Groups seek more mental health funds

OLYMPIA – After historic gains in last year’s state legislative session, mental health advocates descended on the offices of senators and representatives last week with a simple message: Washington’s public mental health system continues to teeter on the brink of collapse.

The response from legislators – who provided $80 million to ease a federal funding shortfall and required companies to provide better insurance coverage for mental illness – is expected to be muted.

“I think the initial reaction is going to be, ‘We thought we took care of it last year,’ ” said Frank Jose, executive director of the Seattle chapter of the National Alliance for the Mentally Ill, a nonprofit advocacy group. “The challenge is to help them understand that last year just prevented a disaster.”

Just weeks after the Legislature adjourned last year, an arcane funding study returned disappointing results for the mental health community, and by late summer, its impact had begun to roil mental health providers. The study led to a 17 percent cut in funding from Medicaid, the state-federal health program for low-income people.

The cut was coupled with federal changes implemented by the Bush administration that have dramatically shifted the responsibility for public mental health care to states. Last year, Washington state’s share of the programs increased from 10 percent of its overall cost to 27 percent, as the federal government tightened restrictions on who could access Medicaid.

Now the question is, how much more can the state contribute?

Senate Majority Leader Lisa Brown, D-Spokane, said the Legislature will likely step forward with more funding but said it had not been determined how much funding will be available.

“It’s disturbing that the federal government is pulling back,” Brown said. The state is “committed to having good outcomes in the community,” she added.

Mental health advocates are seeking $22 million this year, and both King and Spokane counties have said last year’s allocation formula created budget shortfalls and threatened treatment for thousands of clients with mental illness who can’t afford private insurance.

Spokane County claims it lost $1.8 million, and King County said it lost $7.4 million after the state adjusted funding to protect financially vulnerable regions. Spokane County is also pushing for a refund of several million dollars in state fines and a pilot program to divert people with mental illness from jails.

In Spokane County, questions are swirling about the viability of the public mental health system, which cares for some 10,000 people annually. Last fall, the county made deep cuts to service programs in the midst of a $7.5 million budget shortfall.

Earlier this month, the county system failed a statewide review, drawing low scores for its fiscal oversight of programs and reserves, as well as consumer participation, according to state documents. Of the state’s 14 regions – six of which failed the review – Spokane received the second-lowest score.

Last year, the Legislature asked the state to grade each region on a variety of measures, including consumer satisfaction, financial management and evidence of successful programs. To pass, the region had to receive a score of 70 percent. Spokane County scored 62 percent.

The state’s Mental Health Division, which oversees the regional public systems, has not escaped criticism either. The division required each region to submit hundreds of pages of documents, but it initially refused to publicly release scores or has yet to fully explain why some regions failed and others succeeded.

“The comments that they gave us were extremely limited,” said Christine Barada, who was brought in last fall to lead Spokane’s community services department.

The frustration is evident in the county’s written response, in which county officials wrote, “What does that mean?” and “How were questions weighted?”

Last week, the county formally protested the score, suggesting the state required an “unobtainable level of performance.”

Others expressed concern as well.

In a House committee meeting earlier this month, Rep. Patricia Lantz, D-Gig Harbor, questioned why her region’s public mental health system failed the state’s test, calling it a model for other programs across the state.

“It does an outstanding job of serving its consumers,” Lantz said. “It does an outstanding job of collaborating with the community.”

Failing counties may reapply this spring, but they could also face competition from other regional systems or from private companies. County officials have emphasized that services and programs will continue uninterrupted.

But officials and experts are still sorting through the fallout of the review, particularly in failing regions now open to private managed-care firms.

“I think there probably would be something lost at the local level,” said Ann Christian, CEO of the Washington Community Mental Health Council, a professional trade association of community mental health providers. “I think there is a benefit to having local government involved. That has been a strength of our system in the past.”