It was a longshot, The Tanner Health System knows, to try to build a system of robust psychiatric services outside of a big city.
“We are a nonprofit community regional hospital in a nonurban area, so we already have all the strikes against us, right?” said Dr. Kenneth Genova, who is board-certified in psychiatry and neurology and directs Tanner’s program.
Psychiatrists like Genova, who went to medical school in Philadelphia and did his residency in New York, tend to be concentrated in the Northeast and California, certainly not in west Georgia cities like Carrollton and Villa Rica, where Tanner operates.
“You were not in rural areas in the South at all — and for child and adolescent care, you certainly weren’t,” he said.
And yet, Tanner has managed to build up a comprehensive psychiatric system in Georgia, a state that has only about a third of the psychiatrists needed to provide adequate care. The Tanner program includes a full spectrum of services for kids, including inpatient crisis hospitalization, partial hospitalization, and a variety of outpatient programs, including school-based counseling and psychiatric medication management available in dozens of schools in west Georgia. It even has a program that sees children in their own homes, where experts work with the family, too.
As Georgia grapples to find ways to improve a mental health system that often fails to meet the needs of the state’s children or adults, the Tanner program may offer some clues.
Its psychiatry program has grown organically, Genova said, driven by one question: “What is our community need?”
Thirteen years ago, the system opened Willowbrooke, the last new psychiatric hospital to open in Georgia. Now Willowbrooke provides services at locations in Carrollton, Villa Rica and Cartersville. It’s not unusual for families from Atlanta to drive an hour outside of the city to get care for their children at Willowbrooke.
“We have one of the largest divisions of all child adolescent [psychiatry programs] you’re gonna find in the state, even within the Atlanta area,” Genova said.
Credit: Miguel Martinez
Credit: Miguel Martinez
Medical students, residents and fellows drive from Atlanta and other parts of the state to west Georgia, too, for new training programs in psychiatry at Tanner, as it seeks to become both an academic and clinical resource for the entire state.
“Tanner is on the cutting edge,” said Kevin Tanner, a former state legislator who is chairman of the Georgia Behavioral Health Reform and Innovation Commission, a group of policymakers and experts who are trying to find ways to create a well-functioning system of mental health care for all Georgians. “They are obviously working hard to address the issue.”
Overcoming barriers
Georgia has a new mental health parity law requiring insurers to cover mental health care on par with physical health. The state government relies primarily on nonprofit health systems to offer the services. But few have built robust lines of services for mental health, especially when it comes to children.
The Children’s Hospital of Georgia, which is part of the Medical College of Georgia in Augusta, used to have inpatient psychiatric beds but closed them. Children’s Healthcare of Atlanta doesn’t have inpatient psychiatric beds, either.
So most Georgia hospitals hold patients who are in a psychiatric crisis in their emergency rooms until they can transfer them, a wait that sometimes can take days. Then children are often sent to freestanding, for-profit psychiatric hospitals that are part of national chains.
Admission may be blocked at these private psychiatric hospitals, though, for children who have chronic physical health conditions, such as autism, diabetes or epilepsy, along with mental health issues.
That’s the advantage of having children in hospitals that can treat both behavioral health issues and physical illnesses at the same time, noted officials at The Bradley Center in Columbus, part of the nonprofit St. Francis-Emory Healthcare system.
It offers inpatient psychiatric care for children in crisis, and the officials say demand for those services has been rising, especially among those who have never before been hospitalized for a mental health issue.
Credit: Miguel Martinez
Credit: Miguel Martinez
“We see that specifically in our younger population, it’s more prevalent as it relates to suicide attempts, suicidal ideations,” said Brittany Luther-Jones, executive director of The Bradley Center.
Emergency departments in rural areas and even in Atlanta have asked The Bradley Center to take children in crisis.
To create its comprehensive system, Tanner knew it had to figure out how to overcome two of the reasons other health systems, even the largest ones, hesitate to take on mental health: low reimbursements and the challenge of finding medical workers with the expertise to provide care.
About 80% of the children and adolescents they see are covered by Medicaid, which tends to have low payment rates. So, he said Tanner runs a lean operation without much overhead.
Tanner also has to battle with insurers every day who refuse to cover inpatient admissions or simply won’t pay for the number of days in treatment that a child’s doctor believes is essential. Those battles continue in spite of parity laws that require insurers to cover mental health on par with physical health, Tanner’s executives said.
Still, it has created a system it can keep afloat financially while also attracting psychiatrists and other providers to work outside of a major urban center. Having providers train with the system has helped it recruit.
Credit: Miguel Martinez
Credit: Miguel Martinez
And, by building out a robust system, it can respond to patients in a way that makes the most sense for them. By building a “partial hospitalization” option, for example, Tanner can have children who need intensive care come for treatment all day, but go home at night. That helps Tanner avoid inpatient hospitalizations for kids whenever possible. When the children make progress, they can step down to a lower level, all within Tanner’s system.
Tanner says it is driven by the close ties it maintains to its community and thinking about how much of a difference its services could make.
“The whole goal is to keep your community as healthy as you possibly can,” Genova said. “Respond to it — address it.”
The system hasn’t copied other models because it tends to be breaking ground on its own, all with the idea that its local community will see the results.
“If you don’t take care of kids, what are they going to be like as adults?” Genova asked.
“What we are trying to do, particularly with our child and adolescent (services), is maybe this is the route to making a healthier community both now, five years, 10 years, and 20 years from now. We treat our community. This is where we’re at. We keep them here with us and we normalize getting mental health services.”
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