientious objectors (COs) during World War II.<\/p>\n

Mennonite mental healthcare institutions have demonstrated ingenuity and leadership in the face of changing circumstances within the field. Examples over the years include the development of programs to assist in patients\u2019 reentry to the working world, long-term independent living facilities, rehabilitation programs for people with drug or alcohol addictions, and the repeated adoption of new medicines and therapeutic techniques across all programs.<\/p>\n

\u201cThere\u2019s a much broader emphasis now on additional supports that are needed to help a person live within the community,\u201d said John Goshow \u201969<\/strong>, a retired social worker who was CEO of the Penn Foundation from 2000 to 2010.<\/p>\n

One recent example of innovation at the Penn Foundation has been the development of\u00a0 \u201ccommunity treatment\u201d teams made up of a psychiatrist, nurse, social worker and other support staff to provide coordinated care to patients living in their own homes.<\/p>\n

\u201cWe\u2019re trying to take services to where people are, rather than trying to make them come to some centralized place,\u201d said Vernon Kratz \u201957<\/strong>, the former medical director of the Penn Foundation who now sits on its board of directors. \u201cIt keeps people in their communities, it keeps people in their families.\u201d<\/p>\n

Another example of an unprecedented initiative: Amish leaders approached former Philhaven CEO LaVern Yutzy ’70 and others in that Mennonite mental healthcare institution near Lancaster, Pennsylvania, to discuss the development of a treatment program for members of their community. Their collaboration led to the 2005 opening of a new 15-bed inpatient facility on Philhaven\u2019s main campus for patients from the Amish and other \u201cPlain\u201d groups (referring to their \u201cplain\u201d clothing). To date, it has served hundreds of people from 12 states.<\/p>\n

In Goshen, Indiana, Oaklawn opened the nation’s first residential unit to serve adolescents from Amish or conservative Mennonite communities in February 2010. Maria Martin Shisler ’04<\/strong> is a case manager there.<\/p>\n

\"Alumni

Alumni at the Penn Foundation: (from left) property manager Tara Paul Detweiler '94; social worker Donald Detweiler '93; psychiatrist and former CEO Vernon Kratz, class of '57; former CEO John Goshow '69; administrative assistant Donna Dittus Massey, class of '81; therapist Lois Styer Halsel, class of '72; social worker Angela Swartzendruber Hackman '03. Not pictured: social worker Maureen Gingerich Bergey '06, nurse Bethany Hertzler '09, and case manager Lisa Moyer Kauffman '89.<\/p><\/div>\n

Impact of “Managed Care”<\/h3>\n

Changing conditions within the industry have forced all mental healthcare providers to adapt, sometimes in ways that challenge the survival of non-profit institutions seeking to provide compassionate care for all who need it. The advent of \u201cmanaged care\u201d in the 1980s and 1990s \u2013 through which insurers used new reimbursement models to encourage providers to treat more patients through outpatient programs and reduce the length of inpatient hospitalizations \u2013 had a mixed impact.<\/p>\n

In 1993, soon after Yutzy was appointed CEO of Philhaven, 82 percent of the organization\u2019s revenues came from inpatient programs. By his retirement in 2008, overall revenues had doubled but the share of inpatient revenue had dropped to just 32 percent. That drastic shift over a relatively short period of time, he says, threatened to sink the institution. A positive outcome, he acknowledges, was that more patients were being treated earlier and with less disruption to their lives.<\/p>\n

Insurance reimbursements present a huge and ongoing problem for many of the providers interviewed for this issue of Crossroads<\/em>. Gerald Ressler \u201979<\/strong>, executive director of the Samaritan Counseling Center in Lancaster, Pennsylvania, said that many insurers have reimbursed mental health providers at the same rate for the past 15 years, causing providers to see their real income fall dramatically (on the average, $20 worth of goods in 1996 cost over $28 in 2011). Some insurance companies are even cutting their reimbursement rates. Ressler said that the Samaritan Counseling Center\u2019s largest insurer informed the center in 2011 that it will decrease reimbursement rates by 35 percent in 2012 \u2013 a decision that will have a huge impact on the center\u2019s balance sheet.<\/p>\n

\u201cOutpatient mental healthcare is as close to being at the bottom of the [insurers\u2019] priority list as it gets,\u201d said Ressler, a licensed clinical social worker who spent 30 years on the staff at Philhaven before moving to his current job.<\/p>\n

\"Gerald

Gerald Ressler '79, executive director of the Good Samaritan Counseling Center in Lancaster<\/p><\/div>\n

Additionally, when it comes to public insurance programs like Medicaid, reimbursement rates are simply not high enough to allow practitioners to stay in business if they only see patients on those programs, said Tom Martin \u201978<\/strong>, who works as a clinical psychologist in addition to teaching psychology at Susquehanna University. Some practices, including the one in Selinsgrove, Pennsylvania, where Martin now works, have stopped seeing Medicaid patients entirely for this very reason. It\u2019s a reality, Martin says, that points to a key shortcoming in our healthcare system: only employed people have a chance at having decent medical insurance policies. Yet people with serious, untreated mental illnesses tend to have difficulty keeping good, steady jobs with health insurance coverage.<\/p>\n

\u201cIf you\u2019re affected by a mental condition that prevents you from working, then you will not have ready or consistent access to the best mental healthcare,\u201d Martin said.<\/p>\n

Falling in the Cracks<\/h3>\n

People with serious mental illnesses who need care the most are often left to seek treatment at crowded, publicly funded clinics that often, thanks to the constraints of resources and excesses of demand, struggle to provide quality care. And if, for whatever reason, that care isn\u2019t quite enough, or a patient\u2019s illness hampers his or her ability to apply for and receive public assistance, that person is at high risk of falling through the cracks, where the statistics paint a particularly grim picture of the state of mental healthcare in the United States today:<\/p>\n