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Editorial: Mental health reform must keep focus on needy

Fri., Dec. 20, 2013

Kevin Quigley, appointed by Gov. Jay Inslee to shake up the Washington Department of Social and Health Services, finds himself in earthquake mode after a surprise July letter from the U.S. Centers for Medicare and Medicaid Services (CMS).

The federal agency, which covers nearly one-half the $1.2 billion the state spends on mental health services each biennium, decided the county/regional-based system in place for two decades is no longer acceptable. Washington must put those services out for bid, with the possibility private providers might take over in some areas.

Alarms sounded in county courthouses and in Olympia hearing rooms, where Quigley has been roughed up by legislators unhappy with the department’s seeming willingness to roll over to the federal demands despite doubts among state lawyers that the legal basis for the CMS position in all that strong.

They are also concerned that the 20 counties, plus Tacoma, that kick in $90 million from a local option mental health tax will cut off the funds if they lose their voice in the system’s management. The tax revenues support housing and other services for system clients.

But Quigley, who brought a private-sector resume to DSHS, says nothing will happen until CMS clarifies its reasons for the change of long-term policy. And even if the state must comply, implementation likely lies in 2016, not 2014. There will be time to consult with stakeholders and fashion a plan that works best for Washington.

He prefers to see the federal edict as a step toward the integration of mental health, substance abuse and medical services that will eventually better serve clients, and save money.

There is an 80 percent overlap of the mental health and substance abuse populations, he notes, and the mentally ill die 25 years sooner than their unafflicted peers because they do not receive the physical care they need. Inslee has supported the melding of mental and physical health services.

Quigley says that goal is probably five years in the future: “That’s when the big savings and health improvements happen.”

In the meantime, the state must reconcile different payment systems, and help figure out how to provide mental, substance and medical services in shared facilities, all with a minimal disruption to the 41,000 adults and 18,000 children the mental health regional support systems see each month.

Legislators, despite their complaints regarding the state response to CMS, were already calling for a re-examination of the mental health system. They created a task force that is supposed to undertake that study, starting in May. Incredibly, they made no provision for representation by the counties, a lapse Quigley recommends they fix.

Only 38 percent of the Washington population with mental health problems gets treatment, and only 18 percent of those with substance abuse problems. As federal, state, local and tribal governments sort out the jurisdictional and financial issues, those many thousands of clients, and the thousands more the system doesn’t reach, should be the priority.