County won’t treat 125 who are mentally ill

Spokane County’s public mental health system will stop treating 125 people with serious mental illnesses next month.

It is unclear where treatment will come from for the patients, considered by mental health experts to be among the most at-risk in the county system.

“These folks have no options,” said Kasey Kramer, director of community services for the Spokane Regional Support Network, which provides mental health services to county residents. “This has to come to a head for the community to understand just how limited the public mental health benefit is and to decide if we’re going to do something different.”

Community health clinics and psychiatric wards are still struggling from an influx of several hundred mentally ill clients who lost county coverage last winter.

“It’s a travesty in terms of putting these people on the streets,” said Dr. David Bare, medical director for clinics operated by Community Health Association of Spokane, which has absorbed much of the cost for caring for the patients.

In November, the RSN announced that as many as 900 mentally ill people – about one-third of the county’s caseload – would lose coverage because they were not enrolled in Medicaid, the state-federal program that funds the RSN. While the RSN has been unable to provide an exact count, mental health providers say about 400 people actually lost coverage.

At the time, the county set aside $750,000 to treat patients so sick that they faced hospitalizations or were a danger to themselves or others. Only about $100,000 of that fund remains, Kramer said, and it is expected to be spent by the July 12 deadline.

The cuts are the result of the Bush administration’s enforcement of tougher restrictions on Medicaid spending – not on budget cuts to the county, according to mental health experts. The tougher scrutiny from the Centers for Medicare and Medicaid Services were designed to save money for programs where spending has boomed in the past decade.

But officials with Spokane’s RSN hope to preserve its funding level by ceasing services to clients who aren’t enrolled in Medicaid and switching those funds to services for its Medicaid clients. Kramer said the county’s budget could serve an additional 700 people, if they are enrolled in Medicaid.

In King County, officials have not yet decided whether to cut a $2 million fund for non-Medicaid clients who are leaving jails or hospitals. Amnon Shoenfeld, director of King County’s mental health services, said that’s just a small fraction of the $32 million that may be lost.

But Spokane RSN officials fear that if the county continues to serve mentally ill people who aren’t enrolled – either because they make too much money or are unable to fill out the enrollment forms – the system will lose funding in coming years.

The county’s release of the patients last year flooded clinics and emergency rooms.

Sacred Heart Medical Center’s psychiatric ward has had to routinely turn away people in crisis, according to mental health workers. The county continues to send more people to Eastern State Hospital than the state allows, resulting in tens of thousands of dollars in fines each week. Mental health experts say the lack of adequate treatment has led to the increase in hospitalization.

Although his clinic is expected to see many of the patients who lose coverage, Bare said he was not informed of the RSN’s decision until he received a call from a reporter on Thursday. This spring, new patients arrived almost daily with bags of empty medications. In one month, expenses at the clinic’s pharmacy jumped $100,000.

Bare said CHAS serves whoever needs help, regardless of their ability to pay. But he emphasized the clinics simply aren’t staffed to handle the new psychiatriac patients.

“We have two psychiatrists who work one-half day, twice a month,” Bare said in an interview last month. “These people have just been cut loose from the system they depended on.”

The county did not track the progress of the approximately 400 people who lost coverage last winter.

It did sign a $17,000 contract with the Health Improvement Partnership, a nonprofit that helps low-income people sign up for state services. Under the contract, HIP agreed to help the mentally ill try to qualify for Medicaid or find other coverage. HIP officials said only 57 of the 400 clients showed up over the course of several weeks.

“We were expecting a far greater demand,” Ralph DeCristoforo, HIP’s project coordinator, said last month. “It’s unclear why we didn’t see more. It led us to questions, and we gave those questions to the RSN. It’s in their court.”

HIP officials said it was up to the RSN to funnel the clients to them. They requested a list of patients’ names, but the county did not provide one.

Even for those 57 clients, help was difficult to find.

Nearly 60 percent of the clients qualified for a little-known state program called Healthcare for Workers with Disabilities, which was created in 1999 and had no minimum income requirements.

But although advocates estimate thousands of Washington residents qualify for the program, the state had only one worker in Omak to process requests from across the state. When HIP prepared its final report for the RSN last winter, two-thirds of the applications were still pending and the patients had not secured coverage. On Thursday, DeCristoforo said 14 people were eventually enrolled.