Consultants offer plan for mental health treatment center

02.22.2016

In a report issued today, a health consulting firm engaged by the Baton Rouge Area Foundation offers a plan to create a treatment center for East Baton Rouge residents suffering from mental illness and substance abuse problems. Health Management Associates recommends a new nonprofit be formed to establish and run the center, tailoring treatment to residents afflicted with behavioral health disorders.

By intervening early and appropriately with treatment, the center will save the city-parish money compared to the costs of two alternatives available:  the emergency room or prison.

The Foundation began collaborating on this project nearly two years ago, responding to concerns voiced by family members, public safety officials and behavioral health experts. They said prison was no place for people with mental illnesses.

The project began with research into other cities that had experimented with diverting the mentally ill to therapies instead of jails, which have become the nation’s de facto asylums since the mass closure of public psychiatric hospitals.

Research results were promising. In cities where diversion centers operated, overall costs to taxpayers were lower. Bexar County, where San Antonio is located, saves nearly $11 million per year by diverting and treating more than 25,000 people at its Restoration Center. HMA used the San Antonio model to develop the center proposed for East Baton Rouge.

HMA estimates operating a center in EBR – at $5.7 million per year – would reduce ER visits, lower prison medical costs and allow more efficient use of law enforcement time. Some of the parish’s funding mechanisms could be changed to capture the related savings for operating the center.

Diversion treatment centers must rely on multiple revenue streams, HMA says, including public funding, grants and philanthropic support.

Today’s report suggests that one potential source of funding could be Medicaid. If the system is expanded in Louisiana, there’s an opportunity to design a behavioral health program that would provide Medicaid reimbursement for many of the services provided at the new diversion center.

The center’s startup costs, HMA says, may be sharply reduced because the Foundation and local leaders have identified an existing location to house the facility. The Baton Rouge Detox Center on South Foster has ample space for the center. Already designed for clinical services, it only requires retrofitting the interior instead of new construction, which was previously estimated to cost nearly $20 million.

In the Foundation’s report, HMA presents three major recommendations for the center:

1.       Offer a continuum of care that includes early intervention and therapy fitting the patient’s need, based on data collected to identify at-risk residents. Align organizations and services to work together on behalf of the identified at-risk groups. Design programs and therapies that can be covered under a Medicaid expansion. 

2.       Plan and implement diversion processes and services, giving priority to the following: A registered nurse and licensed social worker on a mobile team that will respond to law enforcement calls when people are experiencing a health crisis. Sobering beds at the center will allow people sober up in a safe place, staffed by personnel providing ongoing treatment and appropriate referrals. A Medical Detox program will enable people undergoing withdrawal to be evaluated and medically managed. A Behavioral Health Respite Program will stabilize people experiencing a crisis but who do not need inpatient intervention. A Care Management Team will deliver ongoing support and management for high-risk people and those depending on regular access to behavioral health services.

3.       Work toward a system of care that will allow for an expansion of needed services, as determined by the results of implementing HMA’s recommendations.

Prior to the release of today’s HMA report, an economist hired by the Foundation estimated that East Baton Rouge would directly save $3 million in the first year, $8.1 million per year at maturity and $54.9 in direct costs over 10 years by implementing diversion programs modeled after the San Antonio Restoration Center. Moreover, M. Ray Perryman wrote that successful models in other parts of the U.S. demonstrate significant indirect savings, too, through higher productivity among the mentally ill and reduced homelessness. He calculates such indirect savings generated by the center would total $288.7 million in the first decade.

Today’s report is the result of the Foundation’s request to HMA for recommendations for a comprehensive model of care for city-parish residents suffering from mental illness and substance abuse problems. It reflects more than a year of research, followed by the development of a model proposed by the Clinical Design Committee, a panel of behavioral health and criminal justice experts convened by the Foundation.