Monday, January 17, 2011

Washington state prepares for mental health cuts

From The Tri-city Herald:

Statewide budget cuts have Tri-City mental health professionals and advocates worried that those with mental illnesses will see a decline in care in coming months and years.

Ed Thornbrugh, administrator of Benton and Franklin counties' Department of Human Services, said cuts passed down through the regional service network that allocates state mental health money to the counties means no money is available for outpatient treatment for uninsured, low-income people who also are ineligible for federal Medicaid coverage.

That leaves the department's Crisis Response Unit as the only place those people can go for help when symptoms of their illness become overwhelming. They are called "state only" patients, because the only financial support for their services comes from the state.

"We're very concerned about the state-only money," Thornbrugh said. "That is our public safety net funding."

Greater Columbia Behavioral Health, the regional service network representing 11 Eastern Washington counties and the Yakama tribe, experienced a $1.8 million cut effective Jan. 1 after Gov. Chris Gregoire ordered more than 6 percent cuts to all state agencies in October.

Gregoire's proposed supplemental budget for January through June of this year cuts $17.7 million in state money from the regional service networks statewide; and her proposed budget for the 2011-13 biennium cuts another $17.4 million from the regional service networks for services such as crisis response, evaluation and treatment of mental illnesses for those "state only" patients.

The Greater Columbia Behavioral Health Board in November agreed that county mental health agencies would apply the remaining state money in three priority areas: inpatient treatment, crisis response and residential services. No outpatient services are to be provided.

"It is clear we can't continue to provide outpatient services and still support the state's priorities," the minutes of the Nov. 4 board meeting said.

"Some clients we are currently seeing will have to be given 30 days notice and transitioned," another section of the minutes said.

Thornbrugh said the bicounty human services department had to reduce money for any services that didn't fit those three categories, and prioritize funding within those three categories.

He did not have specific dollar amounts of money cut, or money applied in those priority areas. He noted that Medicaid patients still can receive services.

But Thornbrugh feared for those who are losing services, and how that will affect their ability to cope with their illnesses.

"The difficult part can be that crisis response may do an outstanding job of stabilizing the crisis at hand, but then there is no ongoing care routine to continue to engage that person," Thornbrugh said. "That's where we have that disconnect where crisis response staff can do an outstanding job, but if there is no network ... they are only getting services when in the crisis stage."

Gordon Cable, integrated services manager for the Crisis Response Unit, said he expects to see more people experiencing mental health crises or being hospitalized for inpatient treatment as they lose access to outpatient counseling and a steady supply of medications that can keep those with serious mental illnesses stable.

"We anticipate, with folks not being able to get routine care, it's likely crisis response will become busier. Emergency departments will become busier. Jails may become busier," Cable said. "Those seem to be the three common entry points for folks with mental health crises."

Officials from the two counties and human services, as well as mental health advocates, have been working for years on a consolidated crisis response center that would include, among other things, a place to take people with mental illnesses who are creating disturbances instead of taking them to jail.

But three years after Benton and Franklin county commissioners voted to figure out what it would take to establish the center, it remains merely an idea.

Thornbrugh said it's moving closer to reality. The counties hired a consultant in late 2010 to perform a feasibility study comparing the costs of renovating an existing county building with building something new.

"That report hopefully will be in the (commissioners') hands toward the end of this month," he said.

`Cable said crisis response staff have been talking with the local hospitals about how to prepare for the expected influx of patients.

Anna Bopp, president of the National Alliance on Mental Illness Tri-Cities and the mother of adult children with mental illnesses, said the cuts are making her heartsick.

"I think it's a real travesty," Bopp said. "I think it's like a balloon -- you push in and the air pops up somewhere else. (The people) are not going away."

Bopp also is worried about the proposed elimination of the state's Disability Lifeline program, which provides a small monthly stipend -- less than $300 -- to people who are unemployable because of a disability.

The program is supposed to function as a stop-gap for people waiting to get onto Social Security, she said. But that process often can take years.

"What in the world are people going to be doing? What do they live on? The loss of that program is devastating," she said.

Members of the Tri-City NAMI group will be in Olympia on Monday to meet with lawmakers and try to convince them not to cut any deeper into mental health funding.

"It's going to be a hard sell," she said. "We never give up."