Health Safety-Net Councils

Group Name: 
Amber Royster
Student / CHOICE Regional Health Network

With the number of underinsured, uninsured and underserved growing every day, more and more people are falling through the cracks of a severely fragmented health care system. Community Health Centers, free clinics, and other low-cost community-based health organizations are heavily burdened by this influx of need, and resources continue to dwindle. Fragmentation, the lack of resources, and a growing need for social health services make the prospect of any individual group or organization attempting to mitigate these circumstances an overwhelming and insurmountable challenge.


Sea Mar Community Health Centers’ (Washington State) sliding scale payment system has made them a primary care provider for those who are uninsured or underinsured, and the need has been and continues to be greater than the available resources. Recently, Sea Mar has been experiencing an influx of medication-seeking patients with mental or behavioral health needs, due in no small part to the recent closure of a “pill farm” in Grays Harbor County. As a result of this increased and unmanageable case load, and patient needs that extend beyond the primary care arena, Sea Mar has lost three physicians.


Lack of resources to address the increasing number of patients seeking mental/behavioral health and substance abuse (MH/SA) consults, medications, and case management (due primarily to increased restrictions on public mental and behavioral health facilities, more stringent eligibility requirements for MH/SA coverage, and reduced program funding) diminishes the capacity of Sea Mar clinics to provide primary care services to a growing number of low-income and/or uninsured population. Further challenges have arisen with the recent downsizing of Washington’s Basic Health program; because low income, underinsured, uninsured, and underserved populations treated at Sea Mar clinics also experience higher occurrences of MH/SA problems, the need for MH/SA resources to be available for the CHC community increases.

While primary care physicians can prescribe psychotropic medications (and there is a case for this avenue increasing access to treatment), there is a great concern whether the patient is receiving evidence-based treatment, adequate case management and intensity of treatment, and psychotherapy. According to a 2009 Psychiatric Services article, 59% of psychotropic medications prescribed between August 2006 and July 2007 were written by general practitioners, 23% by psychiatrists, and 19% by other physicians and non-physician providers. This concern is had reached local Sea Mar clinics, and physicians have expressed their discomfort with simply writing a prescription without the proper resources to provide more comprehensive care, or have regular avenues of communication with MH/SA providers to give consult. Not only has the influx of need for this treatment caused Sea Mar to lose valuable provider resources, but the clinics are now practicing acute, symptomatic treatment for MH/SA problems that should be addressed with ongoing therapy, and medication and case management. The license to prescribe psychotropic medications does not by default make primary care
providers able to treat the disorders associated with those medications.

CHOICE Regional Health Network, an Olympia-based health care collaborative organization, convenes and staffs the Thurston County Safety Net Council, a group of local providers and health professionals dedicated to improving access to comprehensive safety net primary care services and maximizing community benefit. Collaborators include local hospitals, public health, local physicians, physician groups, community health centers, behavioral health, and other community-based health care organizations. Membership is fluid, as particular areas that need to be addressed may require more diverse participation. Currently this group is addressing the issue of MH/SA integration with CHC providers, namely Sea Mar. Behavioral Health Resources (BHR) and Sea Mar have partnered through the collaboration of the Council to propose options for mitigating the issues associated with treating MH/SA patients at Sea Mar clinics without those resources readily available.


Create, implement, and regularly convene health safety-net councils in communities large and small to address the heath care needs of vulnerable populations, and act collaboratively to devise and deploy solutions.

Community Action
Thurston County Safety-Net Council
CHOICE Regional Health Network
Verbiage for pattern card: 

Fragmentation, the lack of resources, and a growing need for social health services make the prospect of any individual group or organization attempting to mitigate these circumstances an overwhelming and insurmountable challenge. In order to devise and deploy methods to stabilize a community's health safety-net, leadership from hospitals, physician groups, public health, mental health, and other community-based health organizations must work collaboratively and with intent to maximize community benefit. Health safety-net councils within large and small communities will reveal available health resources, and create opportunity spaces for innovative solutions and collaborative decision making to address the health care needs of vulnerable populations and bridge the gaps of a fragmented health care delivery system.