With experience in both the private and public sector, Jayne Van Bramer is now tasked with leading Maine’s largest nonprofit health system: Sweetser.
The newly minted president and CEO spent the bulk of her career working with the New York State Office of Mental Health. There, she served as the senior associate commissioner for state-operated children’s and adult services. Most recently, she served as CEO at the for-profit psychiatric service Springstone in Oakwood, Oklahoma.
Now, Van Bramer, who began her new role over the summer, will lead Sweetser into its next chapter.
Like many not-for-profit providers, it faces budget constraints and staffing challenges. However, Van Bramer said she intends to bring lessons from the for-profit sector into the organization, as Sweetser continues making moves in community behavioral health.
Founded in 1828 as a resident care home for children, Sweetser now has a number of services, including children and family services, adult crisis and community services, and peer services. The operator serves 20,000 patients each year.
It accepts Medicare, Medicaid and commercial insurance.
Nonprofit behavioral health challenges
Nonprofit behavioral health organizations make up 63% of all mental health facilities, according to a 2018 National Mental Health Service Survey.
While nonprofit and for-profit institutions each have their unique challenges, Van Bramer said that there is a lot they can learn from each other.
“My five, seven years in for-profit behavioral health has really taught me a lot about being able to balance the fact that if you don’t have a margin, you don’t have a mission,” she said. “We have to make smart business decisions, which are sometimes difficult.”
One of those tough decisions included closing an IDD service in north Maine that was losing millions of dollars.
Yet sometimes, the organization does maintain programs at a loss if they can be subsidized with revenue from other programs – and if those programs are important to the community.
“I think the approach to nonprofit and for-profit behavioral health many years ago was very different,” she said. “It’s not so different today.”
Like many other organizations in the behavioral health sector, Sweetser is facing staffing challenges. In fact, 130 million people in the U.S. live in a region with a designated mental health clinician shortage.
“One of the things I’ve seen in multiple states, which is really apparent here, is the problem with the workforce and recruiting,” Van Bramer said.
State incentive programs, such as student loan forgiveness initiatives or a bonus structure, could help recruit and retain staff in the future, according to Van Bramer. In June, the governor of Maine announced a new health worker student loan repayment program. The new repayment program is targeted at doctors, nurse educators, behavioral health specialists and long-term care professionals.
“I personally believe that when people go into behavioral health and health care in general, there’s a bigger calling,” she said. “They want to make a difference.”
While there are many opportunities for employees to do meaningful work at the organization, compensation still needs to mirror competitors’. Nevertheless, this can be a tough ask for the provider because of the reimbursement structure.
Community-based programs key for the future
The future of behavioral health care may look more community-based, according to Van Bramer.
Sweetser has a Certified Community Behavioral Health Clinic (CCBHC) as part of its services. Its offerings include outpatient mental health services and substance use screening, a mobile crisis-response team, case management and peer-support services.
CCBHCs have garnered national attention after the Bipartisan Safer Communities Act (BSCA) allocated $2.16 billion to mental health initiatives and to expand CCBHCs nationwide.
“We want people to be able to stay in the community. We want them to have some symptom relief,” Van Bramer said.
Part of this is helping patients find roles in their community, whether that be a job or volunteer opportunity.
Over Van Bramer’s 30 years in the industry, she said that care has evolved to emphasize value now.
“It’s more about values than volume now. We used to always report on how many people were coming to us,” she said.”I think now, we really want to know that what we’re doing makes a difference.”
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