Missouri saves money by treating people
By Francie Broderick, PfP Executive Director
Originally published: 01/14/2010
When my son was diagnosed with juvenile diabetes several years ago, we were immediately engulfed in a system of care that included education about the illness, instructions on how to avoid long-term complications, diet, exercise and medical treatment.
When a person has a serious, chronic illness, we expect a system of care to help manage the illness through a lifetime. But a parent who has a young adult child experiencing early symptoms of a major mental illness like schizophrenia faces a different reality.
When that parent calls my agency or other community mental health centers in Missouri and reports that her child has dropped out of college, paces the floor all night and might be hearing voices, I have to ask if the child has been declared totally and permanently disabled, and if he has been in a state hospital or been to prison. If not, I must tell that parent to call me back after one of those crises, and then we will try to get him into a system of care.
In other words, first crash and burn and then we will see what we can do to fix things. There is no other area of health care that we treat in this way. As of Dec. 1, these are the restrictions placed on our community mental health system in Missouri because of state budget cuts.
The human cost of this approach should be obvious; less obvious, perhaps, is the economic cost.
Two years ago, a group of mental health providers collaborated with staff of local hospital emergency rooms to identify people often referred to as “frequent fliers” or “high users” of emergency room and hospital services.
We started with 291 people with psychiatric diagnoses, and figured out the 50 who had the highest costs associated with their emergency room visits. What we found both was astonishing and depressing.
In fiscal year 2007, our Medicaid system spent more than $3.4 million on 50 people. What was depressing about this finding was that in spite of these enormous expenditures, these individuals were not getting any better. Their lives still were in chaos, and their physical health and their mental health were deteriorating.
We began trying to track down some of these people and found some were dead and some were in prison or nursing homes.
We got the 18 people whom we found still living in the community involved in a comprehensive treatment program called Assertive Community Treatment -- a model that addresses all of the complicated needs of people with serious mental illness and does so in a fashion that focuses on outreach and staying engaged with the person regularly. We saw lives changed dramatically, which we expected. And these changes also were reflected in the cost data.
In 2007, the cost to the state for those 18 individuals was $1.1 million. For those same people in 2009, the cost was $584,457. In other words, after just a year of community-based services, the cost of treatment was cut in half.
This information is particularly relevant now as our governor and Legislature begin a new session in which we know they are looking for ways to save money. What this data shows is very clear: Cutting community-based mental health services will cost money, not save it.
Over and above the cost savings, if you were that parent making that phone call looking for help, what would you want me to say? “Let your child become dangerously ill and go into the hospital or maybe hurt someone and go to prison and then you will be eligible for our system of care.” Or would you want me to say, “Of course we can help. There is hope, and it is good that you called now before things got worse.“
Is this really a choice?
Francie Broderick is executive director of Places for People in St. Louis.
