Part of Boise's public safety net for mentally ill people in crises unraveled when the Franklin House closed, and the fate of patients who used it is still uncertain.

"When I went there, I was pretty scrambled," said Matthew Weaver, 31, a Boisean whose schizophrenia was out of control at the time. "My brain was misfiring.

"It was such a peaceful place, and it was quiet. I was really sad to see that it was closing."

The state Department of Health and Welfare's decision to yank funding for the house was not a great idea, Boise psychiatrist Charles Novak said.

"Essentially, they are going to shift a bunch of costs to the hospitals' charity and bad-debt services," Novak said. "It's bad for the patients. It's bad for the hospitals. It's bad for the jail, too." Some candidates for care at the house may end up in jail, he said.

The outlook may not be quite that gloomy, said Gina Westcott, mental health program manager for the Health and Welfare region that includes the Boise area.

"I think we will have to wait and see what happens," she said.

The eight-bed house, the only one of its kind in Boise, closed its doors Jan. 16, the victim of state budget cuts. Health and Welfare no longer will pay Saint Alphonsus Regional Medical Center in Boise $325,000 each year to run the place. When the house closed, 17 full- and part-time Saint Al's workers lost their jobs.

The Franklin House logged about 600 admissions each year, and patients usually stayed three to five days.

The fall of the Franklin House means patients will now go to hospital emergency rooms when they need help, ultimately costing taxpayers more, Novak said.

Novak has a point, but Health and Welfare is trying to take some of the sting out of the closure, Westcott said.

The department is putting together contracts with Treasure Valley health care providers to cover gaps in services, including after-hours and on weekends for the most seriously ill, Westcott said.

Those providers would help the poorest and most vulnerable patients in the patients' own homes, Westcott said.

There still will be gaps, she said. Home-based care won't work for the 10 percent of Franklin House patients who were homeless. "Our goal is to help as many people as we can," she said.

From the outside, the house looks like others in the North End. But it had a special purpose: to help catch poor, needy patients in crises before they require more expensive care, such as a long stay at a state psychiatric hospital.

Patients got into the house with a referral from the state-funded mobile mental-health crisis team. It works like a psychiatric crisis hot line. Team members see patients in person or by phone to decide what kind of help they need.

Saint Al's owns the Franklin House and hasn't yet decided what to do with it, a hospital spokeswoman said. It will not run the facility alone, spokeswoman Jennifer Krajnik said. The problem is community-wide, and the fix has to be, too, she said.

Saint Al's officials acknowledge the closure could send more mentally ill patients to hospital emergency departments, where care is more expensive and less efficient. How many patients will end up in emergency departments so far is uncertain, Krajnik said.

"To fully understand the impact it will have on the emergency departments, various tracking mechanisms are being implemented to monitor the true impact and associated costs of serving this population," Krajnik said in an e-mail.

The mentally ill people who used Franklin House are likely to be a drag on the bottom line at Saint Alphonsus Regional Medical Center and St. Luke's hospitals in Boise and Meridian. Those patients are likely to be uninsured or to get by on public health insurance such as Medicaid.

The big Boise hospitals have said in recent months they already are losing an ever-increasing amount of money on patients who can't pay their bills. And Medicaid doesn't pay the hospitals enough to cover their costs of treating patients, hospital officials have said many times.

The quality of Idaho's mental health services for the sickest and poorest consistently ranks at the bottom of the barrel nationwide, while Idaho's suicide rate ranks among the highest, according to advocacy groups such as the National Alliance on Mental Illness.

Idaho spends less per capita on mental health and has fewer ways to help people get treatment in the communities where they live, those studies have shown for years.

The Franklin House was part of Boise's community-based help. Those kinds of services have been a priority nationwide since the 1960s, when officials began emptying state psychiatric hospitals, dismissing them as outmoded and costly.

The Franklin House opened about a decade ago to steer mental-health patients from emergency rooms.

The house falls squarely in the definition of community-based care. An Idaho legislator whose committee spent all summer hammering out a voluminous plan for improving mental health services, including community-based care, was disappointed but philosophical.

"The economic downturn is obviously going to be detrimental to any number of more progressive programs that the state might be considering," state Sen. Joe Stegner, R-Lewiston.

"It was performing the exact functions that we're trying to expand rather than decrease in the state of Idaho," he said of the Franklin House.

Loss of the house definitely hurts, but two-thirds of the people who stayed there still will have access to public mental-health care of some sort, Westcott said. They will have access to case managers, physicians and other help through public insurers Medicaid or Medicare. They just won't have the same degree of access to short-term inpatient help like the Franklin House provided.

"Franklin House closing is difficult for all of us, but I don't want to paint a picture of it as a catastrophe," Westcott said.

Health and Welfare doesn't track the remaining one-third of the house's patients because they have their own health coverage or just haven't been part of Health and Welfare's system.

Perhaps in the nick of time, help will be on the way from another long-awaited source.

A new inpatient facility with 12 beds for addicts who need to detox and eight beds for people in mental-health crises is set to open next year, perhaps in January. That essentially will replace Franklin House, Westcott said.

Weaver can't say enough good things about the house.

Before his schizophrenia was controlled with medicine, Weaver landed at the Franklin House five times, each time in a downward spiral that could have ended with a long stay at a state psychiatric hospital, and a big bill for taxpayers.

His schizophrenia was diagnosed when he was 17 years old. It can make him anxious and very afraid that other people want to hurt him, among other symptoms.

Weaver, who now teaches classes for the Boise chapter of the National Alliance on Mental Illness, doesn't blame anyone for the home's demise.

"I think it's the money," he said. "It's Health and Welfare. They just don't have the money for it."

Colleen LaMay: 377-6448