WHITE SALMON — Comprehensive Healthcare (CHC) informed Klickitat County officials earlier this month that they would cease providing crisis services in the county, effective August 8, 2022.
CHC had held the sole contract with Beacon Health Options to provide crisis services to Klickitat County residents since their partnership with the county began in 1997.
Jodi Daly, president and CEO of Comprehensive Healthcare, wrote in a June 6 letter addressed to county, health, and law enforcement officials, that the decision comes amid several recent developments in the statewide healthcare market; as well, ongoing staffing shortages, and a continued fragmentation of treatment for behavioral health and substance use disorders, have led the organization to end crisis services within the county.
Daly said a 2018 statewide shift towards “fully integrated managed care models” among primary care providers has caused local healthcare organizations, who traditionally referred clients with behavioral health symptoms to CHC, to begin developing programing to provide those services themselves, such as behavioral health care.
“With the above stated changes, behavioral health organizations are now competing for the same employees and for the already small pool of people drawn to Klickitat County,” Daly said in the letter.
She continued to say that following an April 17 meeting between local partners, the organization “took away from that meeting that as the hospitals build up their services, CHC would only be needed for crisis services.
“Although we recognize the need of hospitals to grow and further support the community in other ways, we also strongly feel that if CHC only provided crisis services within the county, we would be missing the mark of a balanced and effective approach to treatment for the most vulnerable members of the community,” she said.
Daly also referenced a May 24 meeting, where representatives from CHC faced tough questioning by county officials, law enforcement, and healthcare providers regarding the organization’s staffing situation, saying that “misinformation, innuendo, and frustration ruled the meeting.
“My staff were not prepared to respond to multiple and varied concerns about the community based mental health program, regulations, and funding streams in a way that would be beneficial to those sharing their concerns,” she said. “If asked, we would have brought data with us to clarify for the commissioners and public …. We have been and will always be transparent in our operations.”
County officials had revealed during the meeting that services requested of a Designated Crisis Responder (DCR), whose primary responsibility is to evaluate a subject to determine whether the subject is at imminent risk and respond accordingly, were denied twice in April. In Washington, only DCRs can detain a person going through a mental health crisis and admit them to inpatient services.
Daly said in a follow-up interview with Columbia Gorge News that the decision to cease crisis services will not affect any other service that they provide in the county, including outpatient behavioral health, substance use, and case management services. Those continue to be offered at both the White Salmon and Goldendale offices.
According to Daly, Klickitat County has been especially challenging to hire in, but with the transition to a new provider for crisis care, she said the county has an opportunity to make positive change.
“I certainly think the county health department can look at models that might actually be a better fit for the county,” she said. “What is born is an opportunity, and I think there is some opportunity.”
A Pathway Forward
The decision to halt crisis services has left county officials and their community partners in healthcare and law enforcement searching for an alternate crisis service provider by the 60-day cutoff.
County Board Chair Jacob Anderson said ultimately the decision on a replacement will come down to the Board of County Commissioners, but in the weeks since CHC announced their intention to discontinue their partnership with the county, commissioners have been meeting with the public health department and local medical providers for guidance.
At the moment, the county is currently exploring short-term options to be able to provide services in an interim stage while county officials work on a longer-term solution.
“We are going to have all-county crisis services in 60 days,” Anderson said. “We have to, that’s not an option.”
Little is known yet about what the crisis services apparatus will look like come August, but Anderson said he would prefer to see the county take on the program through its public health department.
Like Daly, Anderson sees a silver lining in the upcoming transition — “This is our golden opportunity to build mental health care in the county how we want to build it.”
Public Health Director Erinn Quinn is part of those ongoing discussions. While her role is rapidly evolving as time passes, she said she has been active working to gather information and connect resources between vested community agencies to ensure that there will be no gaps in crisis service to Klickitat County residents.
At the same time, Quinn said she is beginning to engage community partners in long term vision planning for what Behavioral Health Services in our county will look like."
Quinn told commissioners last month that around half of all Washington counties operate an in-house crisis center, including nearby Walla Walla, Skamania, and Adams counties.
Funding for those services most often comes from the state of Washington’s Department of Health, and many clinics are also funded on a reimbursement basis, including Skamania County Community Health, Quinn said.
Insurance reimbursements are a start, but would need supplementation in the form of grants or otherwise to offset costs, she told commissioners.
For Klickitat County 911 dispatch, who are most often the first point of contact for a designated crisis responder responding to a call in the county, "what matters to us is having a reliable resource that we can contact, and they can respond in a timely manner," said Emergency Management Director Jeff King.
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