Idaho tries to mend mental health system

Walk-in crisis centers would be designed to help head off tragedy.

(TWIN FALLS) TIMES-NEWSJanuary 5, 2014 

TWIN FALLS — Despite Twin Falls’ high suicide rate and urgent need, the city won’t get a state mental health crisis center.

But the Magic Valley is the next priority after three other centers are established, providing they get state funding, say officials with the behavioral health division of the Department of Health and Welfare.

Such a center is designed to treat at-risk patients before they reach a breaking point. It also would cut psychiatric hospitalization and incarceration.

Treatment of the mentally ill is in the national spotlight because of recent mass shootings. And in Idaho and other states, funding for programs has been slashed since the recession.

“Unfortunately, the public often focuses on mental illness only when high-visibility tragedies ... occur,” wrote the National Alliance on Mental Illness (NAMI) in its 2011 report, “State Mental Health Cuts, A National Crisis.” “However, less visible tragedies take place every day in our communities — suicides, homelessness, arrests, incarceration, school dropouts and more.”

Idaho officials are pushing the crisis centers as one of several initiatives to patch a system in “tremendous need of transformation,” said Ross Edmunds, behavioral health administrator.

In fiscal year 2013, the behavioral health division served 13,389 people, up from 12,626 in 2009, the state reported. While the patient count was rising, state mental health budgets were slashed from $69.5 million in 2009 to $58.6 million in 2013, and 35 state mental health workers were laid off in 2009 and 2010.

“As a large state with about a third of its population living in rural or frontier areas, Idaho desperately needs effective, accessible mental health services and transportation to such services,” NAMI wrote in a 2009 report that gave the state a grade of D for its services.

MEDICAID FACTOR

Also, Idaho has so far not expanded its Medicaid eligibility under the Affordable Care Act. An expansion would give the state $3.2 billion more from 2013 to 2022 and save $97 million in uncompensated care costs, NAMI reported.

Medicaid funding is critical to mental health services. About half of all state-controlled funds for those services came from the program in 2008, NAMI reported. About 70 percent of Idaho’s mental health services are Medicaid-funded, and that share has grown from $112.1 million in 2009 to $137 million in 2013.

If Medicaid were expanded, Edmunds said, that would cover 93 percent of Idahoans now being treated for mental illness by the state.

Bill Aldrich said he wishes the state would expand Medicaid. Aldrich owns the Community Support Center, which relies on Medicaid to serve the severely mentally ill in Twin Falls, Burley and elsewhere.

People will lose their lives because the state wants to save money, he said. The long-term damage, he said, will cost the system more than expansion would.

The state hopes to build the initial centers in Coeur d’Alene, Boise and Idaho Falls to cover a broad geographic area and to coordinate with “organized stakeholder committees” in those areas, Edmunds said.

The sites were chosen because they have “an existing pocket of people that has been pushing this hard,” he said.

THE CENTERS

Fewer than half of Americans who live with mental illness get treatment, and more than 20 percent of people in jail and prison live with mental illness, NAMI reports. Around Idaho, when police contact the mentally ill, their options are limited to jailing them or taking them to an emergency room — neither of which have staff dedicated to dealing with mental patients.

More than 4,500 mental commitment cases — in which a patient is held out of concern for his or others’ well-being — were filed in Idaho courts last year, the Idaho Supreme Court reported. That’s an 82 percent increase since 2007.

That year, 7.6 million emergency room visits nationwide were for mental illness, NAMI reported.

The crisis center would be a voluntary third option — a safe environment where the person and a counselor can talk and draft a recovery plan, letting police do their jobs, Edmunds said. The walk-in centers would be open 24 hours a day, but care must end within 24 hours.

“It isn’t really a treatment modality that these centers are about. It is more of a risk-reduction model,” Edmunds said.

The center then can send people out the door with a better plan or refer them to inpatient psychiatric care, he said. Likewise, an inpatient center, which costs thousands of dollars a day, could refer walk-ins to the crisis center when appropriate, Edmunds said.

“There has to be a community flavor to these things, and there has to be community buy-in,” he said.

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