Sacred Heart Cuts Ralle Program Hospital Ends Program For Mentally Ill To Pump Money Into Child Health

An outpatient treatment program that kept many poor and depressed people out of the hospital is being shut down.

Spokane County will no longer pay for Medicaid patients to attend the 6-year-old RALLE program at Sacred Heart Medical Center.

Officials say they want to spend more money on children.

Because Medicaid patients account for 70 percent of the clientele, the hospital is shutting the program down Tuesday and moving the staff to inpatient services.

For many mentally ill people, the intensive program was the one thing that worked after a lifetime of counseling and medicine.

Patients attend RALLE - Responsible Active Life Learning Experience -six hours a day, for 13 days. An average of 10 patients combine group sessions with individual counseling to learn basic survival skills.

Patients go home every night and face their demons, then return the next day to discuss what worked and didn’t work, said Dr. Cornelis Bakker, medical director of psychiatry at Sacred Heart.

Graduates such as Jennifer Robinson, 29, are saddened by the program’s demise.

A single mother who has spent her life battling depression, Robinson attended RALLE last February.

“It was so amazing,” she said. “It taught me how to deal with my life day to day; how to see warning signs, resolve conflict. I’ve been in a lot of counseling and nothing has worked as well for me.”

Several other county mental health programs are facing cutbacks or elimination. Much of the money to support them comes from Medicaid, federal health insurance for poor people.

In Washington, the state turns over Medicaid money to regional districts - in this case, Spokane County - to distribute to providers who care for the mentally ill.

The county wants to make sure children have the services they need first, then it will distribute remaining money to adult programs, County Commissioner Kate McCaslin said.

Rafaela Ortiz, who manages the county’s share of Medicaid money for mental health services, said RALLE doesn’t serve the group of mentally ill the county is hoping to reach.

RALLE helps people with affective disorders such as depression or anorexia, rather than the chronically ill, like those with schizophrenia, she said.

Medicaid patients will be able to choose among a variety of other providers, such as Spokane Mental Health, Lutheran Social Services and Catholic Charities for outpatient treatment, Ortiz said.

For people who have been through RALLE, other services pale in comparison.

Margie Richey, 37, suffers from anorexia and depression. She attended RALLE after spending 17 days in the hospital. Afterward, she said she felt more confident about confronting the issues that had been sending her into fits of manic exercise and starvation.

“It kept me out of the hospital even longer,” she said.

When a crisis triggered a relapse, she went to Spokane Mental Health. There, a counselor recommended the 5-foot-10 inch woman who weighs 100 pounds on good days attend a nutrition class.

“It was so lame,” she said. “It was like something out of high school.”

Eventually, she convinced RALLE coordinators to admit her for a second 13-day program. “It was a launching pad for me to go out and do the things I needed to do,” she said.

RALLE’s closure is part of an overall trend in managed health care to cut back or ration mental health services.

Few private insurance providers cover intensive outpatient treatment. RALLE costs roughly $250 a day, or $3,250 for the full 13-day treatment.

While that seems steep, it’s less than one third of the cost of hospitalizing an adult in the psychiatric unit, said Roberta Smith, director of psychiatry at Sacred Heart.

Still, because most insurance companies won’t pay the bills, the program will disappear with the withdrawal of Medicaid money.

“It’s a shame that by losing the funding we are losing the opportunity to provide the program to the entire community,” Bakker said. “The reality is mental health services are being restricted to the bare minimum. And that makes it very difficult to give people adequate help.”