Our feature story last week -- "Mad Medicine" -- examined the hidden costs of the state's decision to privatize management of mental health services in Pierce County. But the question remains: will companies like OptumHealth eventually takeover operations in King County and other areas in Washington?
With the long-term budget outlook for mental health services bleak, for-profit companies like Optum that emphasize balancing the bottom-line above all else are an appealing alternative to the costly, somewhat bureaucratic state-run "Regional Support Network" (RSN) system. Moreover, the state Department of Social and Health Services is making "community treatment" -- avoiding lengthy hospital stays except as an absolute last resort -- a priority going forward.
"Involuntary hospitalization can be a traumatic experience that should be used as a last resort," DSHS officials MaryAnne Lindeblad and Chris Imhoff commented in response to our story. "Far and away the best approach to mental health treatment is to have a public mental health system that stresses robust community services and supports...Admittedly, as a state we are not yet reaching these high aspirations."
As detailed in our feature, Optum is eager to expand in Washington, and they have already proposed reducing the number of RSNs from 13 to 3. The state didn't act on the proposal, but a less radical consolidation seems imminent.
Officials from New Mexico (where Optum also manages mental health services) and Pierce County, however, were far from enthusiastic about their experiences with Optum. From the our "Mad Medicine" story:
But Pierce County officials are still on the fence about Optum. In light of the ongoing issues at the jail and the steadily rising suicide rate, Deputy Pierce County Executive Kevin Phelps says the county has "been having discussion about going back to the state.Last week, after the story was published, Phelps called to reemphasize the fact that Pierce County did not initiate the switch to Optum (budget cuts left the County unable to provide all the services mandated by DSHS, which led to Optum being pushed as a solution), nor are they particularly pleased with the outcomes.
"They assured us when we went to the RSN private-sector model, we would not see negative impacts in the community," Phelps says. "We are starting to see some negative impacts, and we need to re-engage in dialogue with the state and Optum to see if we can mitigate those."
"[DSHS] kind of forced us out of the RSN and forced us to go with a provider," Phelps says. "This is not something we eagerly got into."
Once the decision was made, however, Phelps says he and other Pierce County officials had no choice but to make the best of the situation.
"From a public service perspective it was compelling on us to make it work," Phelps says. "It wouldn't help our citizens if it it's a failed system. We wanted to get behind Optum and be as supportive as we can."
And, despite the problems in Pierce County under Optum -- increased suicide rate and suicides, more people with mental illness ending up at the County jail -- Phelps suspects other counties will end up retracing Pierce's footsteps.
"This is going to come up again," Phelps says. "I think they'll try to do this maybe throughout the state. And it won't be the counties that'll be letting it happen, it'll be the state."