Will Klamath Youth Development Center do a better job for less money?

From the Klamath Herald and News, September 4, 2013

When the Klamath County commissioners decided to transfer the mental health department to a nonprofit, they did it because the county was no longer financially able to provide the service. But an equally important question needed to be asked: will Klamath Youth Development Center do a better job?

“I will have to wait and see,” said commissioner Tom Mallams. “My philosophy is I believe they will be more efficient at it. Efficiency isn’t always better.”

“I don’t know whether I would say ‘better job,’ ” said commissioner Jim Bellet.

“I’m not going to say they can’t do a better job, but they can do the same job for less money,” Bellet said.

Bill Guest, CEO of Cascade Health Alliance, the state-designated coordinated care organization that begins overseeing Oregon Health Plan and Medicaid patients in Klamath County this month, seemed confident in KYDC’s ability to be more effective than the county.

“We’ve seen much more stability over the years at KYDC in management than we have at the county,” Guest said, referring to the changes in leadership at the county mental health department, while Stan Gilbert, executive director of KYDC, has been at his post since 1986.

Asked if KYDC was going to do a better job with mental health care in Klamath County, Gilbert said:

“You betcha.”

Beliefs vs. reality

Even though they are not able to predict the future for KYDC, the idea of having a private business perform a service for the county lines up with the commissioners’ philosophies.

“The reason the county can’t be effective and private enterprise can be more effective is private enterprise is focusing on actually getting the individual involved in their own health care, and having them make choices, and having them be responsible for those choices and how it might impact their lives,” said commission chairman Dennis Linthicum. “The reason federal money or state money or county money becomes ineffective is, we give all that money to the CCO, and the individual never sees the result of his bad choices or his good choices. He just is removed in a meaningful sense from his decision-making process.”

Linthicum said he hopes because private companies like Cascade Health Alliance, the county’s CCO, and Klamath Youth Development Center, the county’s mental health care provider, have “lived and breathed in the private world,” they will continue the innovative and creative practices that have kept them in business up to this point, even though they now are receiving public funds.

“They will run more efficiently than government can because government has so many restrictions and the process they have to go through,” Mallams said. “Whatever government can do, private enterprise can do cheaper and better.”

“Private business tends to be a little more nimble than the bureaucracies that are associated with the public sector service,” Guest said. Whether it’s mental health or whatever. There’s more flexibility.”

“There is a real interest in participating in development of a system of care that is more responsive, more efficient, lower cost, and yet provides more consistent, better quality care,” Gilbert said. Working with entities like Cascade, he sees that as the future for mental health care, and general health care, in the county.

The issue of mental health care

According to the Oregon Health Authority, the Klamath County mental health department saw or wrote prescriptions for 1,400 clients before the transition. As of last week, 693 clients had transferred to Klamath Youth Development Center.

Gilbert said he didn’t believe the issue of mental health was as big in Klamath County as, the need for more jobs and economic development, or the need for better graduation rates in schools, or the big issues agriculture is facing with water shortages and drought. But mental health is an important issue.

“I would think that mental health probably doesn’t rise to the level of priority like those other things do, but at the same time, 25 percent of the population would benefit from mental health treatment,” Gilbert said. “They don’t get it. There aren’t enough providers. There’s not enough access to go around. But generally speaking, across the country 25 percent of all Americans need mental health care.”

The Oregon Health Authority said, including KYDC, there are 15 certified mental health care providers in Klamath County.

At KYDC, Gilbert said he prefers psychiatrists to treat about 400 patients at a time. For therapists, he wants to keep the number of cases down to about 50.

“I think people don’t think about it until it affects them directly,” Dannielle Brown, residential program supervisor at Phoenix Place, the facility once managed by the county but now run by KYDC, said about the issue of mental health care. “Or until something major happens.”

Something like the Sandy Hook school shootings in Connecticut last year. Then mental health becomes a big issue for a short period of time.

“And that lasts about five minutes,” Brown said. “It’s a flash in the pan, and everybody’s done.”

She wants to change the perception of the mentally ill and the way the community sees the people she works with every day.

“I definitely think we have the opportunity to provide a lot of community education, get the stigma of mental illness decreased. These aren’t the big scary monsters that go out and strangle you in your sleep. But that’s what people think,” Brown said. “It’s just the stigma of mental illness. There’s a tremendous opportunity to educate the community on mental illness so people don’t fear what they don’t know.”

The majority of the time, if a person is having a crisis, he or she is more likely to hurt him or herself than others.

“It’s that they’re so psychotic that they forget to eat, they forget to drink, they forget to take their meds. They can’t provide for their own basic needs,” Brown said.

What is KYDC’s role now and in the future?

Klamath Youth Development Center first applied to provide mental health care to adults — traditionally the county’s job — in 2000, Gilbert said. Then, KYDC needed permission from the county. KYDC never got permission and continued to only treat clients under the age of 18.

“I knew the only thing that was prohibiting us from treating adults — at the time we wanted to treat families as a unit — I knew the only issue that was preventing that from happening was approval from the county,” Gilbert said.

Now KYDC has that permission, and that responsibility, thanks to the state.

“Initially our goal has been to provide continuity to everybody that was currently receiving services,” Gilbert said. “We do not want any individuals to fall through the cracks … Our No. 1 priority has been to maintain services and provide a secure, supportive, kind environment for patients to get that care.”

Asked what was in store for the future of mental health care in Klamath County, given all that has happened in recent years, months, weeks and days, Brown said she wasn’t sure.

“Oh gosh, I don’t know. I’ve been so focused on getting through this, I don’t know,” she said. “I’m hopeful for the future. I’m hopeful that we can continue to provide clients services and expand the services we’re providing.

“I’m hopeful instead of being the county that’s felt so unstable for the last three years,” Brown continued, “we can be the stabilizing force in the community.”

With KYDC taking the reins of mental health care in Klamath County, Gilbert sees an opportunity to start over.

“Our plan is to have a large conversation with the community,” he said. “What do we want this to look like? Let’s design the kind of system that, as a community, we really want to have.”

To start, Klamath Youth Development Center is going to change its name. Gilbert doesn’t know what that name will be, but he wants to include all the different clients the company treats, young and old.

“We want to find an identity that closely reflects our new responsibility and expanded population,” he said.