Mental Health Cuts Exaggerated County Accuses Spokane Mental Health Of Lying About Funds

Frosty relations between Spokane County and its biggest mental health contractor chilled further this week with accusations of lying and “sabotage” of patient care.

According to a county staff memo, Spokane Mental Health inflated the number of layoffs and budget cuts caused by reforms of the public mental health network.

County staff say they prepared the memo, sent to county commissioners this week, to debunk the perception that care was being slashed for thousands of mentally ill residents too poor to pay for their own treatment.

The memo is the latest salvo in a two-year power struggle over the county’s largest single subcontract. County staff sparred by e-mail and letter for six months to retrieve personnel data from Spokane Mental Health.

As a result of the disclosure, Spokane Mental Health’s lump-sum contract is being replaced with a line-item formula that requires the agency to justify each expense.

“We don’t know what’s real and what’s not real at this point,” said Kasey Kramer, head of the county Community Services Division, which oversees public social services. “We need to verify everything.”

If expenses aren’t verified, the county will withhold payment, he said.

A detailed state audit of Spokane Mental Health’s books is expected next month.

The dispute centers on Spokane Mental Health’s public statement last summer that 90 jobs were lost to cuts in county funding.

Instead, 44 were lost, the agency now says. Six workers will be rehired when the agency and the county settle another lingering contract dispute over the Evergreen Club, a day-treatment clinic for the chronically mentally ill.

“This is way outside a margin of error,” Kramer said. “They lied to the community.”

His memo also says that Spokane Mental Health actually lost just $359,600 from its two-year, $24.4 million budget for public mental health services, rather than the 25 percent reduction previously claimed.

Overall funding for public services increased from previous years, the memo says.

Spokane Mental Health’s claims of layoffs and cuts alarmed its emotionally fragile patients. Social workers say several wound up in the hospital because of their anxiety.

Commissioner Kate McCaslin said she was disappointed that the agency released erroneous numbers.

“I’m not surprised it turned out this way,” she said. “We never believed that (number of layoffs) to begin with. We never thought the numbers squared then.”

David Panken, chief executive for Spokane Mental Health, disputes the county’s analysis, saying 86 positions were indeed cut, in order to bring the agency in on budget.

Although county funding cuts resulted in only half the layoffs, reasons for others are complex, he said.

Some were cut to raise psychiatrists’ pay to $140,000. Others were shifted to computer services when funding for that department was diverted to another agency.

A handful have been rehired, he said.

“I don’t agree they were lied to,” he said. “We said during (budget) negotiations that … in order for us to balance our budget, that’s what we’re going to have to do.”

The dispute is not just about money. Since the reorganization of the mental health care system last year, patients have seen longer waits for evaluations. Kramer suspects the waiting lists can be attributed in part to “sabotage” by Spokane Mental Health.

The agency specializes in treating the chronically mentally ill, but Kramer said some severely schizophrenic patients, who are tough and costly to treat, are being sent elsewhere.

“It’s our feeling that Spokane Mental Health is inappropriately referring severe schizophrenics to other agencies,” he said.

His staff plans to monitor for inappropriate referrals, he said.

Panken disputes Kramer’s charge. Despite the cuts, Spokane Mental Health continues to serve the community well, he said.

“We haven’t been here 30 years doing a good job to get torn down now,” he said. “We’ve keep this community safe. … For this to be happening now is reprehensible.”

Fights between the county and the 30-year-old nonprofit group began in 1997, when staff recommended that commissioners sever Spokane Mental Health’s long-standing agreement to receive all public mental health funds and provide all service.

Auditors criticized the arrangement as one that lacked accountability. But agency supporters lobbied its case all the way to the governor’s office, saying changes would result in packed jails and mental hospitals.

Commissioners approved a plan last year to spread the money among more providers and to hire a managed care firm, United Behavioral Health, to monitor care and expenses.

Despite its protests, Spokane Mental Health remains dominant. The agency receives $12.2 million a year and treated, between its therapists and triage unit, more than two-thirds of the 6,367 patients getting help between July 1 and Dec. 31.

The next largest provider, Lutheran Social Services, gets about $1 million a year and saw 557 patients.

The new system has sputtered since it started in July. Waiting lists for evaluations ballooned, and now hover at 10 weeks at Lutheran Social Services. Spokane Mental Health’s waiting list is four weeks.

People in crisis will be seen regardless of waiting lists. Providers report that many people not previously receiving treatment are flooding into the system.

Pat Terry, acting chief of the state Mental Health Division, said she was concerned that tensions still simmered in Spokane.

“I’m always concerned when that type of friction threatens to decrease the quality of care for the client,” she said.

She said she trusted that problems would be worked out. But if necessary, Terry said she would get involved personally.