Central Utah Counseling comparable to small corporation, serving 2,000 per year
By Suzanne Dean
The name “Central Utah Counseling Center” (CUCC) might evoke a mental picture of an office with a few therapists where people come in for counseling sessions.
But that image doesn’t fit CUCC at all. The operation is more comparable to a small corporation, with a budget of more than $8 million and a staff of 75 divided into three regional teams of about 25 employees each.
CUCC owns buildings or rents space in eight towns in the Six-County Area (Sanpete, Sevier, Juab, Millard, Piute and Wayne counties), including two buildings at 100 North and 400 West in Ephraim and space in a building across the street from the Gunnison Valley Hospital.
CUCC even owns three housing facilities, one in Mt. Pleasant, Richfield, and Nephi, where case managers oversee chronically mentally ill people who face challenges in living independently.
In FY 2019, CUCC provided mental health and substance abuse services to more than 2,000 clients in the Six-County Area. About 700 of the clients were from Sanpete County.
The agency’s services range from providing outpatient and group therapy, to running classes for people referred by the courts, to making sure people suffering from schizophrenia obtain necessary treatment. CUCC even serves as a kind of mental health insurance company that pays claims for some people treated by facilities and providers completely outside the agency.
In terms of governance, the center might be described as a nonprofit, but quasi-government organization. Most of its money comes from federal, state and county governments, including $145,000 from Sanpete County taxpayers.
The board of directors consists of one commissioner from each of the six counties served. Commissioner Scott Bartholomew represents Sanpete County.
But all those facts and figures belie what CUCC is all about, said Nathan Strait, a licensed clinical social worker who joined the agency in 2001 and at the first of May was promoted to chief executive officer.
In a telephone interview, Strait said he gets emotional talking about the impact of CUCC. “I could keep you on the phone for the rest of today,” he said, telling stories about people who have come into CUCC so disabled they couldn’t function.
With the treatment and support they’ve received, he said, “they’ve been able to get on their feet, they’ve gotten jobs, they’ve been able to function in the community.”
CUCC is one of about 2,500 community mental health centers across the United States. The community mental health movement goes back nearly 60 years to Congressional passage of the Community Mental Health Act, signed into law by President John F. Kennedy in 1963.
The goal of the legislation was to get the mentally ill out of asylums, jails, flophouses and living on the streets, and help them live with dignity in the community.
Over time, the term “community mental health” has come to connote any service delivered in the community, rather than in an inpatient facility, that helps someone manage a mental health or substance abuse problem.
In the beginning, most of the funding for community mental health centers came from the federal government. But the intent of Congress was for states to gradually take over paying for them.
That has happened. In FY 2019, direct federal dollars made up only 8 percent of CUCC funding. A state grant provided about 34 percent of the agency’s revenues.
But one of the main ways Utah has paid for mental health centers has been by assigning Medicaid dollars to the centers in return for taking care of Medicaid recipients. In FY 2019, CUCC received an upfront payment of $4.5 million from the Utah Department of Health in the form of federal and state Medicaid dollars.
That payment was CUCC’s largest single source of income, amounting to nearly 56 percent of the agency total. In return, CUCC agreed to take care of the mental health and substance abuse needs of the population of 9,800 Medicaid recipients in the Six-County Area, including 3,400 in Sanpete County.
If you’re on Medicaid and live in the Six-County Area, CUCC is comparable to a network provider for a health insurance company. If you want your bill paid, you have to use CUCC as your provider.
The tie to Medicaid is one of the weaknesses of the community mental health system, Strait says. “If I had my way, we would just serve everybody. But if we tried to serve everybody, nobody would get enough of the services they need.”
The biggest dilemma CUCC faces, agency leaders say, is lack of resources to serve people outside the Medicaid population who can’t afford to pay for treatment on their own.
“Any individual in the Six-County Area can call in and request services,” Strait said, but “not everyone calling can be treated.”
Perhaps the best way to understand CUCC is by looking at the types of clients it serves. The categories tend to overlap.
Medicaid outpatients: In FY 2019, CUCC helped 314 residents of Sanpete County who were on Medicaid. Some of them simply came in for individual, family or group therapy. Some self-referred into CUCC’s outpatient substance abuse treatment program. Quite a few also fit in other categories, such chronically mentally ill or court-adjudicated clients.
Non-Medicaid outpatients with limited ability to pay: “CUCC has a sliding-scale fee (a fee based on income) for the uninsured, underinsured or anyone who has limited or no ability to pay for services,” Strait said.
To request an appointment, call 283-4065. “CUCC does screen and assess individuals based on the severity of their symptoms,” Strait said. “In this screening process, we try to make sure that with limited resources, available funds are spent helping those with the greatest need.”
In FY 2019, CUCC spent $721,773 providing services to non-Medicaid clients in Sanpete County.
Court-adjudicated clients: In FYI 2019, 207 of the CUCC clients from Sanpete County clients fit into this group.
These are people who have been sentenced for various offenses, often alcohol or drug-related crimes, or domestic violence. Their sentences require them to go through a substance abuse or mental health evaluation, and/or complete psychoeducation classes through a certified provider.
In addition, some people coming out of jail or prison are required to get treatment or complete classes as part of their probation or parole.
Clients who have been sentenced to fines, probation and treatment, but not jail or prison, have to pay fees for the services they receive at CUCC. The treatment fees and court fines added together can come to thousands of dollars. And typically, the people involved have limited ability to pay. Some of these clients complain that court-ordered treatment is just a money stream for CUCC.
