mental health
Alumni at the Penn Foundation: (from left) property manager Tara Paul Detweiler '94; social worker Donald Detweiler '93; psychiatrist and former CEO Vernon Kratz, class of '57; former CEO John Goshow '69; administrative assistant Donna Dittus Massey, class of '81; therapist Lois Styer Halsel, class of '72; social worker Angela Swartzendruber Hackman '03. Not pictured: social worker Maureen Gingerich Bergey '06, nurse Bethany Hertzler '09, and case manager Lisa Moyer Kauffman '89.
IN THE DECADES SINCE WWII Mennonite mental healthcare institutions have demonstrated ingenuity and leadership in the face of changing circumstances within the field. Examples over the years include the development of programs to assist in patients’ reentry to the working world, long-term independent living facilities, rehabilitation programs for people with drug or alcohol addictions, and the repeated adoption of new medicines and therapeutic techniques across all programs. “There’s a much broader emphasis now on additional supports that are needed to help a person live within the community,” said John Goshow ’69, a retired social worker who was CEO of the Penn Foundation from 2000 to 2010. One recent example of innovation at the Penn Foundation has been the development of “community treatment” teams made up of a psychiatrist, nurse, social worker and other support staff to provide coordinated care to patients living in their own homes. “We’re trying to take services to where people are, rather than trying to make them come to some centralized place,” said Vernon Kratz ’57, the former medical director of the Penn Foundation who now sits on its board of directors. “It keeps people in their communities, it keeps people in their families.”
Another example of an unprecedented initiative: Amish leaders approached former Philhaven CEO LaVern Yutzy '70 and others in that Mennonite mental healthcare institution near Lancaster, Pennsylvania, to discuss the development of a treatment program for members of their community. Their collaboration led to the 2005 opening of a new 15-bed inpatient facility on Philhaven’s main campus for patients from the Amish and other “Plain” groups (referring to their “plain” clothing). To date, it has served hundreds of people from 12 states. In Goshen, Indiana, Oaklawn opened the nation's first residential unit to serve adolescents from Amish or conservative Mennonite communities in February 2010. Maria Martin Shisler '04 is a case manager there. IMPACT OF "MANAGED CARE" Changing conditions within the industry have forced all mental healthcare providers to adapt, sometimes in ways that challenge the survival of non-profit institutions seeking to provide compassionate care for all who need it. The advent of “managed care” in the 1980s and 1990s – through which insurers used new reimbursement models to encourage providers to treat more patients through outpatient programs and reduce the length of inpatient hospitalizations – had a mixed impact.
In 1993, soon after Yutzy was appointed CEO of Philhaven, 82 percent of the organization’s revenues came from inpatient programs. By his retirement in 2008, overall revenues had doubled but the share of inpatient revenue had dropped to just 32 percent. That drastic shift over a relatively short period of time, he says, threatened to sink the institution. A positive outcome, he acknowledges, was that more patients were being treated earlier and with less disruption to their lives. Insurance reimbursements present a huge and ongoing problem for many of the providers interviewed for this issue of Crossroads. Gerald Ressler ’79, executive director of the Samaritan Counseling Center in Lancaster, Pennsylvania, said that many insurers have reimbursed mental health providers at the same rate for the past 15 years, causing providers to see their real income fall dramatically (on the average, $20 worth of goods in 1996 cost over $28 in 2011). Some insurance companies are even cutting their reimbursement rates. Ressler said that the Samaritan Counseling Center’s largest insurer informed the center in 2011 that it will decrease reimbursement rates by 35 percent in 2012 – a decision that will have a huge impact on the center’s balance sheet. “Outpatient mental healthcare is as close to being at the bottom of the [insurers’] pri-
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