October 7, 2006 in City

Mental health needs often unmet

By The Spokesman-Review

Spokane County suffers from a shortage of mental health professionals, resulting in unmet health care for thousands of residents each week, according to an assessment released by the Spokane Regional Health District.

Because of the shortage, between 7,000 and 18,000 people who might benefit from outpatient counseling are not able to receive it, the report said.

“If they were to attempt to access the system, there would be a waiting list,” said Lyndia Vold, director of the health district’s Disease Prevention and Response Division.

The report found that 8 percent of people in Spokane County have a mental illness or serious emotional disturbance – compared to the state average of 5 percent. The state’s Mental Health Division previously estimated that nearly 23,000 people in the county have an identifiable mental health condition.

The Washington State Department of Health is seeking to have the county designated as a Mental Health Professional Shortage Area. The designation could be used to secure additional grants, Vold said.

The systemwide study also found variations in the levels of care provided to those in the public mental health system – which serves the county’s low-income population – and those served through the private sector.

For example, low-income patients were more likely to be served by registered counselors, who are not required to pass a state examination or meet rigorous training standards. Patients with private insurance are more likely to be treated by licensed professionals, according to the report.

Psychiatrists and psychologists constituted 30 percent of the private-sector providers, but only 2.6 percent of the public-sector providers.

That’s not a complete shock to mental health experts, in part because people in the public mental health system often need broader levels of care. Rather than relying on counseling alone, they may also need social, educational and life-skills training – services that can be provided by counselors without doctorates.

“The needs and responses in public mental health systems are so much broader than what people in the private sector receive,” said Ann Christian, CEO of the Washington Community Mental Health Council, a professional trade association of community mental health providers. “It’s very complex, and it’s hard to make direct comparisons between the public and private sector.”

Christine Barada, head of the county’s community services division, which oversees the public mental health system in Spokane, said her staff had only recently received the report and was not prepared to comment on it.

A psychologist who worked for the county’s community services division helped lead the assessment, but Barada said he had recently retired.

Vold said the public system may “actually be a more cost-effective system.”

For some consumers with special needs, the report said, accessing care in the private sector can be a challenge.

Individuals with limited English language skills, as well as those who have hearing impairments, faced the greatest obstacles in the private sector. Only one-fourth of private-sector psychiatrists reported serving the hearing-impaired, and one-third reported service to individuals for whom English is their second language.

In the public system, 75 percent of psychiatrists said they served those populations.

The assessment also found that fewer than half of providers have policies in place to respond in a disaster – a topic that raised some concern, Vold said. In the event of a disaster, providers may be asked to screen and refer patients, staff evacuee centers or generally oversee a mental health crisis response.

“I don’t think the mental health system has been preparing like other areas have,” Vold said. “I think they need to be brought into the planning piece.”

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