Historically, if a person with behavioral health issues needed immediate attention, there were only two viable options: a trip to the emergency department of the local hospital or a phone call to a 24-hour crisis hotline.
Now, the emerging trend in walk-in behavioral health facilities is providing a potentially better alternative. In the last several months, Urgent Psych Care was launched as the first walk-in facility in the Houston area, dedicated solely to psychiatric treatment and medication management. Additionally, in January, the Eugene, Ore., Rapid Access Center (RAC) and Medical Clinic hosted the grand opening of its facilty.
There also are existing walk-in facilities in major cities like Minneapolis and Los Angeles, and more such clinics may spring up in the near future, experts say.
Why now? The increase is in response to a variety of factors, including the return of military service personnel from overseas, awareness of mental health related to recent incidents of mass shooting, and heightened terrorism fears, says Urgent Psych Care CEO Troy Marsaw.
Another reason for the increasing need for access to service relates to the implementation of the Affordable Care Act (ACA). Oregon is one of 29 states that have adopted Medicaid expansion and seen an increase in demand, driving the need for facilities like RAC.
“Our Coordinated Care Organization (CCO) received an influx of 90,000 newly eligible individuals who are seeking healthcare services,” RAC’s executive director, Susie Dey, says.
Oregon is unique in that it offers CCO healthcare delivery models that bring together local entities to deliver comprehensive care and coverage for people eligible for state Medicaid. CCOs must be accountable for outcomes and have one budget that grows at a fixed rate for mental, physical and dental care. CCOs are governed by partnership among providers and stakeholders who share financial responsibility and risk.
RAC is a partner in the Trillium CCO group.
“Since implementation of the ACA, the 16 CCOs in Oregon have the option to cover medical services, and our CCO is a strong supporter of that,” Dey says.
Rising need in Houston
In Houston, Urgent Psych Care offers full service mental health and medication management, diagnosis and referrals to counseling services. It, too, was launched due to the growth in demand for behavioral and mental healthcare support in the community, according to Marsaw. Houston is projected to double its population in about five years.
“Even today, there are simply not enough practitioners or facilities to handle this demand. Those in need of services are waiting months to address urgent psychological healthcare needs,” Marsaw says.
While Texas has not opted to expand Medicaid under ACA, the state has a far-reaching safety net for the most vulnerable populations.
With the capacity to treat up to 30 patients a day, the Houston clinic is currently open Monday to Friday, 8 a.m. to 8 p.m. and Saturdays, 11 a.m. to 3 p.m., but Marsaw has a long-term plan to expand it to a 24-hour facility. Clinicians treat patients from all walks of life including professionals as well as the homeless and indigent, he says.
Urgent Psych Care currently employs nine professionals, with projections to increase staffing to match growth. The staff includes a medical director, licensed psychiatrist, two licensed psychologists, three licensed professional counselors, one medical assistant and one billing specialist, as well as two security guards.
The clinic’s services are focused on mental healthcare, including psychological assessment; mental health crisis assessment; behavior and medication management; crisis psychiatry; peer support; crisis stabilization services; family therapy; individual treatment plans; and anger management.
Eugene offers SUD services
The Eugene facility was the brainchild of a mental health agency based in the city, Willamette Family, which specializes in drug and alcohol abuse treatment and is backed by a $125,000 grant from the Trillium Community Health Plan. It’s a combination medical clinic and SUD treatment center.
“We treat individuals — often with few skills and limited financial resources — who often face stigma within the community when they access services due to health conditions,” says Dey.
But it’s the ability to provide same-day services that makes the real difference, she says. Waiting lists and other access barriers are huge roadblocks for individuals who need the motivation to seek behavioral health treatment in the first place. The window to engage them is small.
“If they run into barriers, which has often been their experience in their lives, there is a strong likelihood they will give up,” she says.
RAC has two nurse practitioners, seven mental health therapists, 30 substance abuse counselors, four peer support specialists, and one care coordinator on staff. The Eugene facility hopes to treat about 1,200 patients annually.
In fact, RAC saw 233 patients in December, during its soft launch, prior to the grand opening.
It’s also important to make the same-day services affordable, so in Houston, Urgent Psych Care accepts most commercial insurance coverage, as well as Medicare and Medicaid.
“We accept cash and will allow self-pay patients to pay on an installment basis,” says Marsaw. “The amount paid by insurance is dependent on the policy the patient has. Most patients with insurance have small copays, usually under $50, and insurance pays the rest.”