Sue Lani Madsen: The glimmers of hope for mental health

“Our commitment is to continually making things better. You can’t wake up every morning frustrated,” advised Jeff Thomas, CEO of Frontier Behavioral Health. Actually, you can, but it’s not healthy. Not for you or your family member living with mental illness.

Last week’s column describing one family’s frustrations with the mental health system resonated with many families.

“The system itself will wring the living spirit out of you. The aloneness is profound. The sense of helplessness never ends. The glimmers of hope that fail time and time again,” said one reader.

My wife “burst into tears because it hit so close to home,” said another.

“Whenever I discuss my son and his problems, I get all this well-meaning advice that the services are out there … They think it’s all just a phone call away,” wrote another.

It is not, or at least not yet. Integration of mental health services into the health care mainstream has been the goal for more than a decade. The requirment for mental health care benefits to have parity with primary care benefits became federal law in 2008. Actually integrating funds to remove financial barriers to cooperation took effect in January 2019 in the Spokane region.

Frontier Behavioral Health has been working to break down other barriers. “The partnerships we are building weren’t in place a few years ago,” said Thomas. Mental health professionals are now co-deploying on police and fire/EMS response as they encounter individuals struggling. And regional agencies and organizations are talking to each other to improve coordination.

The ACA drove up the demand without increasing the supply of counselors and psychiatrists. According to Thomas, the number of patients statewide jumped by 600,000 when Medicaid expansion kicked in. Drop-in access at Frontier Behavioral Health is designed to serve most people the same day, although workforce shortages can still mean turning people away to come back another day.

“We’re chipping away at unmet needs,” said Thomas.

One chip-resistant barrier is HIPAA, the strict federal privacy law controlling health care information sharing. Thomas chose the word “exasperating” to describe the wall between families and providers. Patients as young as 13 must affirmatively grant access to health care information, and can withdraw it anytime, for any reason.

Counselors and psychiatrists know family members have vital information for effective treatment and can be the necessary support system for both youth and adults. It’s not an easily bridged barrier.

The National Alliance on Mental Illness is a leading advocate for mental health issues, and one of the organizations involved in building bridges. NAMI Spokane hired its first executive director this spring, Laree Shanda, and seeks to expand local education, outreach and family support.

“One of our foremost efforts is to address the stigmas surrounding mental illness,” said Shanda. “The most common misperceptions are the individual just isn’t trying hard enough, or their family did this to them.”

Stigmatizing families is not an improvement over stigmatizing patients.

Dr. Matt Layton is also fighting mental health care stereotypes as Clinical Education Director for Mind, Brain and Behavior at WSU’s Elson S. Floyd School of Medicine. He emphasizes integration of mental health treatment throughout the curriculum. The next generation of physicians will be more aware of mental health and addiction, no longer marginalized conditions but treated in the mainstream. New approaches in psychiatry use medications as just one part of treating the whole person – biological, psychological, social and spiritual.

“That’s the system problem right there, silos,” said Layton. “Separating primary care from mental health, separating chemical dependency from mental health, plus workforce gaps.” Local medical schools and residencies are just starting to graduate new providers to plug the gap.

The latest state budget has provisions to expand telehealth to make up for provider shortages in some areas, but it’s not a long-term solution.

Rep. Joe Schmick, R-Colfax, still sees glimmers of hope.

“For the first time, it feels like there is a plan, we’re looking five years down the road.” Schmick serves as the ranking minority member on the Washington House Healthcare & Wellness Committee. He cited funding for more state hospital beds to relieve pressure on ERs and jails, a new psychiatric teaching hospital to expand both services and workforce, and building on successful supportive housing models in the community as signs of hope.

There is still no one call solves it all. There won’t be one soon. The hope lies in building momentum for change to make things a little bit better tomorrow. “What’s important is changing behaviors and finding meaning and purpose in life, and that takes a long time,” said Layton. For individuals, and for a system.