Our feature story this week -- "Mad Medicine" -- investigates the hidden costs of privatizing mental health in Pierce County, and describes how one Tacoma family became so frustrated with the system they ultimately sent their schizophrenic daughter to live with family in Iran and receive treatment there.
Seattle Weekly spent more than six weeks reporting, researching, and gathering information about the public-to-private transition. Here's what we discovered:
On Optum's watch, Pierce County has experienced a major decline in the number of involuntary commitments to the state mental hospital, and the average number of days spent in psychiatric facilities by county residents fell to nearly 40 percent below the state average. Those outcomes saved millions, and led to Optum being widely touted for its successes. With the long-term budget outlook still bleak, Optum's bottom-line focused approach is enticing to some state and local officials, and the company is now working to expand its presence in Washington.The documents, spreadsheets, and publications embedded below are the basis for much of the information found in this week's feature.
But while some of Optum's results look good on paper, several troubling developments have also coincided with the company's brief reign in Pierce County. Both suicides and suicide attempts have steadily increased countywide since they took over in 2009. The number of mentally ill people booked into the Pierce County jail has risen to the point that one official says the jail has become "a de facto psychiatric facility." And, although fewer people are being hospitalized for mental illness, sources say some patients in dire need of long-term psychiatric care are frequently turned loose, or pawned off on King County so that Optum avoids footing the bill.
For starters, here's Optum's own fact sheet detailing their "Crisis System Redesign" in Pierce County:Crisis System Redesign in Pierce CountyAnother document from Optum, touting their successes in Pierce County:Pierce County RSNClick to view the Medicaid Health Plans of America, Center for Best Practices "Compendium for Serious Mental Illness." Optum's "Peer Bridger" program -- which trains individuals recovering from mental illness to work as mentors in the mental health system -- is lauded on page 24. According to Optum, the program has reduced hospitalizations by 79 percent, resulting in savings of $550,215.Amnon Schoenfeld, director of King County's mental health, chemical abuse, and dependency services division, is an outspoken critic of Optum. In January, he lobbied against allowing the company to expand in Washington, and authored a memo to state officials attempting to debunk some of Optum's claims.Response to Optum RSN Concept PaperThe following spreadsheet was provided by the Washington Department of Social and Health Services. It shows the number of Involuntary Treatment Act investigations, detentions, and revocations by both county and RSN. Note the drastic decline in the number of Pierce County "detentions" (when a mentally ill individual is held for 72 hours for treatment and further evaluation) and "revocations" (when someone is committed to a state mental hospital for 90 or 180 days), while the number of investigations of individuals with mental illness stayed roughly the same.Washington ITA StatisticsThe following document shows the number of "Forensic Evaluations" at Pierce County's jail. Evaluations -- when a trained psychiatrist meets with an inmate -- at the jail more than doubled from 2009 to 2011. According to jail administrators, this indicates more people with mental illness are ending up behind bars as a result of Optum's policies.
The following spreadsheet was provided by the Washington Department of Health. It shows the number of suicide attempts in the main Western Washington Counties from 2001-2010. The "rate" is per 100,000 residents. Note the spike in Pierce County suicide attempts since 2008.Suicide Attempts Western Central Counties 2001_2010When it comes to successful suicides, a page on the Washington State Department of Health website ominously titled "Death Data" contains recent figures for suicides by county statewide. The Pierce County Medical Examiner's website lists suicide data dating from 2004 to 2011.
Source: Pierce County Detention and Corrections Center
Another issue addressed in the feature is the statewide shortage of hospital beds for individuals with mental illness. Former King County Executive Randy Revelle, now the senior vice president of the Washington State Hospital Association, says Washington ranks near the bottom nationally in number of mental health beds per capita. Revelle is leading a Task Force on Inpatient Mental Health seeking solutions to the dilemma. He supplied this document, which shows the number of psychiatric hospital beds in Washington as of 2012:Washington Hospitals Psychiatric Beds 2012More on the bed shortage from the feature:
The situation is so dismal that, in 2010, the state legislature unanimously passed a new law (HB 3076) that allows mental health workers to solicit input from family members, friends, neighbors, etc. about whether a person should be involuntarily detained. But, because more people would assuredly be sent to Western State, the lawmakers delayed enacting many provisions until 2015 to avoid the extra costs - an estimated $12 million for a new ward, additional staff, and operating expenses.All the essential info on HB 3076 is available on the Washington State Legislature's website.