In 2008, Congress passed The Mental Health Parity and Addiction Equity Act that requires “group health plans and health insurance issuers to ensure that co-pays, deductibles and visit limits applicable to mental health or substance use disorder benefits are no more restrictive than the prevailing requirements or limitations applied to most all medical/surgical benefits.”

That continues to be good news for the 3,500 patients that Peninsula Behavioral Health in Port Angeles treated in 2012, be they on Medicare, Medicaid, state health insurance plans or private insurance.

Peter Casey, MSW, LICSW, has been the agency’s executive director since 2006.

“We’ve been a provider in Clallam County since 1971 and started out as a small agency. In 2006, when I came, we just served patients funded from the state with a diagnosis of mental illness,” Casey said. “In 2008, we did a needs assessment and found there were a lot of people with psychiatric illnesses but they did not qualify for state money, such as those with PTSD and anxiety. So we changed our mission to treat anybody who had a psychiatric need. Between 2008-2011, we increased our client census by 1,000 and it’s rising from 200-300 every year, mostly due to poverty issues and the economy’s impact.”

The agency began with five programs and now offers 18, with three focusing on helping veterans.

“We offer an array of services: individual, group and family therapy and we treat from young children to seniors,” Casey said. “In addition to traditional outpatient services, we also provide specialized services for children, crisis services, residential and community support, working with people who are chronically mentally ill in case management and day programs and some recreational therapy. We’ve developed an array of residential services because we can’t treat patients effectively unless we’re assisting them with housing. If they’re not living in a communal way, it’s hard to manage their mental illness.”

One example is the Arlene Engel Home, named after a longtime Olympic Medical Center board member who was a tireless advocate for the mentally ill. The 19-bed facility is a boarding home for chronically mentally ill people who need a high level of staff assistance 24/7. Three transitional living houses are part of a continuum of care in a step-down recovery process to patients being stabilized where they can live independently, have social networks and be monitored on their medications.

PBH is a licensed mental health and certified chemical dependency treatment organization with nearly 100 on staff, including physicians, nurse practitioners, registered nurses, social workers, mental health and chemical dependency counselors. Two-thirds of its professionals have clinical or bachelor’s degrees. Staff expertise runs the gamut from pediatric to geriatric. Last year, the agency saw 692 children under the age of 18 and 474 adults over the age of 60.

Psychiatric needs of seniors

“What we’re seeing, as our population ages, are people breaking down and developing psychiatric symptoms that, to the untrained eye, give the impression of a psychiatric diagnosis rather than a medical one like Alzheimer’s disease. In the elderly population, we see depression, some neurological issues, relationship issues, anxiety over how to make ends meet — do they get their meds or eat?” Casey queried. “Their personalities begin to change and they may have aggressive behavior caused by physiological changes in the brain. They don’t have the resources to control their thoughts and behaviors as they used to and so the response is a much more intense affect,” he said.

Casey noted that for the past two years, PBH has provided behavioral services to the Jamestown Family Health Clinic in Sequim.

“We’re treating a lot of older adults in Sequim — the psychiatric needs in Sequim continue to increase,” Casey said. That’s why he said he was quite surprised and dismayed when the City of Sequim killed its annual contribution of $7,500 to the nonprofit without any discussion with PBH staff.

“We see Sequim as an area of older adults we serve with functional issues — they’re depressed because of many kinds of losses. People think of the Sequim area as well-off, but many aren’t,” Casey said. “It costs $1,700 to treat one client and so we really depend on local funding services. We’re in a dilemma: How do we continue to serve Sequim residents with the cut by the city and the state as well? People we serve without intervention will mean more ER visits, more law enforcement. It’s a tough time.”

PBH organizes its services under the following categories: children and family, adult, community support services, medical, residential, 24-hour crisis intervention and consultation and education. The nonprofit has an annual budget of $5.6 million with $4 million capitated from the state for inpatient and outpatient costs. Of the $4 million, $3 million comes from Medicaid reimbursements.

