Sound Off: Mental health services fade
July 3, 2008 · Updated 10:57 PM
By Tim Clark
I recently retired after serving for nearly 20 years as a County Designated Mental Health Professional. In that capacity I evaluated people with mental illness who were likely to harm themselves or others. It was my job to evaluate whether they were a danger because of a mental illness, and if so, detain them involuntarily to a psychiatric hospital.
A couple of years ago federal administrators began enforcing regulations which reduced federal funding to Washington for mental health services. The state responded with some increased funding and passed a law that allowed Island County to increase its sales tax to make up some of the deficit. The increased state funding was insufficient to maintain existing services. The county-funded services wont begin for many months. The reduced federal funding caused many mental health programs to close. Some of the problems I experienced are:
All community mental health programs were discontinued for persons not enrolled in Medicaid.
All persons evaluated for involuntary detention are billed $150.
Psychiatric hospitals in Western Washington increasingly lack adequate capacity.
Let me describe a typical situation which illustrates some of the problems:
A person tells a friend that he plans to jump off the Deception Pass Bridge, or shoot himself, or overdose on drugs. She calls 911. Police bring him to Whidbey General Hospital Emergency Room. I interview him and learn that hed recently lost his job and his wife is leaving him. He is acutely depressed. We talk about how he can deal with depression with counseling and medications. We discuss how he can deal with his financial and relationship problems. We talk about his suicidal impulses and alternative actions he can take. He would like counseling but has no insurance. He cant afford to pay $100 an hour for private therapy.
Three years ago I could have arranged five crisis counseling sessions at the local mental health center at no cost. Three years ago I could have arranged for him to stay at a respite house in Oak Harbor staffed with mental health para professionals. For the last two years I have had to inform him that he qualifies for no services and he will be billed $150 for talking with me.
Without follow-up treatment I am more likely to conclude that a client presents a serious risk of suicide and requires psychiatric hospitalization. Three years ago I could arrange psychiatric hospitalizations within two hours. There was always a bed. Now, not infrequently, no psychiatric bed is available.
Psychiatric patients are often very disruptive to the emergency room. Not finding a hospital bed, my alternatives were to let him go home, or go back on the street if he was homeless, or detain him temporarily to Whidbey General Hospital until a psychiatric bed became available, which takes a day or two. If the client is delusional, paranoid, or just angry, a police officer is called to make sure he didnt leave the emergency room. If he resists the policeman he is tied to a hospital bed. He receives no mental health treatment in the emergency room. There is no psychiatrist on staff. He is sedated.
I have wondered what the federal officials who decided to enforce the regulations that decimated our mental health services were thinking. I hope their reasons are more benign than I can imagine. The effect on the profoundly confused and hurting people I have been serving has been very harmful.
I share these observations with the hope that Whidbey residents will encourage our elected officials to restore mental health services. The recent increase in Island County sales tax dedicated to mental health services will help. I especially hope those funds will be used to restore counseling programs for clients not enrolled in Medicaid. Also restoring our Respite program would not only help persons who are temporarily unable to care for themselves but also alleviate overcrowding in our psychiatric hospitals.
We need a government in which the primary goal of every part is to solve problems, not reduce their funding. A partnership would do both. Vast sums of taxpayer money are spent by different branches of government maneuvering to force expenditures to come out of the others budgets.
My hope for this letter is to inform you of the pain and suffering experienced when government doesnt work. Lets make it work. All of it. It will take all of us.
Tim Clark has lived on South Whidbey since 1975. Besides working as a County Designated Mental Health Professional he has worked as a Child Protective Service Social Worker and provided data analysis for research on child abuse for the Washington State Office of Childrens Administration Research for 15 years.