Kitsap Mental Health staff waiting to see fallout from budget cuts that left 261 patients without treatment
By ANDREW BINION
Bremerton Patriot Staff Writer
April 22, 2011 · Updated 2:04 PM
The elderly man, a Kitsap County resident, was admitted to the emergency room because he was likely to kill himself.
The hospital, outside of Kitsap County, telephoned Kitsap Mental Health, where he used to be a client before he was discharged, one of 261, due to budget cuts. The hospital needed information on his medication and where they could send him.
It’s a scenario those with the community mental health agency say highlights what can happen when people who need mental health treatment are left untreated, and one they say may become more common. Staff at the agency learned about the elderly man’s condition because of the phone call.
Details of the incident cannot be released under federal privacy laws. However, the man was one of 261 clients receiving outpatient treatment the agency discharged starting Dec. 1 when state money to pay for lower-income patients was cut. The agency was providing them counseling, medication and help with life tasks. More than 100 additional people have been turned away since the cuts took effect.
The man had been enrolled in an outpatient program that provided therapy and case management for elderly patients, ensuring he had medication and help with other life tasks.
“Right now the majority are OK enough, but I think that’s probably due to the fact they have several months supply of medication,” Denise Hughes, supervisor for the community mental health agency’s adult services team, said Tuesday.
Kathy Smallwood, 66, of Bainbridge Island, was one of the patients cut near the start of the year. She had been going to the agency for the past 10 years, getting treatment for acute depression.
“It just absolutely devastated me,” she said. Smallwood, who does not own a car and lives in a subsidized apartment, has been able to find a psychiatrist through the Seattle Cancer Care Alliance.
But the loss of the relationships at the agency has been difficult.
“They were my support, they helped me through a lot of things,” she said.
In addition to dealing with depression that leaves her unable to do anything but cry, since becoming a client at Kitsap Mental Health Smallwood had two heart attacks, battled cancer, lost her mother and endured other family hardships. After paying for medications, she lives on about $200 a month.
Harrison Medical Center’s emergency department hasn’t noted an increase in the number of mental health admissions, but Hughes said the effects of leaving so many people without treatment may be delayed for as long as the prescriptions last.
“They haven’t had time to run out,” she said.
In the case of the suicidal man, Hughes believes the terrifying and costly crisis could have been avoided if the man was still a client with the agency.
“I don’t think it would have happened,” she said.
Those discharged suffer from some of the most serious mental illnesses, schizophrenia, bipolar disorder, major depression and post-traumatic stress disorder, and need treatment, said Executive Director Joe Roszak. Before discharging them, agency employees researched each patient’s case, a process Roszak described as long and painstaking.
“We did a lot of leg work hooking them up with any kind of resources,” Hughes said, including from the Kitsap-area tribes. Staff also made referrals to any psychiatrists or psychiatric nurse practitioners who would take the patients. Often it was a primary care physician who agreed to step in, sometimes a family member. Along with a supply of medication, they were then left to their own devices.
Employees who worked with those discharged fear what they will face.
“That’s the real heartbreaking part, and especially for clinicians, it’s necessary that they really know their clients really well and understand their stories,” Hughes said.
During the last legislative session, lawmakers had to close what was in March a $4.6 billion shortfall in the two-year budget cycle. In Gov. Chris Gregoire’s proposal, which the Legislature approved, $17.7 million was cut from the Regional Support Network non-Medicaid funding program. Analysts estimated the cut would affect 26,000 people statewide, said Ralph Thomas, spokesman for the state Office of Financial Management. Kitsap Mental Health’s share of the cut was $817,000.
That money paid for the treatment of 461 people who did not qualify for Medicaid because the value of their assets was too great, but many of whom were low-income, Roszak said. By reviewing each case, staff members found 55 patients who did qualify for federal dollars and 14 were found to have other sources of funding. However, staff members identified 111 patients who were not eligible for Medicaid dollars, yet whose condition was so severe the agency chose to use dollars from other programs to pay for their treatment.
It is a plan Roszak admits is a drain on the other programs. The agency has a paid staff of 447 and an annual budget of $21.3 million.
Lawmakers have approved restoring some of the cuts, offsetting them by $5.1 million, though Roszak said he doesn’t know when the money will be made available.
The options for those left without care are not many, and none are good, he said.
“You will see them in the ER, you will see them incarcerated, you will see them out in the streets and the bottom line is you will see more of them in the cemetery,” Roszak said last week. “Those are the four options.”
Harrison Medical Center’s Emergency Department had not seen an increase in visits from people with a mental health crisis from January through March, said Louann Bean, executive director of emergency and urgent care services. She said the emergency room gets about eight visits a day from people whose primary complaint is a mental health issue.
However, as the emergency room is often the place where those experiencing a mental crisis go, Bean said, officials will pay attention to those numbers in case they rise.
“We certainly expect that it will affect us,” she said.
Stays can often last more than four hours, although the longest Bean remembers is 96 hours.
“We are talking days,” she said.
And often, the hospital is forced to absorb the cost of stay.
“The longer somebody is here, the more resources are needed to take care of them,” Bean said. “When resources are consumed in one area, they may not be available in another.”
One of the other places those experiencing a mental break wind up is the Kitsap County jail. However, sheriff’s office spokesman Deputy Scott Wilson said the jail often doesn’t know when a mentally ill person is booked into jail. Because of privacy laws, jailers would not likely know the person being booked was, or is currently, a patient with the agency.
Those with Kitsap Mental Health wonder if it is a matter of time.
“We don’t really expect to begin to see the impact for several months,” said Rochelle Doan, spokeswoman for Kitsap Mental Health.