CCMSD changes lane on mental health care plans

The Board of Trustees for Crook County Services District (CCMSD) will not at this time be introducing the Senior Life Solutions program to provide mental health care for residents aged 65 and above.

Instead, the board has opted to fill a nurse practitioner vacancy with a candidate who has a dual specialty that includes mental health.

The board heard a presentation at its last meeting from Kirby Johnson of Senior Life Solutions, a program offered by Psychiatric Medical Care of Tennessee. The program offers intensive outpatient group therapy through a contract that would have provided a team of on-site medical personnel; the service would be fully refundable by Medicare.

Johnson was asked send over the contract for review. However, at last week’s meeting, reservations over how appropriate the program would be for this community led to a change of heart from the board.

Wrong Demographic

“As I stated last meeting, I think we clearly have a huge need for mental health services in the community and in the state and, while the 65-and-up is an important segment, I’m even more concerned about the folks under that,” said Trustee Mark Erickson.

He shared the most recent state report on mental health cases, which included 16,365 clients served in 2022 in Wyoming.

If you look at those clients by age, he said, only 6% of the total were above the age of 65.

The largest group mentioned was between 25 and 34, which represented 35% of clients. He also noted that 23.8% were below the age of 18.

“My concern…is that that program specifically is only going to give us coverage for 6% of our population. I’m not downplaying it…but I’m very passionate about the other end of the spectrum,” he said.

Erickson said he feels strongly that CCMSD needs to provide mental health support for younger groups – in particular, those below the age of 40.

Cost Concerns

The contract with Senior Life Solutions could ultimately have been expanded to include younger age groups, but only if it was successful. Erickson brought up the concern that the Senior Life Solutions program is not guaranteed to pay for itself unless it attracts enough patients covered by Medicare.

When reviewing the contract, Erickson said it had become apparent that the program involves fixed costs of somewhere in the region of $40,000 per month, paid to Senior Life Solutions for management and personnel for salaries. This would then be recouped in Medicare reimbursement – but only if enough Medicare patients utilize the service.

The contract, he pointed out, is for a mandatory three-year term.

Trustee Brent Fowler agreed with Erickson’s concern that this would mean the district was on the hook for those monthly expenses if the program failed to attract enough clients.

“It’s great to have it here, but if we don’t have the patients to get reimbursed then it’s still our expense,” he said.

Erickson noted that, in his opinion, the program’s ability to succeed in Crook County is questionable, as he is unsure whether the group setting of the therapy offered by Senior Life Solutions is appropriate for a community that, as a whole, tends to keep things private when it comes to personal issues.

Direct Employee

The question of mental health services initially arose due to the resignation of a clinic provider who was able to offer mental health support to her patients.

Erickson offered an alternative solution that would still allow CCMSD to fill this gap without risking a significant financial burden.

The focus, he said, should be on, “How do we replace what we already were taking care of and how do we expand that and encourage people [to use it]?”

At this time, the district is looking to fill a vacancy for a nurse practitioner. Erickson suggested that this could position could be filled by an employee who is able to offer mental health services.

“I would rather we look into finding a [provider] that has a background in mental health,” he said.

Erickson explained that he would like to see this position be a direct employee of the district with an emphasis on mental health but the ability to also assist with physical healthcare.

CEO Micki Lyons described one potential issue with this plan. The district could go ahead and employ a mental health provider directly, she said, and she wholeheartedly agrees that younger age groups should be included.

However, she asked the board to consider the wisdom of adding a position that would have no mentorship or resources.

“We are taking one mental health practitioner and sticking her in three clinics with no oversight as far as a psychiatrist, no other nurse practitioners that she can bounce ideas off,” she said. “She’s kind of on an island by herself.”

The board was generally in agreement that mental health is something CCMSD should offer and that the best route forward would be to start small and grow the service organically according to need.

Trustee Brent Fowler stated that he agreed with Erickson’s desire to provide mental health care for younger age groups “110%”. Overall, mental health care is a need, he said, and the board already knows that the service that was available through the clinic provider is missed by the community.

Trustee Robin Hibbard also agreed with the concept of building up the service later, noting that this would also provide real data as to how much of a need is out there in the community.

Micki made the suggestion that the board watch the progress of Senior Life Solutions on its newly launched contract in Buffalo, which is a similar community to Crook County. If the program works, she said, it may be worth reconsidering it here.

“I’m never going to say never,” said Erickson, to sounds of agreement from his fellow trustees.

A motion was made to authorize Micki to pursue filling a vacant position for a nurse practitioner able to serve as both a family provider and mental health provider.