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Professional News
Parity, Prevention Could Remedy Access Crisis, Report Finds
Psychiatric News
Volume 37 Number 22 page 2-27

In fewer than three months, a task force of the Minnesota Psychiatric Society (MPS) produced a comprehensive report that responds to a wide-ranging charge concerning the lack of access to inpatient care.

Anil Godbole, M.D., told Psychiatric News, "The report is a commendable effort that offers a good analysis of the causes and effects of lack of access to inpatient care. The task force did its homework. I hope other district branches will follow in their footsteps."

Godbole is president of the National Association of Psychiatric Health Systems and is a member of President George W. Bush’s New Freedom Commission on Mental Health. He forwarded the MPS report to Michael Hogan, Ph.D., the commission’s chair.

Bush appointed the commission to examine the public and private mental health systems and make recommendations for improvement.

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Eric Larson, M.D.: "The problem is not salaries for psychiatrists, but getting funding to the mental health system in the right way and for the right services."

In August MPS President Kevin O’Connor, M.D., asked Eric Larson, M.D., chair of the mental health department at Park Nicollet Clinic, to head a task force that would assess the decrease in availability of inpatient/intensive outpatient treatment programs over the last 10 years, determine the causes of the shortage, describe the harm resulting from lack of access to services, and recommend steps to alleviate the crisis (Psychiatric News, September 20).

The task force identified seven key factors that contribute to the shortage of inpatient beds (see box on page 27).

Godbole offered a "resounding yes" when asked if the factors are typical of problems in other states.

He added that the task force had provided good examples of the personal impact of the shortage. Patients wait in emergency rooms as long as 72 hours for attention or are diverted to out-of-town or even out-of-state facilities. Psychiatrists have become increasingly unwilling to submit to the difficult working conditions involved in providing inpatient care, with the result that access is further limited.

The task force argues, "Inadequate funding, due to lack of parity in mental health reimbursement, is at the heart of this crisis."

MPS recommends that psychiatric reimbursement for inpatient and outpatient care be increased to parity with general medical and subspecialty reimbursement and that hospitals be reimbursed at rates that allow them to cover costs.

The report also recommends reimbursement for preventive activities such as case-management services and crisis response that would help patients avoid hospitalization. Public and private payers should work with mental health professionals to design rehabilitative services, rather than focusing on utilization review.

MPS cites a program at the Veterans Affairs Hospital in Minneapolis in which a community-based team works with patients to help them avoid repeated hospitalization (Psychiatric News, November 1).

The report encourages collaboration with primary care practitioners and suggests exploration of alternative methods of delivering psychiatric services.

MPS recommends a coordinated dialogue that would result in an "organized approach to mental health care delivery that bridges inpatient and outpatient care and that bridges gaps [among] the multiple private and public payers."

Larson told Psychiatric News that the dialogue had already begun. The Minnesota Hospital and Healthcare Partnership, the trade association for the state’s hospitals, sent the report to the state’s major insurance companies, with a letter of endorsement.

The Minnesota Mental Health Advisory Council, which advises on public mental health issues, invited Larson for further discussion after his initial presentation about the report.

"Reimbursement is key," he said. "But we try to make the point that the problem is not salaries for psychiatrists, but getting funding to the mental health system in the right way and for the right services."

Godbole told Psychiatric News that commission members had discussed the crisis in access to inpatient care in several committees, such as those concerning Medicaid, the elderly, and children and youth services. He believes the problem transcends any single committee and deserves specific attention as an important issue.

APA Vice President Steven Sharfstein, M.D., told Psychiatric News, "MPS has correctly identified the simultaneous need for both a systemic and a fiscal fix for our failing mental health system. Let’s hope that the New Freedom Commission shares their insight that we need access to the right services, not more utilization review, to solve the acute care crisis."

Sharfstein is president and chief executive officer of the nonprofit Sheppard Pratt Health System in Maryland.

The report, "The Shortage of Psychiatrists and of Inpatient Psychiatry Bed Capacity," is posted on the Web at www.mnpsychsoc.org/TFRpt.pdf.

Anchor for JumpAnchor for Jump

Eric Larson, M.D.: "The problem is not salaries for psychiatrists, but getting funding to the mental health system in the right way and for the right services."

In August MPS President Kevin O’Connor, M.D., asked Eric Larson, M.D., chair of the mental health department at Park Nicollet Clinic, to head a task force that would assess the decrease in availability of inpatient/intensive outpatient treatment programs over the last 10 years, determine the causes of the shortage, describe the harm resulting from lack of access to services, and recommend steps to alleviate the crisis (Psychiatric News, September 20).

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