Interview with Brennan Francois, MS Chief Executive Officer Parkridge Valley Hospital

Recently I sat down with CEO Brennan Francois in his office at Parkridge Valley Hospital, a local psychiatric facility owned by HCA Healthcare, to discuss some of the major issues confronting mental health care.

Personable and articulate, Mr. Francois began his career in mental health care while still in college with Parkridge Valley as a technician in the adolescent treatment unit. Rising through the ranks to his current position, he has seen psychiatric care from the point of view of an entry level employee through his current CEO position.

When asked about the some of the major issues impacting the delivery of mental health services, he immediately stated that while Congress passed the Mental Health Parity Act some years ago, requiring insurers to pay for mental health care at the same level as physical health care, the regulations as to how such parity is to be achieved have yet to be passed by Congress and implemented by the Department of Health and Human Services.

Thus insurances companies continue to reimburse providers at sub-parity levels resulting in short hospital stays (six days on average) which are woefully to adequately treat serious mental illness. Add to this the lack of out-patient resources to provide continuing care and we have a national mental health care system that is in crisis. Small wonder that jails and prisons have become de-facto treatment options for many mentally ill persons.

Anther factor adding to the difficulties faced by those who access the mental health treatment system is a shortage of psychiatrists, resulting in wait times for non-emergency out-patient appointments of up to six to eight weeks.  Mr. Francois stated that the region which includes Hamilton and several surrounding counties is currently twenty-eight full-time psychiatrists short.

Another issue is the shortage of both private and public in-patient beds. This is coming at time of not only stagnant re-imbursement rates to private hospitals, but also in the wake of dramatic reductions in funding for state regional psychiatric hospitals.

Mr. François would also like to see an increased number of psychiatric beds designated for the treatment of young adults, 18 to 25 years of age. At present, an in-patient psychiatric unit may include three or four generations, often negatively impacting the therapeutic milieu when younger patients, who may be more disruptive and who certainly have different life concerns, are housed with older adults.

 

Mental illness is seldom a discrete, acute condition, which can be “cured” with a single in-patient stay. Instead, most psychiatric conditions, like major depression, bi-polar disorder, and schizophrenia, are chronic. Thus clients require a continuum of care from in-patient hospitalization to out-patient counseling and community services. Such services are currently over-stretched and inadequate. Mr. François cites the need for more social workers to assist clients in managing chronic illness and group homes for those who experience difficulty functioning outside of a structured environment. He also cited the need for respite care for the high percentage of the mentally ill who are cared for by family members, as well as medical group homes for those who suffer from chronic medical illness as well as mental illness.

 On the positive side, Mr. François sees the increased use of partial hospitalization and intensive out-patient programs as effective ways of helping clients avoid repeat hospitalizations.  Increased partnering and cooperation among mental health providers, including the local Crisis Response Team, is also a positive development. Additionally, the local sheriff’s department and county jail personnel have received intensive training in handling mental health issues which has also netted positive results. He also cited the increased presence of specialized dementia assessment and treatment units as a positive approach in meeting the needs of the growing elderly population.

When asked how health care reform will impact mental health care, Mr. Francois reiterated that while there is much uncertainty about the effects of new government policies and regulations, he hopes that health care reform will finally result in parity for psychiatric treatment and increased incentives for cooperation and collaboration among mental health care providers.