A short-term, voluntary treatment center for people with mental illness and substance abuse problems is scheduled to open in the Central District in late July despite protests from some homeowners concerned about living next door to the facility.
A mobile crisis team that includes mental health professionals and peer counselors on staff will refer people to the facility, as will police and paramedics. All stays are voluntary, but the cops can deliver someone to the door in handcuffs. Only people who have "not committed a violent crime and do not have a history of violence" are eligible. Nevertheless, a potential influx of mentally unstable, homeless, drug addicts has rankled some people in the neighborhood, delaying the project by more than a year. The NIMBY uproar culminated with a lawsuit, which was rejected by the King County Superior Court in early 2012.
The concern -- detailed in last year by Central District News and KPLU, among others -- was mostly quelled with promises of close supervision and careful coordination from the County. Of course, there's also the expectation that the facility will not only help stabilize some seriously troubled individuals, but also potentially save millions as fewer people end up jail, emergency rooms, and/or the state mental hospital.
Amnon Shoenfeld, director of King County's Mental Health, Chemical Abuse and Dependency Services Division, says previous work with the Committee to End Homelessness and a criminal diversion program produced similar results. "We found that, by housing people with mental illness and substance abuse problems that are frequent users of public services, we can tremendously reduce [costs]," Shoenfeld says. "It's saving money for taxpayers and providing better care for individuals."
If that phrasing sounds eerily familiar, it might be because officials from OptumHealth, the for-profit company now managing Pierce County's mental health services, said similar things about their recently established community treatment programs in "Mad Medicine," the feature story in this week's edition of Seattle Weekly.
Cheri Dolezal, executive director and CEO of Optum's Pierce County operation, couldn't speak directly to Azadeh's case, but she emphasizes that Optum's goal is to stabilize patients in the least restrictive setting possible. "If you listen to a person, they'll tell you what they need," Dolezal says. "Sometimes they think they need to be hospitalized because that's the way the system is, when in actuality there's lots of things you can do in the community to help them feel safe, provide space for them to recover, and get them the support they need."In the story, however, Shoenfeld is an outspoken critic of Optum. Optum's strategy has succeeded in sharply cutting costs, but has also raised concern.
Dolezal says Pierce County was simply detaining far too many people. In her view, many individuals can be convinced to seek voluntary care through Optum's new initiatives, such as the 24-hour recovery response center or the mobile outreach van. Not only are those options less restrictive, they are also far less expensive. Medicaid will not pay for many of the costs associated with involuntary commitment, so the process tends to drain a disproportionate amount of the ever-dwindling state-only funds.
Shoenfeld worries that something tragic is bound to happen when people with serious mental issues, who elsewhere in Washington might be involuntarily committed, are allowed to roam the streets. "If you make a mistake, it can have very real consequences," he says. "But at the same time, they don't want to force someone into a hospital if outpatient [treatment] can work."Shoenfeld notes that the difference between the two approaches is financial (as a public agency, the King County mental health system keeps 2 percent of funds for administration costs versus 10 percent pocketed by Optum for profit and management), and philosophical. While the number of Pierce County residents committed the state mental hospital has plummeted under Optum's watch, the county is seeing more people with mental issues end up in jail, and perhaps migrate up to King County for services.
"There's a profit incentive for Optum not to hospitalize people," Shoenfeld is quoted as saying in this week's feature. "It's a natural area to look at to make sure that's not driving decisions about what needs to happen when people with mental illness are presenting a danger to themselves or others."
Although there might be some unfortunate side effects specific to Optum's approach, the principle of "community treatment" -- keeping mentally ill people out of restrictive hospital settings unless they absolutely need to be there -- is still gaining traction across the state. And for good reason.
"Mentally ill people typically hate being in the hospital," says Ginny Peterson, former president of the Pierce County chapter of the National Alliance on Mental Illness. "It can be a reset button [for them], but they don't like staying there. And it's expensive. If we can avoid it, we should."