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Mental Health Agencies Try to Fix Patients’ Waits



Valley News Staff Writer
Thursday, August 17, 2017

Lebanon — Two major Upper Valley mental health agencies hope to significantly reduce their waiting lists not by adding staff, but by changing their approach to scheduling.

Instead of adding names to a waiting list when new patients call seeking care, officials at Lebanon-based West Central Behavioral Health in June began telling patients to come to the agency’s offices in Lebanon or Claremont on certain days at set times, said Suellen Griffin, West Central’s chief executive.

The goal is to reduce the time wasted when people don’t show up for scheduled appointments, Griffin said.

It’s “all about improving access to services,” she said. “We clearly say that our goal is to try to (help) people when they need it.”

Prior to implementing the new system, known as Access Redesign, Griffin said, West Central had a 33 percent no-show rate, and the bulk of them were for the first appointment.

Because they were reserving time for people who didn’t show up, some patients found themselves waiting three or four months before getting an appointment, she said.

Now that people simply come in when they are able — within the nine to 10 hours a week West Central allots for this purpose — the agency has begun chipping away at its existing waiting list, she said. By culling about five people a week from the waiting list, Griffin said she hopes to whittle it down to nothing by the end of September.

The waiting list for children’s services at West Central’s Newport office already has been eliminated, she said.

Griffin described the change as a “huge transformation for the agency.”

In New Hampshire, West Central is the first of the 10 community mental health agencies that is trying this new form of scheduling, Griffin said. The effort, which is supported by $70,000 in grants to cover training and consulting costs, began in June 2016, and has also involved reducing the number of questions asked during the initial intake process, she said.

The agencies also instituted a no-show policy that says patients no longer are patients if they miss a certain number of appointments.

In July, officials at Springfield, Vt.-based Health Care and Rehabilitation Services began directing patients to call for an initial evaluation over the phone as part of a pilot program in the agency’s Springfield office, said Kate Lamphere, the organization’s adult services division director.

The intake person first determines what type of care the caller needs and then either directs the patient to emergency services or schedules an appointment, she said. Higher-risk patients are seen first, she said.

This marks a change from previous practice where patients were invited to come to a walk-in clinic, where they would go through the intake process and then schedule an appointment with a clinician for a later date, Lamphere said.

The need for change came to HCRS officials’ attention through community forums and surveys of community partners, said Lamphere.

They heard that it “takes too much effort to get into services,” Lamphere said.

Patients found that they were having to come in two or three times before being able to see a therapist, she said, noting that each trip to an HCRS office requires patients to arrange transportation and time off from work.

Depending on the success of the Springfield pilot program, Lamphere said, the agency plans to roll out the scheduling change to its other locations, which include offices in Hartford, Windsor, Bellows Falls and Brattleboro.

The Upper Valley agencies are in good company nationally.

Three hundred mental health agencies around the country are doing some form of workflow redesign in an effort to get patients in to see clinicians at the right time for them, said Chuck Ingoglia, senior vice president of public policy and practice improvement for the National Council for Behavioral Health, which counts both West Central and HCRS among its member community mental health agencies.

Getting people in for care as close to the time that they are seeking it as possible increases the likelihood they will show up, he said.

The agencies should get credit for “taking the bull by the horns here” and determining “how can they be a better resource in their community,” he said. “It doesn’t seem like the federal government or the states are going to be putting more money into behavioral health in the near future.”

While the scheduling change seems to be helping patients access the care they need, Lamphere said, there is still room for improvement.

HCRS is chronically understaffed, she said, noting in the July interview that both the Springfield and Hartford offices were seeking clinicians.

Waiting lists are “longer when we are short clinicians,” she said.

Nora Doyle-Burr can be reached at ndoyleburr@vnews.com or 603-727-3213.