Adult Mental Health System
At present, Travis County does not have a complete study on capacity of the
entire system or empirical data on what capacity should be. For a complete
listing of local services and providers, Appendix C is provided from Hotline
for Help's information and referral database. "Best Practices" (see Best Practice
section in this report) are being researched and implemented. It is recommended
that as the planning process continues, a thorough study of capacity be made
to determine needs and gaps in the community.
Private Sector Psychiatric Services
There is mounting evidence of a growing decline in access to private psychiatric
care. Area family and consumer mental health organizations, accustomed to hearing
the need for more public services, are now hearing more and more from insured
members about problems accessing psychiatric care. They explain that access
is declining due to increased insurance limitations for inpatient and outpatient
services, low annual or lifetime coverage maximums, insurance company reluctance
to pay for services (sometimes even when pre-approved). Most recently, people
are searching for new psychiatrists since low reimbursement rates are influencing
psychiatrists to drop out of insurance plans and hospital networks. These anecdotal
difficulties are backed up by regional and national information, P. Brown,
(personal communication, December 4, 2000 and January 22, 2001).
Disparities in benefit design for behavioral health care have been around
for a long time but are increasing. Behavioral health care is subject to different
limits, caps, deductibles, etc. than general health care. Unlike the general
health care sector where there has been a shift to greater outpatient care,
behavioral health services are being squeezed on both the inpatient and outpatient
sides. According to The Hay Group study, Health Care Plan Design and Cost
Trends: 1988-1997, the value of behavioral health care benefits have been
cut in half over the last decade. In 1997 dollars (Figure 7-3), while the value
of general healthcare benefits has declined 7% (from $2,326.86 per covered
individual in 1988 to $2,155.60 in 1997), the value of behavioral healthcare
benefits has declined 54% (from $154.08 in 1988 to $69.61 in 1997). P. Brown,
(personal communication, December 4, 2000 and January 22, 2001).
Additionally, behavioral health as a percent of the total healthcare benefit
dropped 50 percent (Figure 7-4) in 10 years (decreasing from 6.2 percent in
1988 to 3.1 percent in 1997). P. Brown, (personal communication, December 4,
2000 and January 22, 2001).
Though science is providing greater treatment options and hope, services are
declining. The Hay Group also analyzed "Current Trends in Health Care Costs
and Utilization," a Mutual of Omaha report. Comparing services in 1991
to 1996, the report revealed declining psychiatric office visits, lower doctor
reimbursements, drastically reduced inpatient days, inpatient admissions and
length of hospital stays for patients, P. Brown, (personal communication, December
4, 2000 and January 22, 2001).
For regional data, the Texas Society of Psychiatric Physicians (TSPP) and
the Texas Medical Association conducted an extensive survey in 1998. Of the
1,818 psychiatrists, the vast majority (64 percent) of the respondents who
practice in the private sector reported a decrease in overall access to care.
When comparing answers from the 16 Texas affiliates about changes in the last
5 years, Austin's psychiatrists are among the most concerned P. Brown, (personal
communication, December 4, 2000 and January 22, 2001). In 1998, Austin psychiatrists
were third in the state when reporting a decrease in access to inpatient care
by 74.4 percent and second in the state in reporting decrease in access to
outpatient care by 62.8 percent over the preceding five years (Table 7-8),
P. Brown, (personal communication, December 4, 2000 and January 22, 2001).
Decrease in access to service is also recognized in the availability of local
private psychiatric beds. Charter Austin announced the closing of its 40 bed
psychiatric facility in January 2000. Its parent company, Charter Behavioral
Health Systems (CBHS) of Alpharetta, Georgia also announced it would close
or consolidate 33 of its hospitals, more than half its facilities. This is
significant since CBHS manages the largest chain of psychiatric hospitals in
the U.S. The two remaining psychiatric hospitals in Austin, Seton Shoal Creek
and St. David's Pavilion, had also been considering closing due to financial
difficulties but are currently working together to find a "community solution".
A merging of services is being considered, with Seton Shoal Creek being the
likely location due to its larger capacity. If these plans don't go forward,
Austin's availability of private inpatient psychiatric services will be in
crisis. The hospitals' President and CEO identified three areas of particular
concern that reflect national and regional patterns, P. Brown, (personal communication,
December 4, 2000 and January 22, 2001):
- Rising Costs
- Shrinking health plan reimbursement rates
- Changing patterns of care
Austin is struggling to maintain inpatient psychiatric services and private
sector psychiatric beds, as are many cities across the country. Table 7-9 reports
the number of private sector psychiatric beds in Travis County (Park, 2000).
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