Boise police officers handle 20 mental health calls a day.

Lewiston police are instituting a new program, like Boise's, to deal with the demand on officers to be on-the-street mental health counselors and social workers.

More than a fourth of all the people in Idaho prisons have underlying mental health problems. It's 80 percent at the Ada County Jail.

The largest share of indigent cases that Idaho counties finance is for mental health cases.

Mental health problems are often the cause of other medical conditions that send the poor and uninsured to emergency rooms.

Idaho ranks sixth in the nation for suicides per capita.

According to the working group that recommended Medicaid expansion to the governor, a large number of the people who would be covered under the expanded program include young, childless adults with mental health and substance abuse issues - the very people who show up in prisons or put police officers in violent situations while endangering others.

On March 9, a mentally ill veteran pointed his gun at three Ada County deputies and a Boise police officer. He ended up in a hospital with at least four bullet wounds.

"This was something that potentially could have been prevented with proper mental health services in this community," Sheriff Gary Raney said Wednesday.

Idaho's desperate police officers, overwhelmed prisons and cash-strapped county governments are not the stereotypical advocates for more spending on mental health care.

These varied groups are identifying mental health needs at a time when Idaho has an unprecedented choice: whether to accept $365 million from the federal government in 2014.

Is anyone in Idaho connecting these dots?

"If all these people were dying of cancer, legislators would be doing something about it," said Sherry Skinner.

Her brother, Troy Epperley, died in a suicide-by-cop episode in 2012, distraught about his impending divorce. Skinner has become an advocate for strengthening mental health programs in Idaho.

IDAHO IN THE MINORITY

The proposed Medicaid expansion would cover about 104,000 Idahoans who have no coverage now.

It is offered under the Affordable Care Act, also known as Obamacare. But it is not mandated, after the U.S. Supreme Court ruled that states don't have to take the money if they choose not to.

Idaho is one of 14 states not participating. Gov. Butch Otter has proposed studying broader Medicaid reform before accepting the money.

Republican governors in many states favor expanding Medicaid, including New Jersey Gov. Chris Christie and Arizona Gov. Jan Brewer.

Republican Gov. Jim Kasich of Ohio, no fan of Obamacare, highlighted mental illness last month in his State of the State speech.

"I do not believe in the individual mandate," he said. "But in this case, extending Medicaid benefits will help us on many levels, including the positive impact this decision can have on the mentally ill and the addicted."

CRISES ARE EXPENSIVE

Members of Gov. Otter's working group unanimously recommended last year that Idaho accept the Medicaid expansion. This year's legislative session is winding down, but group members are still trying to persuade legislators not to leave federal Medicaid dollars on the table.

Rep. Tom Loertscher of Iona introduced a bill last week to expand Medicaid and dissolve the existing Idaho program that pays the medical bills for poor, uninsured Idahoans.

Experts agree that expanding Medicaid would be a step toward stemming Idaho's high suicide rate by providing preventive care for men and women whose mental health needs today are addressed only when they're in full-blown crisis.

"If people could just get to a primary health care provider ... we could solve most of our mental health problems," said Gina Westcott, a regional mental health program manager for the Idaho Department of Health and Welfare who has worked in the field in Idaho for two decades.

Perhaps the most vocal and passionate voice for improving the system to help people before they're in trouble is Boise Police Chief Michael Masterson.

Mental health holds deemed necessary by police have more than doubled throughout Southwest Idaho in recent years, he said.

THE BURDEN ON TAXPAYERS

Besides police officers and prisons, uninsured Idahoans' mental health issues put a load on Idaho taxpayers. In 2011, the largest share of cases in the state's $26.6 million Catastrophic Health Care Cost Program were for mental health diagnoses. Idaho counties spent another $24.5 million on indigent care in 2011.

Under a Medicaid expansion, approximately 90 percent of the Idahoans who rely on the counties' indigent funds and the state Catastrophic Program - which kicks in after the county has spent $11,000 on a person's medical needs - would be eligible for health care coverage, according to Otter's working group.

"If lawmakers could really follow the money, they'd see that not taking the Medicaid expansion means that every homeowner is suffering because of involuntary hospitalizations for people without insurance," said John Reusser, director of the recently reopened suicide-prevention hotline.

'FUNDED OPTION'

Every legislator knows Idaho needs to do more for the mentally ill, said Steve Millard, president and CEO of the Idaho Hospital Association and a member of Otter's working group.

"But it's the invisible disease," he said. "When they don't see it, they don't think about it."

It's there, nonetheless. A study by Leavitt Partners in the work group's report found that mental health issues underlie many other health problems.

The concern that has stalled expansion - that it could stick Idaho with big bills in the future - are "scare tactics," said Millard. Instead, conservative Idaho lawmakers should see this as a way to save Idaho and the counties money even as they help people.

"I'm as conservative as most of the legislators," said the CEO, "but this is the opportunity to have the opposite of an 'unfunded mandate.' It's a funded option."

States have the ability to drop out of the expansion at any time.

A FINAL PUSH

The day Loertscher introduced the Medicaid expansion bill, Corey Surber, director of Community Health Initiatives for Saint Alphonsus Health Systems, addressed a group of legislators and the public.

Surber, a member of Otter's working group, said the need to invest in mental health services is urgent amid concerns about public safety and police encounters with suicidal subjects.

Surber acknowledged that it's late in the session to be pushing a new bill. Expansion advocates waited until after the Legislature debated the other controversial heath care bill - a state-run health insurance exchange - before turning to Medicaid expansion.

"Who knows if the bill makes it out this session? But waiting a year means a loss of real dollars," Surber said.

DOLLARS AND PEOPLE

Its impact on Idaho families is real, too, said Troy Epperley's sister, Sherry Skinner.

"Troy was amazing," she said. But she doesn't sugarcoat her brother's story. Epperley was troubled. So troubled, Skinner sometimes slept at his house because she was afraid to leave him alone during severe bouts of depression. The way he chose to end his life in May was "absolutely horrifying," she said.

Epperley left three sons and three nieces behind.

In better days, Troy Epperley was the man who bought a whole cart of food for kids collecting donations at a grocery store. He stayed out late in a snowstorm to help motorists as other drivers sped past.

Suicide has touched the family in other ways. Eric Dilworth, the Meridian man who died in a suicide-by-cop episode in December, was a former classmate of Epperley's.

"Last summer my teenaged daughter knew of three separate suicides, not counting her uncle," said Skinner.

"But no one talks about it. Suicide just becomes normal for them."

Anna Webb: 377-6431