No matter your views of the Affordable Care Act, when it comes to treating the mentally ill, Lesley Dickson says it should benefit Southern Nevada at a time it needs some help.
Medicaid has grown by more than 160,000 people since the end of September. The Affordable Care Act requires insurance companies to provide benefits for mental health and substance abuse sold on exchanges — a benefit largely excluded in the past, said Dickson, executive director of the Nevada Psychiatric Association.
With expansion of Medicaid, the state announced its proposed reimburse rate to hospitals at $944 a day for treatment of psychiatric patients – an increase from $460 a day in place for a decade. It’s no coincidence that area hospitals have been adding psychiatric beds the past couple of years because they see the potential of it being financially worthwhile, whether through Medicaid or private insurance, Dickson said.
“The bed rate was so low it wasn’t considered financially feasible to have a psychiatric ward,” Dickson said.
Valley Hospital recently announced plans to create a 50-bed psychiatric unit on the third floor that would open by the end of the year. Only psychiatric units inside hospitals are eligible to be reimbursed by Medicaid for patient’s ages 22 to 64, which is the bulk of mentally ill people needing care, Dickson said.
The addition of psychiatric beds is part of a push to deal with a crush of mentally ill patients in hospital emergency rooms around the valley. Seven Hills Hospital, a private mental health and substance abuse facility, recently expanded by 36 beds and is planning another addition.
“They were opened with a lot more people having insurance so that they could take care of them and get paid for it. That’s why there has been an expansion of private beds,” Dickson said. “A lot of insurance companies weren’t covering mental health and substance abuse to any great extent but that’s changed with the new rules of Obamacare covering insurance, Medicaid and Medicare. Obamacare is absolutely a game changer.”
Despite the expansion of the Medicaid rolls and additional money to pay for in-patient care and options for mental health coverage in private insurance, the region’s mental health problems won’t be adequately met, said Stuart Ghertner, the former director of the Southern Nevada Mental Health Services, which serves about 16,000 patients a year.
Ghertner said high deductibles on insurance plans may keep people away from the care they need and Medicaid reimbursement rates may not be high enough for people to get the outpatient care they need.
“People will have (the possibility of) more access but whether they are able to use it is yet to be determined,” Ghertner said.
Ghertner said it would take additional state funds to deal with mental health issues for the region’s needy. Funding levels once at $106 million in 2006 had fallen below $90 million. He said they need to be raised to $125 million to $150 million to begin to address problems in Southern Nevada.
The money is needed to add psychiatric beds and provide housing and outpatient care for those with mental illness, he says. Southern Nevada is susceptible to having more mentally ill people than other cities because it’s a transient community and the warmer climate makes being homeless easier than cold-weather locales.
“A lot of our seriously mentally ill people are homeless, and they’re poor. We don’t have enough outpatient programs to treat these people, and the waiting list to get into Southern Nevada Adult Mental Health is sometimes three, four or five weeks,” Ghertner said. “It’s a vicious cycle. People can’t get in for treatment; they go to the emergency room; they get hospitalized; they get discharged from the hospital; they can’t get into an outpatient clinic for treatment; they have no where to go and they go back to the emergency room.”
The growth of psychiatric units will require more psychiatrists in Nevada, and the state has had trouble recruiting them, Dickson said. Nevada has 6.5 psychiatrists per 100,000 people. That’s below the 12.7 per 100,000 nationally, according to the University of Nevada School of Medicine. The region has also been trying to address a shortage of child psychiatrists as well.
“We are very underrepresented medical field in regards to how many patients we have to treat,” Dickson said. “People with mental illness represent somewhere in the 20 percent-plus of the population,” adding that some figures show that more than 50 percent over a lifetime will experience some sort of psychiatric problems.
“The biggest problem is we don’t have enough people to take care of them,” he said.
Dickson said that it will be difficult to fill that need when there’s a national shortage and competition has always been stiff from California where they can pay people $40,000 to $50,000 more than in Nevada. It may take promises of loan repayment incentives and housing to attract psychiatrists, she said.
When it comes to child and adolescent psychiatrist, the University of Nevada School of Medicine has created a fellowship training program in Las Vegas, said Lisa Durette, the director of the program and medical director of Healthy Minds, a mental health practice specializing in children and families.
Southern Nevada is near the bottom tier in the nation with fewer than a dozen board-certified child psychiatrists. Comparable cities have 60 to 70. That means children have to wait and are seen instead by pediatricians, family practice doctors, general psychiatrists or others who aren’t qualified to treat mental health illnesses that affect youths and are different from mental illnesses that impact adults, she said.
“We are desperately underserved,” Durette said. “We decided that since we haven’t been able to successfully recruit child psychiatrists to town that we will grow them ourselves with the intent to keep them.”