Amid low ranking, area mental health coverage improving

Williamson County this year ranked fourth—above Travis County—in statewide health rankings, yet its numbers for mental health services were staggeringly low.

Compared with the “Top United States Performers” at a ratio of 360:1, Williamson County had 1,190 patients to 1 provider, according to County Health Rankings & Roadmaps.

As Williamson County continues to grow, mental health providers are also seeing an increased number of patients served each year.

Mental health providers in the county say the numbers and treatment options improve each year, but many agree that more work must be done to bridge the coverage gap.

Kathy Pierce, chair of the Williamson County Behavioral Health Task Force, which focuses on countywide mental health policy and system changes, said the issue is something that needs to be improved not only in the county, but statewide.

“It’s not just Williamson County; there’s a big issue if you look at any [county across the state], especially those that have some rural areas in them,” Pierce said. “This creates challenges and we have to think of creative ways [to solve them].”

When the mental health group started meeting in 2003, Williamson County had one hospital system, no behavioral health hospitals and far fewer providers, Pierce said. The county now offers four hospital systems, two behavioral health hospitals and more providers specific to mental health.

Access to resources
Located in Georgetown, both behavioral hospitals in the county, Rock Springs and Georgetown Behavioral Health Institute, offer 24/7, 365-day services as well as free assessments to residents of Williamson County and the surrounding area.

The county’s first inpatient behavioral health facility, Rock Springs, opened in 2014 and treats adults for mental health and substance abuse issues. The facility has a 72-bed inpatient wing as well as outpatient wing and a military program. Services such as detox, short-term rehab and medicine stabilization are all available at the center.

Rock Springs officials said before they came to the area, patients had to go into Travis County to receive help and that now they are serving people from as far north as Waco and as far south as San Antonio, as well as individuals from out of state.

The Georgetown health institute serves patients ages 12 and up at its 118-bed inpatient facility and outpatient facility. The facility offers veteran services, individual and group therapy, substance abuse and detox as well as specific adolescent and geriatric wings and offers one of the only psychiatric intensive care units in the area.

Both hospitals also take advantage of services offered from Bluebonnet Trails Community Services, working with them to ensure under-and-uninsured patients are served.

Bluebonnet Trails offers a variety of services to people in need in the region, with facilities in Cedar Park, Georgetown and 11 other cities.  Along with behavioral health services, Bluebonnet Trails offers support and resources for autism, crisis services, dental, early childhood intervention, family health care and more.

Executive Director Andrea Richardson said in the past year the organization received 3,540 calls through their call center in Williamson County.

In Cedar Park, Bluebonnet Trails partners with Cedar Park Regional Medical Center out of an office established on the medical campus to provide psychiatric assessments, counseling, case management, substance use treatment, peer support, family partner services and more.

In Georgetown, the organization can offer services within its San Gabriel Crisis Center, which has 12 beds in a crisis respite unit. A typical length of stay ranges from 1–10 days.

Bluebonnet Trails accepts all insurance plans.

“We do not turn persons away who have an inability to pay. Instead, we offer screening for eligibility for sliding fee discount programs and public assistance programs supporting your healthcare needs,” Richardson said.

Hospitals in the area
Rock Springs and health institute officials said they have very close relationships with area ERs and help with the transition from the ER to the facilities. Both places are open 24 hours a day every day which  also allows patients to bypass the ER if they do not also need medical clearance.

At St. David’s Georgetown Hospital, anyone who comes to the emergency department with a mental health concern will have a medical clearance screening while also having their mental health needs addressed, according to Marge Connors, director of emergency services.

The ER staff is trained specifically to handle all types of medical and mental health emergencies and concerns, and outside crisis intervention resources can also be called in.

“I’m surprised [Williamson County] scored low,” Connors said. “In my experience treating emergency room patients, I believe we have a lot of options for mental health services in this area.”

At Cedar Park Regional Medical Center, the emergency department is able to provide medical stabilization and a medical clearance for patients before they are transferred to one of the psychiatric hospitals in the greater Austin area. Laura Balla, Cedar Park Regional spokesperson, said this is a common practice for hospitals.

“Our team contacts a Crisis Intervention Team through the sheriff’s office or the Mobile Crisis Outreach Team provided by Bluebonnet Trails to evaluate the patient,” Balla said.

County challenges
Throughout the county, mental health facilities continue to address challenges. Pierce said one issue is finding funding sources for beds—in particular, for patients who do not have insurance.

Richardson said population growth also plays a role. The 2015 U.S. Census Bureau statistics estimated Williamson County’s population reached 515,000, a 20 percent increase from 2010.

To address growth, Richardson and Pierce said teams have to think of creative solutions to help the community.

“We focus on internship programs that introduce behavioral healthcare to students determining a career path,” Richardson said. “We offer services through telemedicine systems providing more timely access to services and to lessen the burden of travel for both the family and the provider.”

Another obstacle is reaching the county’s rural regions, where Pierce said there are fewer providers. The task force is working with the county’s emergency medical services to ensure community health paramedics reach these regions.

Richardson said the federal Substance Abuse and Mental Health Services Administration notes the no-show rate for outpatient behavioral health services hovers around 30 percent. 

“We attribute a large part of our 27 percent no-show rate to a lack of transportation for persons to travel to our office-based services,” Richardson said. “In response, as with many providers, we are expanding operations to areas creating ease of logistical access for families and placing services where the families frequent, including our local schools.”

Damien Robinson, the Chief Operating Officer at Rock Springs, said Williamson County has been proactive in serving the population with mental health issues, but that there is still more work and education to be done.

“I think nationwide numbers for mental health providers are low,” Robinson said. “Even with our facility and [the health institute], we are still underbedded for Williamson County.”

Georgetown Behavioral Health Institute officials said the issues in coverage come from a lack of providers.

In the future, health institute officials said they want to create a residential treatment center and an outpatient psychiatric clinic to help provide more regular medication checks and check-ins with doctors to help cut down on people having to recheck themselves in for treatment.

Looking to the future
Williamson County Precinct 2 Commissioner Cynthia Long said the county still has room for improvement, although strides are being made in the right direction.

“Williamson County has been a leader in dealing with individuals with behavioral health issues,” Long said. “Ample resources in this area will always be a challenge, but Williamson County has risen to the occasion with its innovative approach.”

Pierce said she would like to see more collaboration as more people come into the area. She said talking about mental health is important to help break the associated stigma.

“I would really like to have mental health be thought of like diabetes or cancer where you’re not afraid to talk about it,” she said. “It’s really important that people have wellness, and your mental health is a part of an overall wellness.”