Island Hospital's Psychiatry & Behavioral Health Clinic
- Need: Anacortes of Washington State, has limited access to mental healthcare services. In addition, psychiatric or behavioral health services were sparse for students in the Anacortes School District.
- Intervention: Island Hospital opened a Psychiatry & Behavioral Health Clinic that serves patients on their campus and created a program to provide services at schools located in the Anacortes School District.
- Results: Over 3,000 mental health and social work appointments have been facilitated at Anacortes's public schools. Thousands more appointments have been provided at the clinic to meet the mental health needs of the community.
Washington State ranks 38th in the nation in mental illness prevalence and access to mental healthcare. In Anacortes, a rural town on Fidalgo Island, access to mental healthcare is limited due to transportation challenges, geographic location, provider availability, and cost.
Anacortes's Skagit County is a designated Health Provider Shortage Area (HPSA) for mental health and has a provider-to-patient ratio of 1 to 6,000. Because of the shortage, primary care and emergency department providers have had to take the place of psychiatrists and behavioral health specialists, offering patients mental healthcare to their best of their ability. Many of these professionals have limited experience or training on how to provide these services. Patients have also had to travel long distances to reach mental health services located off of the island.
In 2010, Island Hospital opened an outpatient Psychiatry & Behavioral Health Clinic that integrates psychiatry and behavioral health with primary care. The clinic is the first public hospital-sponsored clinic of its kind in the state. This video features patients who have benefited from the Psychiatry & Behavioral Health Clinic:
Up until 2008, the Anacortes School District received psychiatric and behavioral health services through a county-sponsored intervention program. Because of the recession, the funding ended, leaving hundreds of students and families without mental health and social work support. The Anacortes School District appealed to the Psychiatry & Behavioral Health Clinic for help shortly after the clinic's doors opened.
The clinic responded and started a school-based mental health outreach program that serves adolescents, school staff, and families with psychiatric and behavioral health concerns. Clinic providers are located on site in Anacortes' public schools several days per week.
Through this partnership, the School District Safety Assessment Team was developed. This team includes local law enforcement officers, district administrators, mental health providers, and school counselors to conduct risk and threat assessments for youth who engage in threatening verbal or physical behavior at school.
Island Hospital's Psychiatry & Behavioral Health Clinic is largely funded by the Island Hospital Foundation. The clinic also receives funding from the Anacortes School District, the City of Anacortes, private foundations, and local service organizations.
Island Hospital's Psychiatry & Behavioral Health Clinic offers services to all ages and includes those who are largely dependent on government subsidies. The clinic primarily offers mental health therapy, medication management, and social work services.
Services for students and school staff in the Anacortes School District include:
- Monthly mental health consultations at Island Hospital's Psychiatry & Behavioral Health Clinic
- School year access to services on Island Hospital's campus
Since 2016, community philanthropy groups have expanded funding to allow for additional social work services for students attending the local alternative high school. The program also has grown to utilize clinic supervised, masters-level interns to extend access and facilitate more visits.
Since 2012, the school-based intervention program has facilitated more than 3,000 mental health and social work appointments at public schools in the Anacortes School District. Below is a listing of the types of positive outcomes:
- Individual mental health therapy appointments
- Individual social work services appointments
- Safety assessments for at-risk students
- Referrals for basic needs, medical coverage, post secondary planning, housing and legal aid
- Several students made appointments with psychiatric specialists or primary care providers for medication management following appointments intervention appointments
Awards and Recognitions:
- In 2016, Intalere recognized Island Hospital for its work in psychiatry and behavioral health with the Community Impact and Innovation Award.
- In 2015, Island Hospital was a winner of the Jackson Healthcare's annual Hospital Charitable Service Awards, a program that recognizes hospital-sponsored programs that set new standards for health and wellness through education, access, and delivery. The psychiatry and behavioral health program was one of 10 to be named a "Program of Excellence" and given $10,000 for impacting underserved communities.
- In 2014, the Island Hospital in Anacortes was the winner of the Washington State Hospital Association Community Health Leadership Award, the highest honor of its kind in the state.
Reimbursement issues, provider recruitment and retention and patient access continue to be challenges for the hospital and clinic.
Island Hospital's Psychiatry & Behavioral Health Clinic has run into several difficulties while providing services. Medicaid reimbursement rates have not been able to cover the cost of providing care to Medicaid-insured patient. In the first 5 years of operation, the clinic lost nearly $1,000,000. This led to the clinic's difficult decision to stop accepting Medicaid patients to save on cost.
As a result of the decision, the clinic was able to balance their budget, but primary care clinicians had to manage psychiatry and behavioral health cases, and the emergency room experienced an increase in psychiatric admits. To solve this problem, the Island Hospital Foundation designated funds in 2015 to support access for Medicaid-insured patients. These funds help offset costs initially, but have since been depleted.
Another difficulty at the beginning of the clinic's operation was due to the demand for services. Only 6 months after opening, appointments were scheduled several months out. Immediate needs for services could not be met. To address this dilemma, the clinic hired a second psychiatrist and a psychiatric nurse practitioner. Demand for services remains high and provider schedules are at capacity in spite of increased hires.
Below are steps on how to duplicate a school-based intervention program similar to the one created by Island Hospital's Psychiatry & Behavioral Health Clinic with the Anacortes School District.
- Conduct a community needs assessment to uncover psychiatric and behavioral health needs
- Reach out to your local school district to establish a partnership
- Decide on a name for your organization
- Find a funder to financially support your initiative
- Partner with a local healthcare provider
- Designate internal relationship roles to support communication and ongoing funding
- Create a system for reporting results on a regular basis
- Conduct ongoing assessments of your program to evaluate its status and define areas of improvement
- Regularly communicate to funding entities and
community leadership regarding program needs and
Contact InformationSuzanne Staum, Mental Health Therapist, ASD Intervention Program Manager
Island Hospital's Psychiatry & Behavioral Health Clinic
Children and youth
July 20, 2016
Date updated or reviewed
July 19, 2018
Suggested citation: Rural Health Information Hub, 2018. Island Hospital's Psychiatry & Behavioral Health Clinic [online]. Rural Health Information Hub. Available at: https://www.ruralhealthinfo.org/project-examples/918 [Accessed 23 January 2022]
Please contact the models and innovations contact directly for the most complete and current information about this program. Summaries of models and innovations are provided by RHIhub for your convenience. The programs described are not endorsed by RHIhub or by the Federal Office of Rural Health Policy. Each rural community should consider whether a particular project or approach is a good match for their community’s needs and capacity. While it is sometimes possible to adapt program components to match your resources, keep in mind that changes to the program design may impact results.