Improving Access to Behavioral Health Care

Recently it was reported that a man suffering from a mental health disorder had 43 visits to the emergency room and eight in-patient stays in only seven months. This individual's troubles illustrate a widespread, increasing problem in healthcare.

The number of Missouri patients seeking help for mental health conditions and substance abuse has increased dramatically in recent years; often these individuals are un- or under-insured and seek treatment in the emergency room. There they are stabilized, released without any referral for follow-up care, and many times quickly end up back in the ER.

According to the National Institute of Mental Health's web site, mental disorders are common in the United States. "In a given year, approximately one quarter of adults are diagnosable for one or more disorders." The costs associated with mental health and substance use disorders are significant. In an August 2013 bulletin, the Substance Abuse & Mental Health Services Administration (SAMHSA) reported that in 2009 the nation spent a total of $172 billion on the treatment of mental illnesses ($147 billion) and substance use disorders, which accounts for nearly 10% of all-health spending. Importantly, public spending accounted for 69 percent of substance abuse treatment spending (compared to 49 percent of all-health spending), and 60 percent of mental health disorder treatment spending (versus 49 percent of all-health spending) in 2009.

To help slow the ER-treatment cycle and decrease state and federal healthcare expenditures, the Missouri Department of Mental Health (DMH) provided funding to seven sites across Missouri for "The ER Enhancement" (ERE) project. The ERE is designed to develop effective intervention models for people in mental health crisis, create alternatives to unnecessary or extended hospitalization, and reduce unnecessary ER visits. Each site is teaming up with hospitals, community mental health centers, law enforcement, substance abuse providers, and other community services to coordinate care for people with mental health conditions and substance use disorders.

The Missouri Institute of Mental Health (MIMH), an UMSL research unit, received $380,000 from the DMH to evaluate the outcomes of the seven sites and report on data such as changes in ER utilization, enrollments in treatment programs, housing and employment, involvement with law enforcment, and more.

Rita Adkins, project director at MIMH and principal investigator on this project, is leading the MIMH evaluation team to see whether the ERE goals and objectives are being met. The team is using an online web-based data entry system developed at MIMH and designed so that each site can securely report patients’ progress.

“It is very fulfilling to work on a project that makes such a positive impact on others," Adkins said. "Not only are there changes on an individual level, but to society as a whole."

But what about the man with 43 visits to the ER over a seven-month period? He is engaged with the ERE project and, over the last three months, he has had no hospital visits, is now attending college, and has a part-time job.

"We look forward to continued success with the ER Enhancement program,” Adkins said.

MIMH Evaluation Team for the ERE Project

Rita Adkins leads the ERE Evaluation team

The ER Enhancement Project Evaluation Team (Missouri Institute of Mental Health):
Back Row from left: Keith Eldridge, project analyst expert; Suzanne McCudden, project development specialist; Mandy Nelson, eesearch lab technican
Front Row from left: Rita Adkins, project director (and PI for the ERE); Mary Dugan, research assistnat professor; Michelle Hendricks, research assistnat professor
Not Pictured: Jayne Callier, programmer analyst expert; Julie Matthews, research specialist; and Liz Sale, associate research professor

Rita Adkins, MPA, is a project director at MIMH with over 18 years’ experience in project management. She has been involved with a number of federally funded mental health and substance abuse projects. Adkins was the project manager for the Consumer-Operated Services Program (COSP) Multi-Site Research Initiative Coordinating Center and was responsible for the day-to-day management of the evaluation of the Screening, Brief Intervention, and Referral to Treatment (SBIRT) project. She is currently responsible for the evaluation of the Emergency Room Enhancement project