But according to Strait, “a limited amount of revenue is generated from CUCC’s adjudicated population” and the fees paid don’t cover the costs of providing the services.
Clients who have completed jail or prison sentences often qualify for Medicaid for a period after release, so their costs are covered.
The psychoeducation course that draws the most participants is “Prime for Life,” designed to teach people about substance use disorders and how to cope with life without turning to substances. According to Strait, the CUCC fee for Prime for Life is one of the lowest in the state for the course.
There are other courses in anger management. And especially for people coming out of jail and prison, a course called Moral Recognition Therapy tries to get to the bottom of thinking errors that people use to justify criminal behavior.
Drug Courts: CUCC participates in the drug court programs set up in Sanpete, Sevier, Juab and Millard Counties. Drug court requires participants to submit to random drug screens, participate in group and individual therapy, at make regular appearances in court.
Successful treatment generally lasts from 12-18 months for participants and can consist of up to 9-10 hours of treatment per week, Strait said. Beside individual, group and family therapy, CUCC often supplies medication management appointments and case management services.
Chronically mentally ill: In FY 2019, 362 of the Sanpete residents receiving services from CUCC were assessed as chronically mentally ill. The group includes not just people with schizophrenia and bipolar disorder, but people who have suffered for years with depression and anxiety.
About 35 of CUCC’s staff of 75, including more than 10 employees based in Ephraim, are case managers, master’s-level psychiatric nurse practitioners, and psychiatric RNs or LPNs who focus on helping these clients get along day to day.
CUCC staff supervise some of them in agency-owned housing, and make visits to others who live in government-subsidized housing or even with their families. The staff tries to make sure clients take prescribed medication and encourages them to come into the center for socialization groups.
Medicaid inpatients: “I had no idea when I took this job how much I would need to know about insurance,” Strait said.
In fact, CUCC essentially serves as a mental health insurance company for people on Medicaid who end up being admitted to hospitals for psychiatric or substance abuse care. Most such individuals from the Six-County Area go to Utah Valley Regional Medical Center or Provo Canyon Hospital, a smaller hospital for psychiatric patients only.
The facilities submit the bills to CUCC, which pays them out of the “capitated,” or up-front, Medicaid dollars it receives from the state. Since Medicaid funding to CUCC is capped, those claim payments reduce funds available for outpatient and chronically mentally ill services.
Behavioral Health Care Network (BHCN): This is a program set up by the Intermountain Health Care Foundation to manage charitable care for people in the Six County Area who have mental health or substance abuse problems.
Frequently, a patient starts with an IHC primary care physician, since IHC is the dominant health care system in several of the six counties. The person’s family doctor refers him or her to an IHC therapist or facility, and the patient applies for charity funding to pay for the treatment.
Because the IHC Foundation is a tax-exempt charity but is closely affiliated with IHC, it is not good form for it to pay IHC providers directly. As a result IHC has asked CUCC to act as its fiscal agent. The IHC Foundation makes grant to CUCC with the grant amounts based on the populations of counties the foundation selects to participate in the BHCN program.
CUCC as a whole manages nearly $360,000 for BHCN clients. Of that, $140,000 is earmarked for Sanpete County residents.
IHC providers and facilities submit claims to CUCC, which processes and pays them, just as it does Medicaid inpatient claims.
“It costs us money to do this,” Strait says, but the expense is worth it because it makes treatment available to people in the community who might not to qualify for services through CUCC directly.
Clients in crisis: CUCC has three masters-level clinicians on call 24-7 to take calls and sometimes meet face-to-face with current CUCC clients or anyone in the Six-County Area who is “in crisis.” The crisis number is (435) 469-2822.
The crisis could be a client feeling suicidal, a chronic patient having severe hallucinations or delusions, or situational problems, such as being removed from housing or a spouse threatening physical violence.
Sometimes people call the national suicide prevention hotline (1-800-273-TALK) or use the SafeUT app. Those calls are routed to a crisis team at the University of Utah Institute for Neuropsychiatry. Periodically, the U. of U. team contacts one of the CUCC clinicians on call for help handling a case from one of the six counties.
A couple of months ago, when CUCC presented an annual report to the Sanpete County Commission, Commissioner Scott Bartholomew expressed concern about suicidal individuals calling 911. CUCC representatives agreed that dispatchers and law enforcement officers aren’t necessarily trained to handle such calls.
Brian Whipple, recently retired as CEO at CUCC, mentioned that the national suicide prevention hotline number is scheduled to be changed to a three-digit number people can easily remember, such as 988. At that point, calls that now go to 911 might start to go to the U. of U. team.
Whipple noted that the Huntsman Foundation, operated by the family of the late Jon Huntsman Sr., recently donated $150 million to the U. of U. to expand mental health services in Utah. Huntsman family members have expressed particular interest in getting mental health services out to rural areas, including setting up “receiving centers” that could provide face-to-face crisis services to rural residents.
Does all the public money that goes into CUCC, the effort its staff puts out, the tapestry of programs and services the agency provides, make a difference in the lives of residents in the Six-County Area., including in Sanpete County?
For Strait, the answer is yes. “I tend to think most people can change,” he said. “Based on thousands of clients, I’ve seen the bulk of them change, at least to some degree.
“According to Dante, the gates of hell have a saying over them: ‘Abandon hope all hope, ye who enter here.’ Thousands of individuals living with either mental illness or a substance use disorder have done just that, abandoned hope. Our goal as a center is to restore hope.”