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Caring for mentally ill: 3 counties’ success stories
TIMES WATCHDOG: While other areas of the state face a crisis caused by the shortage of psychiatric hospital beds, three Central Washington counties have kept the mentally ill out of emergency rooms by providing intensive outpatient and early-intervention programs.
Seattle Times staff reporter
YAKIMA — Valerie Thompson felt herself losing control.
She started seeing imaginary men, then hearing knocks on her door.
In a past life, these types of symptoms ended in suicide attempts and involuntary detentions. But this time, Thompson knew what to do.
The 58-year-old woman, who had been diagnosed with bipolar disorder, called her case manager, whom she had grown to trust through repeated home visits.
The case manager made sure Thompson went to the Sunrise Club, a support center for mentally ill Yakima residents. She went with Thompson to a doctor, who prescribed a medication change. And she continually checked on Thompson’s status.
Thompson was yanked back from the ledge, without needing to go to a hospital.
Experiences like Thompson’s are common in Yakima, which employs an innovative approach to mental health that officials here say has saved lives and largely shielded patients from a mental-health capacity crisis gripping the rest of Washington state.
Statewide, thousands of involuntarily detained residents have already this year been “boarded,” or forced to wait for hours or days in hospital emergency rooms and medical units before receiving psychiatric treatment, a Seattle Times examination found. In King County, the traumatizing experience is now occurring in nearly two-thirds of detentions.
But in Yakima, Kittitas and Klickitat counties, only 11 patients out of 320 involuntary commitments this year have endured that kind of wait without treatment. And for seven of those who were boarded, it was because they had other medical problems that needed to be addressed before psychiatric treatment could begin.
Some of the region’s methods may be difficult to implement in larger cities.
But experts say that nonetheless, there are lessons to be gleaned from a rare success story.
The area’s approach, crafted over two decades, centers on a set of intensive outpatient and early-intervention programs aimed at preventing hospitalizations. Keeping patients out of hospitals saves money, allowing for investments in local efforts to help the mentally ill.
That positive cycle has led to the state’s lowest per capita psychiatric patient hospitalization rate: The region is currently using just 19 of its 31 allocated beds at Eastern State Hospital.
The chief executive officer at Central Washington Comprehensive Mental Health, a private nonprofit that conducts almost all the psychiatric services in the three-county area, said the success shows that while more mental-health treatment beds are sorely needed in Washington, there are also other ways to address the problem.
“There’ll never be enough dollars and there’ll never be enough beds,” said the CEO, Rick Weaver. “You have to do something about it. You can’t be a victim.”
Born out of crisis
The Yakima area’s efforts were born out of a crisis that was similar to what the rest of the state is facing.
In 1990, Yakima County involuntarily committed more residents per capita than anywhere else in Washington — and didn’t have nearly enough space for them.
The detainees poured into the ER at Yakima Valley Memorial Hospital, untreated and preventing nurses from helping other patients, as they awaited a spot in the hospital’s psychiatric unit.
Then frustrated hospital officials abruptly decided to stop accepting mental-health patients in the ER altogether. With no other option, the county began sending all detained residents who were severely mentally ill to wait for treatment in jail.
The state intervened, demanding a new plan.
The next year, Yakima responded by opening Washington’s first Triage Center, a 16-bed, unlocked facility where residents who are in a mental-health crisis, or impaired by drugs or alcohol, can connect with experts, get medication and stay until their needs are met.
Other areas have recently opened similar centers. King County opened one, called the Crisis Solutions Center, last spring.
But in Yakima, it was the first of many moves funded by grants and, eventually, savings from reduced hospitalizations.
In all, Weaver and Vice President Paul Nagle-McNaughton said, their organization now runs 104 programs aimed at serving mentally ill patients in the community and reducing the likelihood they will need to go to a hospital.
Among the programs is the Sunrise Club, which Valerie Thompson attends daily, and a special nursing home for psychiatric patients.
Another is a unique dual-disorder center, which provides care tailored for the many patients with both mental-health and chemical-dependency problems.
Comprehensive also has an “assertive community treatment” team, which provides what supervisor Courtney Hesla described as “inpatient care without walls.”
“The team goes to people’s homes, makes sure that they’re taking medication, helps them with housing, everything,” Hesla said.
When a crisis arises, officials make a point to meet patients where they are. Whereas mentally ill people in other counties are almost always evaluated for possible detention at an emergency room, some 80 percent of Comprehensive’s evaluations take place in the community.
If the person is sick enough to fit the criteria for involuntary commitment, officials try to persuade him or her to seek treatment voluntarily. That’s usually more effective, and cheaper because it does not have to be done in a hospital setting.
The result is fewer involuntary commitments.
The Yakima area is succeeding even compared with similar regions.
In the nearby Tri-Cities, with a similar population, instances of waiting for treatment have sharply increased, from eight in 2009 to 84 in the first six months of this year.
Yakima is not allowing more dangerously mentally ill patients out on the streets, Weaver and Nagle-McNaughton said; it’s allowing more safe mentally ill patients out on the streets.
Pete Schoordyk agrees.
The 75-year-old man recently decided to move his family from Seattle because he believed his son would get better mental-health treatment in Yakima.
“They really care about the patient,” Schoordyk said. “It’s a good system.”
“We need more”
Karen Keiser, the top Democrat on the state Senate Health Care Committee, said the Yakima system represents the type of approach that lawmakers envisioned when they started downsizing state psychiatric hospitals years ago.
Unfortunately, Keiser said, other areas like King County have not been able to successfully implement it.
The state has recently made an effort by funding more intensive outpatient programs. About a dozen assertive community treatment teams are operating, said Maria Monroe-DeVita, a University of Washington professor who trains the teams.
“We need more,” she said.
Medicaid expansion could help the state move further by giving more poor residents access to routine medical care, including mental-health care.
Several officials said the expansion, which began last week, should mark the beginning of a new era in mental health in Washington.
Among the most optimistic is Ed Thornbrugh, a mental-health administrator in the Tri-Cities — the nearby area in the throes of a capacity crisis.
“More people having the purchasing power to obtain early intervention, preventive, routine, maintenance care ... will hopefully reduce services for deep-end care,” he said. “That’s the light at the end of the tunnel here.”
Brian M. Rosenthal: 206-464-3195 or email@example.com. On Twitter @brianmrosenthal