When talk turns to health care, people often only consider one aspect, the physical. Yet mental health is every bit an equal partner in an individual’s wellbeing, even more so for those struggling with emotional difficulties and substance abuse.
Manatee Glens, the county’s primary mental health care provider, needs a life preserver of its own. Serving a rising tide of children and adults desperate for care at treatment centers sometimes at capacity, Manatee Glens is near the breaking point. Herald reporter David Gulliver wrote about the issue in detail last Sunday.
The Manatee County Commission holds the two keys essential to Manatee Glens’ future, as the owner of the land that is home to its main campus and as the steward of the county health care fund. As commissioners begin tackling this urgent problem in the coming days and weeks, they would do well to keep in mind this thought from Manatee Glens chief executive Mary Ruiz: “Any plans for health care have to include behavioral health. We can’t just care for people from the neck down.”
High cost of indigent care
The region’s struggling economy continues to batter families, draining the bank accounts of the jobless, putting people out on the streets and straining relationships. Half the 12,000 patients Manatee Glens treats have no insurance and a quarter are children.
Hundreds of Manatee Glens’ indigent patients are transfers from the county’s acute care hospitals, but the mental health care provider has been forced to refuse transfers more and more for want of beds in a center at capacity. Those hospitals are then stuck with patients in more expensive emergency room care, which then puts additional pressure on the county’s health care fund.
This is the point where the costs of operating physical and mental health care operations converge, which commissioners should consider when dealing with that soon-to-be depleted fund.
Manatee Glens wants to expand is crisis center from 24 beds to 30 but lacks the money and cannot wait the years it would take to raise funds from donors. The situation is critical now.
If the hospital obtained ownership of the campus land, that would provide collateral for a bank loan. Manatee County, which leases the land to Manatee Glens for one dollar a year, should transfer title to the hospital — as it has in the past with other nonprofit organizations. First, however, the hospital must come to terms with the two other tenants at the campus — Manatee County Rural Health and Manatee County Meals on Wheels — and those negotiations are expected to continue this week.
County reduces funding
The tougher, long-term issue pertains to Manatee County’s contribution to the Manatee Glens budget out of the health care fund, once known as the indigent care fund. The fund’s money came from the sale of the once publicly owned Manatee Memorial Hospital and is dedicated to covering some of the costs of caring for poor people.
This year, commissioners increased reimbursements to the acute care hospitals, with Manatee Memorial and Lakewood Ranch Medical Center sharing $6.9 million annually for the next three years. Meanwhile, county support to Manatee Glens has fallen more than $300,000 since 2007-2008, to only $674,000.
This inequitable, shortsighted position backfires considering how expensive emergency rooms sometimes get stuck with mental patients turned back by an over capacity Manatee Glens.
Most of the indigent care money Manatee Glens receives pays for involuntary substance abuse commitments that the sheriff’s department brings under the Marchman Act, with the number of cases soaring from 300 to 2,300 a year.
Plus, the mental health center is seeing a rising number of patients committed for emergency or involuntary care under the Baker Act. And charity outpatient services are also increasing significantly.
Manatee Glens has been diligent in cutting costs, replacing expensive residential treatment with cheaper outpatient services and adding a walk-in center with outpatient addiction care. The idea that the hospital can reduce costs more is dubious at best.
Give mental care its due
Come November, county commissioners will start the discussion on the health care fund, which is forecast to run dry in four years. One idea is asking voters to approve some sort of tax, possibly a half-cent sales tax increase.
The county cannot abandon its responsibility to reimburse hospitals for indigent health care — both physical and mental. As commissioners discuss this entire issue, we encourage greater consideration for mental health as the under-served stepchild to the big acute care hospitals.