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Douglas County Hospital may drop mental health service

Concerned with rising costs and its ability to keep pace with increasing demand, Douglas County Hospital (DCH) is considering phasing out its mental health outpatient care unit.

After more than 20 years as the primary mental health provider in the area, the hospital needs to reevaluate whether it can afford to keep providing mental health services, according to Bill Flaig, DCH chief executive officer.

"We lose about $800,000 a year on that business," Flaig said. "We've tried to minimize our losses, but over the last several years we haven't been

Flaig said the growing financial burden, combined with the recent departures of the hospital's administrative and medical directors, made it time for DCH to look at whether mental health fits in with its core mission.

"We're finding out that most community hospitals our size aren't in the outpatient mental health business," he said. "Maybe it makes more sense to go to a regional agency, like Lakeland [Mental Health Center], to provide these services."

A nonprofit provider that emphasizes a community-based care model, Lakeland has offered a myriad of mental health services to west central Minnesota residents since 1949.

Currently, DCH is talking with the organization, which has four clinics and employs about 150 mental health professionals, about taking over the hospital's mental health unit.

At its regular monthly meeting Friday, the hospital board authorized Flaig to continue negotiations with Lakeland, and to draft a services contract.

Flaig said by contracting with Lakeland, DCH could immediately shave $200,000 off mental health care costs - it could transfer two nurses and two administrative staffers back to the hospital - and possibly more in the future.

At present, Flaig said, DCH's mental health unit sees about 3,000 patients, a number that has held flat for several years as the hospital has capped the clinic's staff level due to the high cost of mental health care.

"There is a tremendous amount of need out there," he said. "It's a bottomless pit, to be honest with you."

The hospital can't keep up, Flaig said, but Lakeland can.

"They've got so much more experience with [providing mental health care] than we do," Flaig said. "The bottom line is we think they'll do a better job because this is the only thing they do."

Claire Prody, Lakeland's executive director, said through its experienced and knowledgeable staff the agency is able to partner with local providers to better coordinate services for patients, which both improves overall care and reduces costs.

"It's much easier to stay in touch with what's in the best interest of a client when you have all those services attached together, he said, "and also that ultimately helps keep people in the community out of hospitals.

"That cost is very high," he added.

Prody said he expects that, if approved, the transition would take between three and six months, in order to get the hospital's mental health staff re-credentialed - required by the insurance industry - under Lakeland.

Flaig said all DCH mental health staff would be re-hired at Lakeland, or offered a position at the hospital if they chose not to migrate.

Mike Woods, director of Douglas County's social services department, which works with DCH on mental health services, said his office had heard talk of a transition, and the department supports the hospital.

"Lakeland has a long history of providing these services and would make a good fit," Woods said in an e-mail statement to the newspaper.

Blake Evans, PhD, licensed psychologist, is not so sure.

Director of psychology for DCH's mental health unit, Evans said he's concerned what impact switching to Lakeland would have on the level of care provided in the county.

As is, he said, the hospital's mental health clinic is staffed with a high proportion of highly educated, doctorate-level professionals.

Lakeland, by comparison, relies more on licensed mental health professionals with either a master's or undergraduate degree, Evans said.

"Lakeland definitely provides a good standard of care - they do," he said. "Theirs is up there with the rest of the county and the state in terms of standard of care.

"We've just been doing more than that for a long time."

And while Lakeland would likely reduce costs for the hospital, it might increase them for Douglas County, Evans said.

"The reality of it is, Lakeland receives large subsidies from counties [they service] and the state to provide the care they do," he said.

Evans said with financial support from Douglas County, he believed the hospital's mental health unit could also be sustainable.

Prody said Lakeland is both county- and state-subsidized, which is a direct result of the low reimbursement rate for mental health services compared to other medical care.

"We can try to be more efficient," he said, "but at the same time all of our counties do provide subsidies."

Evans said he thinks there could be benefits by bringing Lakeland into the county, but, "Being the director of psychology, I see cons and how that can affect our patients and level of care we provide."

But Bill Klein, Lakeland's regional site director, said county residents wouldn't experience lower quality of care under his agency's treatment model.

Lakeland is staffed with many qualified professionals, he said, with different levels of training who all work together in developing patient treatments.

"That's what our internal philosophy is; it is very much to have a team-oriented approach," Klein said. "I don't think it would reduce quality at all; in fact, my belief is that it would enhance it."

And, he said, for most of the mental health services Lakeland offers, such as a diagnostic assessment or individual or group therapy, a doctorate degree isn't needed.

"Those are types of services that can be delivered by any designated mental health professional," Klein said. "That's the primary need."

Evans sees it differently.

"Wouldn't it make sense in mental health that someone with a better education and training would provide better service?" he said. "It is a different level of service, which is again why it's more expensive."

Hospital officials plan to make their final decision in January on whether to contract with Lakeland for future mental health services.