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County's mental health treatment crisis deepens

STORY BY EILEEN KELLEY, (Week of November 8, 2012)
Photo: Dr. Subhash Tiwari, a psychiatrist, saw final patients last week.

They are scared. They feel lost. Many already said their good-byes as they were tearfully ushered out the door after learning their affordable psychiatric appointments at the Treasure Coast Community Health clinics were going to be their very last.

Treasure Coast cut loose the patients because it was told it could no longer spend federal grant money to shore up the psychiatric program. The roughly 400 patients the agency let go – on top of the personnel problems at the Mental Health Association – have thrown the area’s mental health counseling programs into a crisis mode.

In addition, it doesn’t appear Treasure Coast will allow former mental health patients to use its pharmacies for low-cost prescriptions even if they found other counselors, as was suggested earlier this week. That will force many patients to go without medications when their 30- to 90-day supplies run out.

The developments at Treasure Coast and the Mental Health Association prompted the Mental Health Collaborative of Indian River County to schedule a meeting at some point this week to discuss the county’s mental health woes.

For the most part, the patients let go by Treasure Coast are poor. One third of them have no insurance at all.

Of 940 patients seen this year for psychiatric and behavioral health issues such as addiction, 74 percent had incomes below 150 percent of the federal poverty level.

“I don’t know what to do,” said a 54-year-old Vero Lakes Estates woman, who broke down and cried upon learning that Treasure Coast Community Health will no longer be treating adults who need psychiatric and addiction care.

The woman, who had been institutionalized in 1986, said she spent 15 years off her medication until discovering the community health centers.

“You don’t want to know what I went through,” she said between sobs.  “And finally I was able to meet a doctor who was able to help me. Now what? Where are we going to go? So we stop our medication?  Are they just going to leave us out there so we wind up in jail? I mean it, where are we going to go?”

The woman’s fear is exactly what bothers Dr. Subhash Tiwari, a former psychiatrist at Treasure Coast.  “In some cases it has been very difficult,” he said. “I’ve had some patients break down and cry. I’ve had patients who are angry and don’t fully understand what has caused these decisions to be made.”

Like the woman, Tiwari was also shown the door last week after seeing the last of his patients.  His job has been eliminated, but Tiwari says he’ll survive.  He just cannot say that about his patients with any ease.

“For physicians, it’s fine. We can find jobs. It is really not an issue. The real issue is our patients,” he said.

What has happened, he said, could be considered a crisis.

“(Our society) most certainly tends to leave out those patients who have no money and no insurance,” he said. “I think private practice caters to people who have insurance.

“In my opinion, the biggest problem the county is now having is that there is a huge number of people whom we were seeing at the Treasure Coast Community Health who cannot easily go to another practice because they cannot afford it. 

“What’s happening speaks of the system.  We are a relatively wealthy community, and yet we’ll have several hundred people who will go off their medications,” Tiwari said.

The agency’s chief executive officer Vicki Soule said she had no choice but to end psychiatric services to 438 adult patients because of the excessive costs associated with providing care.

Of those patients, 371 were seeking psychiatric care while the remainder were seeking help to curb addiction.

The clinic – founded on the principle of helping the poor – offered a sliding scale fee those without jobs and insurance. 

The problem was the psychiatrists still billed the center more than $100 a visit, while many of the patients could only contribute about a quarter of that fee.

“The reality is, mental health is really a community effort,” Soule said. “State and federal budgets are really being challenged to reduce. Community donations and community efforts are going to be needed to respond to this.”

When the center notified its current roster of patients, it handed them a sheet with other facilities that may be able to help them.

Only New Horizons of the Treasure Coast offers a comparable low cost – from $3 to $80 a visit on a sliding scale  – for a 15-minute medication management visit.  But the cost is $250 to have an hourly visit with a psychiatrist where the patient can talk out issues, as well as have the mandatory one-hour evaluation for new patients.

The lowest payment Legacy Behavioral Health will accept is $60 for a 15-minute visit. Likewise, the mandatory psychiatric evaluation would be $185 for new patients.

Neither agency has a pharmacy, where steeply discounted psychiatric medications can be filled and refilled.

“I don’t know what I am going to do,” said a 47-year-old Sebastian woman who also suffers from bi-polar disorder.

“They are leaving me hanging here.”

The woman, recently institutionalized for nine days after a suicide attempt, said her medications cost her about $100 a month at Treasure Coast pharmacy.  During her last visit, she said she had to borrow money from a worker there to get her prescription filled.

“Everything is just getting worse,” the woman said.  “How am I going to get my medications (with) medicine being so expensive?  It is supposed to be a community center to help people. There is supposed to be a system to help.”

After reporting on the closure last week, Vero Beach 32963 posed a question to the clinic: Would it consider allowing its poor psychiatric patients to continue to refill their medications from the center’s low-cost pharmacies in the event the patients are able to get a prescription from psychiatrist.

Soule’s answer was no. “We’d love to take care of the whole world,” she said. But in this case they can’t.

Soule said the psychiatric patients who have had their last session at the clinics have been sent away with medications to last them between 30 and 90 days.

She said patients can only get pharmaceuticals from Treasure Coast’s pharmacy if they are being treated by an on-staff physician or dentist, and those pharmaceuticals must be related to the physical ailment they are seeing a doctor or dentist about.

As for psychiatric patients who may go to the clinic’s dentist, but still need anti-anxiety medications on a daily basis because of mental health disorders, Soule said: “Unfortunately, that is a dilemma.”