By JACK HEALY
Published: July 24, 2013
SALT LAKE CITY — H. Rachelle Graham, who has spent the last 15 years in hospitals and in therapy battling depression’s chokehold, was finishing up an exercise session at Utah’s largest mental health provider when she got the news that she would no longer be treated there.
Citing budget cuts, the nonprofit agency, Valley Mental Health, was removing Ms. Graham and some 2,200 other people from its roster and transferring them to other providers, a change that mental health advocates said was striking in its size and sweep, even in these austere times.
“It was devastating,” Ms. Graham said.
Officials with Valley Mental Health emphasized that no one would be left without mental health coverage. All of the 2,200 patients will be able to receive similar services from a network of clinics, counselors and treatment centers across Salt Lake County, the most populous in Utah.
Still, the changes have shaken providers and recipients of mental health care in Utah while testing the resilience of its safety net as hundreds of Medicaid patients try to find new psychiatrists and counselors and wonder who will fill their next prescription. Some patients said they felt whipsawed by the shift, and were reluctant to part with counselors or support groups they had known for a decade or more.
“There’s a level of anxiety hanging over everyone,” said Rebecca Glathar, executive director of the Utah office of the National Alliance on Mental Illness.
The tremors at Valley Mental Health come as politicians at the Republican-led Statehouse confront broader questions about what level of care Utah should provide to its poor residents. Utah still has not decided whether to accept the Medicaid expansion offered under President Obama’s health care law, and officials here are steeped in a debate pitting this conservative state’s reflexive distaste for bigger government against calls to extend care to more needy Utahans.
Gov. Gary R. Herbert, a Republican, has asked a group of politicians and health care officials to look at the state’s Medicaid options, including an idea to steer people eligible for the Medicaid expansion into private health insurance.
Advocates said Utah had long struggled to meet the needs of its people with mental illness, especially poorer residents and people living in rural corners of the state. A 2012 report by the state’s Division of Substance Abuse and Mental Health found that only 31 percent of those in need were receiving mental health care. In part, it blamed lingering stigmas against mental illness, a view echoed by people in treatment.
“Utah still has this old-fashioned view of mental illness,” Ms. Graham said. “Like, you just need to pray, or snap out of it.”
Ms. Graham, 35, said she started cycling in and out of hospitals when she was 20. She was raised Mormon, but said she struggled as a teenager to reconcile the church’s views on homosexuality with the realization that she is bisexual. She said she had tried to kill herself with a drug overdose, and had struggled to fight off crippling depression and anxiety while juggling the demands of holding down a job and keeping an apartment.
She found an outlet in writing — she has published one young-adult novel through a small publisher of lesbian fiction — and found solace in group therapy and group discussions at Valley Mental Health with other people trying to cope with mental illness.
Valley Mental Health, which had about 10,000 clients before the recent reductions, is by far the largest and most expansive mental health agency in the state. It treats autistic children, recently released prisoners, people who have just attempted suicide and those who need little more than prescription refills to help manage their depression or anxiety.
The organization has also faced years of money problems. In 2009, it announced plans to lay off more than 100 employees and slash several programs to cope with drastic budget shortfalls. Over the past two years, Valley Mental Health said, its $28 million budget fell by more than $5 million, as the county received less in Medicaid payments and a for-profit company took over managing mental health services in Salt Lake County.
County officials hired that company, OptumHealth, a subsidiary of the UnitedHealth Group, to bring more efficiency and wider services to public health care. But Valley Mental Health seemed to struggle under the new layer of private management.
“We were the safety net,” said Gary Larcenaire, Valley Mental Health’s chief executive. “We went from ‘We want to take care of you’ to ‘Can we have your insurance card?’ ”
As the money dwindled, Mr. Larcenaire said, Valley Mental Health made a decision: it would stop serving some 2,200 people and shift its focus to patients with more severe problems who needed more intensive care. It started sending letters to clients, telling them, “For those who are doing well, we will stop providing services.” The letter gave a phone number for patients to call to find new services.
Therapists and county officials said the decision had caught them off guard and had created waves of alarm and uncertainty. Ben McAdams, the mayor of Salt Lake County, called the decision an outrage and has asked for an audit of mental health services in the county.
Officials from Salt Lake County, OptumHealth and Valley Mental Health said they were trying to make the change as easy as possible. But for people like Christina Osburn, 33, it was a gaping disruption. She said she had been seeing the same psychiatrist for a decade and had been unable so far to find a new doctor.
“I’m completely at a loss,” she said. “They leave you with nowhere to go.”