Many Montanans cross border for mental health service

WILLISTON, N.D. — Mercy Medical Center in Williston, N.D., operates a small psychiatric unit that serves a sprawling, sparsely-populated area spanning two states.

Gazette photo/PAT BELLINGHAUSEN Tammy Lyseng, Mercy Medical Center social worker, works in a psychiatric hospital unit that serves people from Montana and North Dakota.

Nearly a third of inpatient admissions to the mental health unit in the red brick community hospital are Montanans. It's not surprising that Eastern Montana people cross the state line for psychiatric care. There's not a single psychiatrist practicing in Montana east of Billings. In good weather, Billings is a four-hour drive from Sidney. Williston is a mere 40 miles away.

In January, for example, 12 of the 36 patients admitted to the psychiatric unit were from Montana, and six of the 12 were covered by Montana Medicaid.

Trish Lee, the registered nurse who heads Mercy's 14-bed psychiatric unit, said most patients are adults, many are geriatric. The unit has one full-time psychiatrist and one part-time psychiatrist on medical staff. Psychiatrist Charles Lear also sees patients in Mercy's mental health clinic next door to the psychiatric hospital unit.

The staff of the community mental health center in Sidney drives a van load of clients to Mercy Medical Center once a month for appointments with Lear. Diane Savage, director of the Sidney day treatment, praised Lear for working with her staff and clients. She said he is available by telephone when his patients need help between office visits. Savage also credited Mercy Medical Center for working with Sidney residents.

Mercy, a private, nonprofit hospital operated by Denver-based Catholic Health Initiatives, has made some changes in its psychiatric care in the past year. An adult partial hospitalization program was eliminated. Alcohol detoxification care was transferred to the psychiatric unit from the chemical dependency center. Mercy's chemical dependency program discontinued inpatient treatment, but provides a residential program that includes intensive outpatient treatment for adolescents and adults and overnight housing in the treatment center.

Because the two programs are located side-by-side, psychiatric patients who need treatment for addiction, can start it while in the hospital.

Don Walhus, director of the CD unit, had seven patients in his residential program the day a reporter visited him. Alcohol is by far the most common substance of abuse among Mercy's patients, followed by marijuana and methamphetamine.

Walhus works extensively with Montana because Mercy has a contract to provide chemical dependency treatment to Daniels, Phillips, Sheridan and Roosevelt counties in northeastern Montana through High Plains Chemical Dependency Services. In addition, Mercy operates its own outpatient chemical dependency treatment office in Sidney.

Recruiting and retaining staff is a challenge, Walhus said. "The assumption is that people would work for less in rural areas. You have to pay them more to get them here."

Mercy is recruiting two psychiatrists. One prospect wants to reduce his educational debt through service to a rural under-served area. Walhus said the health center is short of psychiatric time with just one physician working in its clinic. Also, Walhus is looking ahead to the psychiatrist's expected retirement.

Tammy Lyseng, one of two social workers in Mercy Medical Center's psychiatric services, sees a definite difference in payments between the Montana and North Dakota Medicaid programs.

Mercy submits claims to Montana Medicaid on paper and usually waits four to six weeks for payment, which is a preset fee based on the patient's diagnosis, not on actual charges or cost of care. On the other hand, the hospital files electronic claims with North Dakota Medicaid and has received payment in as little as 10 days, Lyseng said. The North Dakota program pays a percentage of charges, which works out to be about 78 percent of the hospital bill. That's still better than what Montana Medicaid pays, Lyseng said.

"North Dakota Medicaid is very generous in paying for chemical dependency treatment," Walhus said, adding that Montana Medicaid doesn't pay as well.

Some Montana patients arrive at Mercy with no insurance coverage, neither private nor government plans, Lee said. The North Dakota hospital also has treated some Montana people covered by the state's non-Medicaid mental health plan. That plan doesn't cover community hospital care, so Mercy — like Montana hospitals — receives no payment for inpatient treatment of these individuals.

Lyseng said she sees fewer North Dakota psychiatric patients who have no insurance coverage. "Most of our seriously mentally ill are covered," she said.