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Originally published Wednesday, February 19, 2014 at 4:04 PM

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Editorial: Integrate mental health with primary care

Integrating public mental health, chemical dependency and primary care services are a worthwhile priority for the Legislature in the remaining weeks of the session.


Seattle Times Editorial

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LAST summer, the federal government demanded, based on an obscure audit rule, that Washington state tear up its public mental-health system and effectively open up vital services to privatization.

After pushback from the state attorney general, the demand was rescinded — to the relief of many. Washington’s mental-health system has problems, but bureaucratic foot stomping by the federal Centers for Medicare & Medicaid Services wasn’t helpful.

Nonetheless, the episode may prove, in part, to be a blessing in disguise. The federal demand helped prompt Gov. Jay Inslee’s administration to propose broader reform, involving integration of the public mental-health system with chemical-dependency treatment and primary care.

Those ideas have been talked about for a while, but are now working their way through the state Legislature. The Senate version, SB 6312, and House version, HB 2639, have different approaches but a shared vision. Both have strong bipartisan support.

Currently, mental health is provided by regional networks, chemical-dependency treatment by counties and Medicaid-funded primary care by yet another entirely separate system. They operate as stand-alone silos, with limited coordination. This structure, dictated largely by antiquated funding models, is wholly inefficient.

Breaking down these silos is complicated but feasible. The state has a big incentive to do this work. It would reduce the incidence of people with serious mental illness dying earlier — on average by 25 years — than the general population, largely because of preventable illnesses.

Elsewhere, integration of behavioral health and primary care has saved money, partly due to lower use of emergency care, and has produced better health. Several mental-health providers, including Navos in West Seattle, have already opened primary-care clinics within outpatient psychiatric facilities.

The 2013 Legislature planted the seeds for integration, via a task force to re-examine the mental-health and chemical-dependency systems, and by setting much-needed performance measures for these systems. The proposals in the Legislature build on that ongoing work.

Integration of these services is fundamental government reform — potentially saving taxpayers money while offering better health care to some of the state’s most vulnerable citizens. That should be a strong incentive for the Legislature, in the remaining weeks of the session, to get it done.

Editorial board members are editorial page editor Kate Riley, Frank A. Blethen, Ryan Blethen, Sharon Pian Chan, Lance Dickie, Jonathan Martin, Thanh Tan, William K. Blethen (emeritus) and Robert C. Blethen (emeritus).



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