Lack of windows may doom new treatment center

Spokane County mental health officials may recommend that the county close down its new behavioral triage center, an ambitious but flawed project that came to be representative of the system’s financial woes.

The county opened the $5.5 million building last year to ease the burden on hospital emergency rooms that had seen a sharp increase in the number of patients with mental illness and addiction problems.

But due to its lack of windows, the building did not qualify for a license for extended treatment and evaluation – a problem that may prove fatal in the midst of the county’s $7.5 million budget shortfall for mental health programs. Because the building did not meet state guidelines, the center was unable to accept patients brought in by law enforcement, and could only care for patients for less than 24 hours, according to county officials.

The building, which was designed in part to reduce the number of patients in long-term psychiatric hospitalization, incurred nearly $2 million in operating losses in its first year, according to a report from the state’s Mental Health Division.

In an e-mail to employees, the center’s director, Jan Dobbs, said the county’s mental health officials plan to recommend that the commissioners close the center. Christine Barada, the county’s director of community services, said no final decision has been made.

The news comes at a critical juncture for the county mental health system. Spokane County commissioners have asked the public to approve a 0.1 percent sales tax increase at next month’s election. The three-year tax would generate about $6.5 million annually to keep afloat existing services, and fund programs that have recently been cut.

“We have to take ownership for the past,” county Commissioner Mark Richard said on Wednesday. “We clearly had some management issues.”

But the tax, Richard said, is essential to “prevent the catastrophic degradation” of a mental health system that suffered drastic cuts this fall and faces more in January.

“We don’t see any other way out,” Richard said. “We can continue to cut services, or we as a community can rise to the occasion.”

The triage center scaled back its hours of operation this fall, after the county imposed $500,000 a month in cuts to mental-health programs across the region. Stricter federal regulations coupled with lower Medicaid reimbursement rates have driven the financial problems, according to county officials.

Facing the shortfall, top mental health officials have scrambled to determine which services they must fund to comply with their state contract.

The triage center does not appear to be required by contract, officials said.

Kasey Kramer, who resigned as the county director of community services this spring because of health problems, proposed building the triage center in 2003.

County officials leveraged a savings fund to build the center, apparently wary that the federal government would seize unspent savings, according to the state report. The county mental health system must now pay back more than $2 million to the reserve fund, which it is required to maintain. Last month, officials said it contained only about $5,000.

Barada, who took over as director of community services last month, said the center is “not working the way it was envisioned. I think it has been successful and there are a lot of numbers to support that. But it could work better.”

The center has served 2,800 people since it opened in July 2004. Of those, only 189 had to be hospitalized in the two weeks after their release, according to a report issued by the center this month.

The county had a contract with Spokane Mental Health to provide crisis response services at the triage center, but David Panken, the nonprofit’s executive director, said his agency was not initially consulted on its design.

“We weren’t really involved in any of the design of the building,” Panken said. “We raised the issues after the facility was open.”

Richard said the county has acted responsibly to correct its budget problems by asking the state to review its programs.

“As a fiscal conservative, one of the few times I would support a tax is to help care for those who can’t help themselves,” he said.

The county initiative has the backing of law enforcement and Sacred Heart Medical Center, as well as United Way’s Spokane chapter.

“We have noted for a long time that access to community mental health services have been declining,” said John Tombari, a member of United Way’s board of directors. “We have found over the years that monies spent on preventive care are the best dollars spent.”