April 29, 2007 in Idaho

Mental health reform focus of lawmakers

Betsy Z. Russell Staff writer

BOISE – Just days after state lawmakers approved “monumental” reforms in Idaho’s approach to treating mental health and substance abuse problems, a troubled young man was driving from state to state, allegedly hunting down and killing former high school buddies from Boise whom he blamed for stealing his “powers.”

John Delling, 21, had harassed his Timberline High School classmates for years. He’d been violent; he’d been arrested. He’d been kicked out of the University of Idaho after threatening other students. He’d been ordered into anger management.

But Delling’s parents said they never found help for their mentally ill son.

“There was no preventative safety net in place to correct or rein in a potentially serious situation; no legislation, no mental health entity, nor any church-based aid could get a firm handle on this,” they wrote in a letter to the Idaho Statesman newspaper in Boise. “John was very sick and needed more than this system had to offer.”

Two weeks after Delling allegedly shot three young men in Idaho and Arizona, leaving two dead, an attack by a troubled student at Virginia Tech stunned the nation and claimed 33 lives.

Howard Belodoff, a Boise attorney who for 17 years has pressed the “Jeff D.” lawsuit challenging how Idaho treats mentally ill children, said these disturbed young men are not going unnoticed by the system before they act out.

“They’re just troubled kids – it’s no different than what happened at Virginia Tech,” Belodoff said. “You know who these kids are. The kids are known to local county probation. … The judges know.”

But he said Idaho still is plagued by a system that lacks treatment options in communities around the state for mentally ill youngsters.

“Unfortunately, when somebody gets killed it puts a spotlight on it,” he said. “That’s a symptom of the neglect. Get these kids before they get so bad that they’re lost, and they can’t help themselves.”

It’s not just youngsters that Idaho’s mental health system fails. With no “parity” law requiring coverage, most insurers in the state don’t cover treatment for mental illness. State-funded services for the mentally ill or addicted tend to focus on crisis intervention or costly hospitalization. Few options are available for people suffering from both addictions and mental illness, and Idaho’s per-capita spending on mental health treatment is among the lowest in the nation, according to several studies.

“The irony of mental health treatment throughout almost the entire system is that people have to break the law to access the system,” said Sen. Joe Stegner, R-Lewiston, who has led reform efforts in the Legislature for the past four years. “We’re still working on that.”

A black hole no more

Lawmakers for years have viewed the situation as a “black hole” – a problem so great that they could dump any amount of money into trying to address it, and it wouldn’t even make a dent – so they weren’t enthusiastic about trying.

But that’s starting to change.

Sen. Dean Cameron, R-Rupert, co-chairman of the Legislature’s joint budget committee, said the panel had “an entire paradigm shift” this year. Lawmakers now recognize that they have to invest in treatment or face even larger costs for prisons and for societal consequences.

“We’ve made a significant step forward,” Cameron said. A series of legislative reforms enacted this year – a dozen bills, and nearly $12 million in new state funding – is aimed at making significant changes in the system.

Some of the changes are incremental: increasing funding for children’s mental health treatment by $947,700 a year, adding $389,000 for county probation offices to focus on juvenile substance abuse and mental health treatment, setting up a psychiatric residency program to try to eventually attract more practicing psychiatrists to Idaho.

Other changes are larger, such as expanding substance abuse treatment in prisons with 19 new staffers, opening up spots for 275 more offenders in mental health and drug courts, and starting work on an eventual $50 million secure mental facility for the state. One new law creates more options for judges to order community-based treatment, rather than just order offenders incarcerated.

Another new law required a standardized assessment to determine how to best treat a patient’s problems. The assessment was completed and unveiled last week, months ahead of schedule.

A grant program is prompting communities to look into detox centers and other needed services.

Rep. Margaret Henbest, D-Boise, said, “We’re talking about going from a position of immobility and calling this a ‘black hole’ to … OK, let’s roll up our sleeves. … Twelve million – that’s huge.”

Treatment before prison

It will take time for the changes to be felt, and there’s plenty more to do, cautioned Henbest, a nurse practitioner who serves with Cameron on the joint budget committee and with Stegner on an interim committee that studied substance abuse and mental health treatment issues over the past year.

One of the major bills passed this year commits the state to funding and complying with a $250,000 consultant’s analysis of how the state should restructure its substance abuse and mental health treatment system, including making immediate treatment available to children and families, upping the number of probation officers to shrink caseloads, and looking at a regionally based treatment system, rather than one focused on state institutions.

Henbest said, “Has the system changed? No. Is it changing finally? Yes, and there’s the political will to do it.”

Sen. Joyce Broadsword, R-Sagle, served on the interim committee with Henbest and Stegner. She said, “I think we accomplished more in this one year for people with mental health issues than we have in the last 10 years together.”

Patti Tobias, administrative director of the state courts, called this year “truly historic.”

Broadsword, a second-term lawmaker, said, “We need to really focus on the treatment aspect prior to sending them to prison. Hopefully we can eliminate some of those instances like Virginia Tech or the Delling case.”

Henbest said there’s no guarantee. “You can’t always successfully compel somebody to take their medications, engage in therapy and work on recovery. The state can only do so much.” But, she said, those services must be made available to patients.

“The single greatest gap, I would say, is access to community-based treatment – consistent access to services regardless of what point of seriousness you are at with your disease,” she said.

Henbest noted that focusing on crisis intervention only goes so far. “It’s not uncommon for somebody to come out of the hospital and not have enough community support so that they don’t continue to be stabilized,” she said.

Many lawmakers and state officials have been marveling that the interim committee on mental health and substance abuse treatment accomplished more than any other interim legislative committee in years. Not only did the group’s many recommendations quietly pass into law; many passed unanimously.

Stegner has been working on the issue since he first joined the Senate Health and Welfare Committee as a freshman senator in 1999. “Someday … I’d like to know maybe we did fix this,” he said. “As frustrating and as depressing as some of these incidents are, the reality is that they’re not going to go away. … We have to get better at how we try to help people.”

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