“The more we use for inpatients, the less we have for outpatients, but if we don’t treat outpatients then we have more inpatients,” Casey said. “Last year we hospitalized 120 people. Of those inpatient admissions, 42 were for 36 Sequim residents and if the residents were uninsured, PBH paid for the hospitalizations.”

PBH primarily is funded by the state of Washington through a contract with the Peninsula Regional Support Network, which is managed by Kitsap County.  It also receives funding particularly for children and families through the Department of Social and Health Services, as well as from grants for specialty populations from United Way, grants and a 1-percent sales tax for treatment of residents with chemical dependency and mental health problems.

Agency philosophy

“We treat everything from depression and anxiety to ADHD and psychosis,” Casey said. “We’re very conservative with medications and that’s not our first intervention — counseling is because not all symptoms are necessarily biologically based, for example, depression. Is it from losses or a biochemical depression, which we can determine through talk therapy.”

Casey said most patients are seen from a few weeks to a few months. “I’ve learned,” he said, “people come here because of a crisis that’s really thrown them off in their functioning, work and relationships. I see our job to see what caused the changes in their lives and what tools we can use to get them back in their lives. I see our task to get them back on track, help them with issues and give them the tools to deal more effectively.”

He acknowledged that the era when mental health providers could give their clients as much care as they needed over a long period of time is over.

“If we treat people respectfully and successfully within a short time to a place where they can incorporate skills, then they can get back into their world,” Casey said. “This work is not just cognitive but emotional. That’s the important part of doing this work. There’s a whole movement and philosophy of recovery. We have people who have been homeless, not able to take care of themselves, who’ve become contributing citizens again. Relationships, working and having support — all those things are possible for people with mental illness.”

Adult Outpatient Services

Angela moved to Port Angeles in November 2010. She had left a violent relationship and she and her 10-year-old child were homeless. Fortunately our local program serving victims of domestic abuse, Healthy Families, sheltered them in their safe house and referred Angela to Peninsula Behavioral Health for counseling services.

“At first, I was really scared, but I sat in a room with someone that didn’t know me and told my story. Finally somebody understood me.”

Her counselor helped her understand that her symptoms of nightmares, shakes, fear of leaving the house and fear of riding in a car with the windows up were all part of a disorder called Post Traumatic Stress Disorder.

Angela was then referred to the medical staff who found the right medications to manage symptoms, even the nightmares. She also was referred to the Dialectic Behavioral Therapy Skills Group. That group, she said, “changed my life forever. Everyone needs those skills. I incorporated them into my life and brought them home to my family.” She has overcome her depression and anxiety and has some stress management skills that are helping her cope with the challenges of raising her children who are living with her.

“All this time I thought I was alone. Probably millions of people suffer like me. The skills I have learned make me grateful. I think everyone could benefit from them,” Angela said. She continues to attend the DBT Skills Group and shares her progress and encourages other group members.

— Supervisor Bob Nuffer contributed this story

Residential Services

My name is Mike Martin and I’ve lived at Arlene Engel House for the past 10 years. When I started going to PBH’s Horizon Center, I made friends and became good at playing pool. Horizon is a good place to go.

They have groups and fun outings and I like the dinners best.

My case manager and I started talking about me getting a job. One day I walked into Safeway and spoke to the manage; he told me to fill out an application online. Max, the peer counselor at Horizon, helped me fill out the application. I’ve been working at Safeway every since. I like going to work, being around people and being busy very day.

PBH has helped me out a lt. The people who work there support me, believe in me and help me work through my problems. I want to say thanks to everyone for their support.

— Mike Martin

Mental Health First Aid

Mental Health First Aid is a 12-hour training certification course that teaches participants to identify, understand and respond to signs of a mental health crisis.

The certification program introduces participants to risk factors and warning signs of mental health problems, builds understanding of their impact and overviews common treatments.

Mental Health First Aid training is open to professionals, community members, family members and other interested parties who wish to improve their mental health literacy.

For more information, visit Mental Health First Aid or contact Julie Calabria, clinical director, at 360-457-0031, ext. 158 juliec@peninsulabehavioral.org.

— Courtesy of Peninsula Behavioral Health