One way or another, taxpayers are going to pick up the tab for mental illness in the Spokane area.

Even if the federal government, the state of Washington and Spokane County all keep reducing the level of funding they appropriate for mental health programs, the low-income clientele they have served will remain, and their needs will persist. They will merely manifest themselves in different ways, showing up in the budgets and workloads of different public and quasi-public agencies.

If emergencies such as crisis hospitalizations and suicide responses are to be cut, as Spokane County Commissioner Mark Richard predicts they will under a pending budget cut, those cases will show up as police calls and emergency room visits.

If medication, counseling and other outpatient care are reduced, as Richard expects, the patients who lose those resources will appear in the jails and clinics.

Thus, when county officials say they will have to lay off as many as 200 mental health workers because the state has trimmed their funding by $3 million, don’t expect the cost of public services to decline. Indeed, the county may forestall program cuts for now by trimming from other budget areas, imposing cuts on different populations. Or the county may loan the Regional Support Network’s public mental health system $2 million.

Or many of the needs posed by chronic mental illness will just be ignored by the agencies that traditionally handle them, and a troubled population will be left to fend for itself. In many cases that will mean more tormented souls struggling to cope by themselves in a hostile, chaotic world.

“To me, it’s a core function of government to take care of these people,” Richard once said.

Unfortunately, there seems to be a disagreement over just which government that would be. The federal government has been reducing the amount of funds it allocates to local mental health programs for the past few years. This year it ordered that those patients who – often because of their condition – never got around to signing up for Medicaid, cannot receive treatment with Medicaid funds, even if they’re otherwise eligible.

When that threatened to withdraw services from 40,000 Washington residents, the state appropriated special funding to ease the blow. Under complicated formulas, Spokane County expected $3 million more from that source than is now headed this way.

To compound matters, the state penalizes Spokane County if it sends more patients to Eastern State Hospital than state officials in Olympia think should go there. Those penalties have run as high as $400,000 a month, and the state is unreceptive to the idea of waiving them as a means of offsetting the reduction in appropriations.

With so many political entities involved (and so much turf to protect), the situation is confused. But the indisputable fact is that trimming mental health programs will only divert pressure to other areas of government where the role will be reactive rather than preventive. The result will be little if any overall savings in public dollars, but a significant reduction in effectiveness.