Mental health system ailing

The fallout of a relatively simple change in federal policy can be felt here, in a new wing of the Spokane County Jail known as 4-E, where the men who slip through the cracks of the state’s mental health system frequently land with a thud.

Jeff Knight, a 49-year-old Spokane man who said he earned $1,000 last year doing odd jobs, has been diagnosed with clinical depression by a psychiatrist.

Under changes in federal regulations, Knight can no longer receive mental health services through Medicaid, the vast government health program tasked with caring for impoverished Americans, because he has failed to fill out the proper paperwork.

Bouncing on and off medication, he has been imprisoned 20 times in the past six years, again and again, for violating a protection order by his girlfriend. Each month, county taxpayers spend about $40,000 on medication for inmates with mental illnesses, according to the jail.

“I guess I’m here because I’ve got nowhere else to go,” Knight said.

Mental health experts say a fundamental shift in the mental health system has begun to trickle down to Spokane, to jail inmates, elderly residents living independently, child victims of sexual abuse, and teenagers with schizophrenia and bipolar disorder.

“The federal government is fundamentally trying to redefine what it is responsible for,” said Doug Porter, director of the state’s Medicaid programs for the Department of Social and Health Services. “On every front, they are pushing back on states. I don’t see how we can avoid a decline in services.”

Medicaid is jointly funded with state and federal taxes.

The change in federal regulations saved Medicaid about $82 million for the biennium in Washington state, but forced the Legislature to allocate about $75 million to keep the mental health system afloat. Medicaid reimbursement rates dropped about 20 percent across the state, but only 7.5 percent in Spokane.

In a budget proposal recently released by Spokane County, more than $450,000 a month will be cut at the end of September from services for people with mental illnesses, and officials have predicted a shortfall of $7.5 million this year – about one-fourth of the total spending on public mental health. Even with the cuts, the county’s expenses will exceed its revenues by $2.8 million in the next six months, according to the budget.

“It will take apart services for people who are severely mentally ill,” said David Panken, executive director of Spokane Mental Health, which will lose $3.3 million under the proposed budget. “Without that, it will destroy the system.”

The cuts are coupled with the fact that in the past three years, more than 1,300 low-income people in Spokane County have lost public mental health care. Although those people were not enrolled in Medicaid, county officials were allowed to use surplus funds to treat them – a stipulation no longer allowed by the federal government.

State and local leaders say the new federal rules may force wholesale changes in the system, dictating not only what services are available but whether the states and counties should bear a larger burden of mental-health care for the poor.

“I do think we have some serious questions about what the future of the mental health system in Washington state will look like,” said Robin Arnold-Williams, secretary of the state’s Department of Social and Health Services. “We have to grapple with, ‘What do we want to provide to people in this state?’ “

Arnold-Williams said the mental health system is “not sustainable as it is. The human fallout will be painful.”

In a home on the city’s South Hill, the cuts quickly became evident to Troy Hartz, as well as two dozen other students who attend a high school for students with mental illnesses.

Hartz, an 18-year-old with Asperger’s syndrome and an anxiety disorder, has attended MAP – an acronym for Multi-Agency Adolescent Program – since sixth grade, when teachers told his parents they were unable to educate him in public schools.

“He’d come home from school and beat his head on the bed post,” said his mother, Cindy Lott. “He couldn’t function because he was such a target of the other boys.”

Spokane Public Schools, which operates the school in conjunction with Spokane Mental Health, announced last week the school will open, despite the loss of $28,000 a month in funding beginning Oct. 1. But they were unable to tell students what role their therapists – who historically worked daily with the students – would play in the restructured school.

Shane Stevenson, 16, said he became so distraught in public schools that he wrote out a contract to have another person kill him.

“I pretty much said he could kill me any time for any reason,” Stevenson explained at a recent rally in front of county administrative buildings. “I didn’t have the guts to commit suicide.”

MAP, he said, is his last chance at graduating from high school.

At Lutheran Community Services Northwest, which provides counseling to women from violent relationships and children who are the victims of sexual abuse, 15 therapists and eight support staff were notified that the funding for their positions will end in a month.

“We know we have 235 clients today who won’t have therapists at the end of September,” said Dennis McGaughy, the nonprofit’s regional vice president. “In my 32 years in the business, I’ve never seen this big of a downturn, ever. It is just huge. The most vulnerable in our community are going to suffer.”

Sixty-year-old Kathy Popoff relies on volunteers from an Elder Services program to take her to medical appointments. The program, which serves 600 Spokane residents, will lose about $45,000 a month – approximately half its budget.

Officials plan to stop the volunteer transportation program, known as Care Cars, and no longer provide 24-hour-a-day emergency response. Unless other funding can be located, Elder Services also will end its Gatekeepers program, which trained postal carriers, apartment managers and meter readers to identify at-risk elders.

On Friday, social service advocates vented their frustration and criticized the Bush administration for cutting spiraling Medicaid costs at the expense of people with mental illnesses.

Roy Harrington, a former state welfare administrator now with Washington State University Spokane’s Child and Family Research Institute, said the mental health cuts have been coupled with decreased funding for public health programs, low-income housing and child welfare. He warned that more cuts are looming.

“There is a cumulative impact that is decimating people at a community level,” Harrington said. “If what we think has happened up to this point is bad, we ain’t seen nothing yet.”

The county jail is one of the few beneficiaries because the Legislature’s recent allocation earmarked money to help people with mental illnesses who are leaving incarceration. The jail will receive an additional $15,000 a month to help inmates with mental illnesses find stable housing and medications when they leave.

Ronald Fay King, a 51-year-old inmate with schizophrenia who was booked into jail for first-degree assault last month, said outside of jail he lacked medications and a place to stay.

“I ain’t got nowhere to go,” said King, who was homeless. “When I get out I’m wild and crazy as hell.”