Mental Health Reforms Increase Complaints County Happy With Changes After Hiring Managed Care Firm Last Summer, But Denials Of Hospitalization Worry Advocates For Mentally Ill

Doctors, therapists and social workers agreed: The girl was sick and needed to get into a mental institution.

Natalie Orth, 17, had tried suicide once, gulping aspirin. She pledged to try again. She repeatedly ran away from her parents and foster homes, hanging out on Spokane streets with sex offenders, smoking “sherms” - cigarettes soaked in embalming fluid.

If hospitalization were denied, Dr. John Jaccard wrote, “this unfortunate young woman will … become completely dysfunctional with little hope of productivity in adulthood.”

Yet she was denied several times in December by the county’s managed care company.

“I don’t know what to do,” a sobbing Natalie said then. “I think I’m going to end up dead pretty soon.”

Natalie’s mother, Therese Orth, was incensed: “The question is, are we going to help her, or is she going to end up dead?”

Therese Orth hasn’t been alone in her frustration. Six months into controversial reforms of the Spokane County mental health system, a rising number of complaints are being logged about access to mental health treatment.

The reforms were intended to give county government more control over the $23.5 million in state and federal funds it receives annually to treat the mentally ill. The goal is to keep the mentally ill healthy enough to avoid long-term commitment at Eastern State Hospital. Historically, about 11,000 people a year have been helped by the system.

County officials say they’re proud of the changes instituted last summer. Patients now have a wider choice of therapists and specialists. And United Behavioral Health, the managed care firm hired to monitor treatment and handle hospital admittance, is churning out reams of useful data for administrators and therapists.

New programs have sprouted, including one to treat substance abuse and mental illness at the same time. And three new positions were created to help homeless people get treatment for undiagnosed mental illness.

As a result, more people are getting help, said Raphaela Ortiz, head of the county mental health department. A year ago, before the reforms, about 350 patients were added to treatment rolls monthly; now the tally is about 450.

“I think we’re doing a good job,” she said.

But complaints from patients and their advocates about decisions by UBH are increasing. Rick Sprague, the county’s ombudsman for mental health care, says complaints about the system have shot up 20 percent since last summer.

In particular, Sprague is concerned about UBH’s denials of hospitalization. Since UBH took over, it has rejected 15 requests for hospitalization - something that virtually never occurred before.

But the complaints aren’t limited to hospitalization issues.

Ron Wilmot’s needs are less critical than Orth’s, but his family has no answer to the question: Where can a severe schizophrenic go during the day to stay out of trouble?

Candy Waldron, who cares for Wilmot with her boyfriend, has called every program she can think of, including those for the developmentally disabled and for seniors.

Each inquiry has fizzled. Day programs for the mentally ill, she learned, largely vanished with last summer’s reforms.

The remaining alternative, the Evergreen Club, has said it will take Wilmot to train him for a job. But Waldron says Wilmot’s disabilities are too severe to make training worthwhile.

As a result, Wilmot is left alone for hours with Waldron’s two children, Aaron, 6, and Danielle, 12, before school, when Waldron and her boyfriend are at work. When the children leave, Wilmot is alone.

He’s used the time to scream at the bathtub and to blow out the pilot light on the gas stove. Last week, Wilmot skipped his medication and shoved Aaron.

“Every time I hear the phone ring at work, I think the worst,” said Waldron, 33. “I’m afraid he’s going to hurt the kids … hurt them to the point where they’re not going to be able to call.”

Caseworkers have heard it before. The most common recourse for people like Wilmot, they say, is to spend the day at the STA bus plaza.

Sprague, the ombudsman, said the most critical problem is the one encountered by Natalie Orth: gaining admission to community psychiatric hospitals.

“The question I have is, are those who really need hospitalization able to get in?” Sprague said. “I’m not sure they are.”

As part of last summer’s reforms, the county government took on financial responsibility for admissions to Sacred Heart Medical Center’s psychiatric wing, which offers short-term hospitalization.

Officials hired UBH - at a cost of $1 million a year - because the firm had public-sector experience in San Diego, Seattle and Vancouver, Wash.

But patients in those communities, particularly Seattle, have complained of UBH’s denials as well. “Not being able to get in is significant,” said Sherry Storms, Seattle’s mental health ombudsman, in an interview last year. “If they can’t get in, they’ll end up involuntarily committed, in jail or dead.”

Since being hired here in July, UBH has denied 15 people hospitalization requests at Sacred Heart.

Most of the denials involved children, such as Natalie Orth. Nearly one out of every 10 admission requests for children has been turned down, and the numbers have risen steadily since July. Seven cases were denied in December alone.

“The people that are there on the line are more than willing to help, but I’ve found that their hands are tied,” said Therese Orth, Natalie’s mother. “They’re getting told there is no money. Where did the money go?”

Sprague, too, fears the denials are a cost-saving move that could hurt patients.

“When money savings are realized, I haven’t heard an assurance that, say, 50 percent are going to preventative care,” he said.

Questions about where money has been spent should be answered in May, when a state auditor’s report is released.

Kasey Kramer, Ortiz’s boss, said the denials are a good sign. Doctors and therapists, unaccustomed to working with UBH, are testing admission criteria.

“I think it’s an appropriate testing. But being the steward of the taxpayer money, I think it’s also appropriate that we’re cautious,” he said.

His staff notes that the number of Spokane children hospitalized last year is about equal to the tally in King County, which has four times the population of Spokane County.

“I’ve looked at each case of denial, and I’m comfortable with the decisions,” Ortiz said.

But it took extraordinary measures to rescue Natalie Orth. UBH officials thought Orth didn’t qualify for short-term hospitalization, and the county initially felt it couldn’t afford long-term hospitalization.

Natalie’s caseworker and therapist became so frustrated with UBH’s denials that they were willing to put their jobs at risk and call Kramer and Ortiz directly. They also threatened to call the media, but never did.

Within a day, Kramer’s office overruled UBH and, along with Spokane Mental Health, tapped a special fund for the girl’s care.

They agreed to write a special contract to put Natalie in Tamarack Center, an inpatient clinic for mentally ill youths, until March, at a cost of $20,000.

“We were concerned that nothing would happen unless we got involved at the level we are,” Kramer said in a December interview.

“We can’t turn a deaf ear to the clinicians. They were clearly upset, they were distraught.”