The afternoon meeting in July 2004 was an informal get-together between two executive directors, who often met to discuss issues that affected both of their organizations in Alaska's central Kenai Peninsula. No one would have predicted that a seed planted that day—to build a facility that houses both a community mental health center and a community health center—would become reality just three years later. Even more surprising has been the enthusiasm of both organizations' boards to consider an even more integrated approach to care.
The community mental health organization is Central Peninsula Counseling Services (CPCS), which recently celebrated its 30th anniversary. With 100 employees and a $5 million annual budget, CPCS provides a comprehensive array of clinical and rehabilitation services for seriously emotionally disturbed children and severely mentally ill adults, operates an adult day center for the frail and elderly, and provides around-the-clock psychiatric emergency services.
Central Peninsula Health Centers (CPHC) is a five-year-old federally qualified health center with a $4 million budget and more than 50 employees. CPHC operates Cottonwood Health Center, a primary care clinic, and Aspen Dental Clinic, providing services regardless of patients' ability to pay. The organization particularly focuses on prevention and chronic disease management.
Both CPCS and CPHC serve vulnerable and economically disadvantaged residents of the central Kenai Peninsula in south-central Alaska, a popular tourist destination for outdoor enthusiasts. The central Kenai Peninsula is a large rural area with almost 33,000 residents. Much of the employment is seasonal, unemployment rates are relatively high, and roughly 20% of the population lacks health insurance of any kind. Health status statistics for the area reveal relatively high rates of chronic health conditions including mental illness.
Historically the relationship between CPCS and CPHC was friendly but limited. In 2004, CPHC secured a grant to provide behavioral health screening and brief intervention services to its medical patients and subcontracted with CPCS to provide these services in the primary care setting. This initial integration of staff and services, albeit relatively modest in scope, served as the foundation for the colocation discussions that followed.
For CPCS, colocating with a community health center will provide benefits for both consumers and the organization. With youth and adult mental health programs currently split between two communities 11 miles apart, it is challenging to manage and coordinate services. Families with both child and adult consumers must travel to two separate locations. Psychiatric services are offered primarily at one site, thus limiting access. Maintaining two facilities has increased operational expenses through use of courier services and duplication of support staff, utilities, transportation, and building maintenance costs, which are particularly challenging in the current funding environment.
For CPHC, the new building represents an opportunity to create a healthcare setting optimally responsive to providers' and patients' needs. CPHC currently operates in a rented facility with neither adequate space nor a functional design, and it cannot meet the growing organization's needs.
For both organizations colocation will provide economies of scale and operating efficiencies through shared maintenance, phone system, information technology, and utility costs. We also are considering sharing administrative functions, such as human resources or finance. Yet regardless of the cost savings and increased efficiencies, the most compelling argument for colocation is that it will create the opportunity for consumers to receive holistic, coordinated care.
A recent study revealed that persons with serious mental illnesses die 25 years younger than the general population, with much of the disparity attributed to inadequate medical care of chronic physical and mental disabilities.1 This study clearly underscores the need for integrating primary care and behavioral health services. Although some of CPCS's clients are being seen by CPHC providers, many do not have a medical home. The organizations' colocation will increase the likelihood that CPCS's consumers will access CPHC's services and vice versa. Colocation also will create an opportunity for consultation among providers and the development of more collaborative treatment protocols.
The New Facility
Fund-raising for the new building has been a joint effort, and has rapidly increased the organizations' sense of partnership. Thanks to CPHC's early leadership, a strong base of funding has been secured. To date, commitments to cover more than 60% of the $10 million project have been provided by the Denali Commission, Rasmuson Foundation, Alaska legislature, Alaska Mental Health Trust Authority, Salomon Foundation, and personal pledges from board members and staff, while decisions on other grant requests are pending.
CPHC is the project's developer and has had primary responsibility for the building's planning, design, and financing. We are using a condominium approach to the building's ownership to assure that each organization has a voice in decision making. Groundbreaking for the new facility, Peninsula Community Health Center (PCHC), was June 16, 2006, and the projected opening date is November 1. Kluge & Associates designed the building.