A section of this week's feature story about Pierce County's experiment with privatized mental health raises questions about the increases in both suicides and suicide attempts in the Tacoma region. And the first question that comes to mind is this: Why have so many south Sound citizens been trying to kill themselves lately?
In an era when both public agencies and private companies are expected to do more with less, Optum consolidated and cut costs. The key component of the belt-tightening was a sweeping overhaul of the county's approach to mental-health care. Under the old model, troubled patients like Azadeh were more often involuntarily committed to the state mental hospital, where they faced lengthy--and costly--stays. Optum, on the other hand, began preaching "recovery and reintegration into the community." In other words, a stretch at the hospital is the absolute last resort.While ostensibly more humane, and certainly more cost effective, Pierce County's new approach under Optum has been accompanied by some unsettling side effects. More from our story:
"Their focus is supporting individuals in a manner that will allow them to continue on their road to recovery," says Tim Holmes, the administrator for behavioral health at Puyallup's MultiCare Good Samaritan Hospital, an Optum contractor. "It's a philosophical shift that's at the core of these changes."
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 by county residents in psychiatric facilities fell to nearly 40 percent below the state average.
In 2008, there were 508 attempted suicides--a rate of 62.8 per 100,000 residents--in Pierce County, according to hospital admissions data from the Department of Health. Those numbers increased to 603 and 75.3 in 2009, and again to 636 and 79.5 in 2010. With the exception of Skagit County, where suicide attempts also spiked over the past two years, the suicide-attempt rates for western Washington counties have remained comparatively constant. Even more unnerving, the number of successful suicide attempts in Pierce County steadily increased from 2008 to 2011, from 124 per year to 145, according to the Pierce County medical examiner.It's not detailed in the story, but here are the figures for suicide attempts in Skagit County:
Dolezal [the CEO of Optum Pierce County] says the spate of suicides at Joint Base Lewis-McChord partially skewed the data, and notes that Optum has erected billboards to educate the public about the new crisis-hotline number. "We're actively doing something," Dolezal says. "But there's no excuse for it."
Skagit County's mental health system is managed by the North Sound Regional Support Network (RSN), which also includes Island, San Juan, Snohomish, and Whatcom Counties. The North Sound RSN is publicly managed, but executive director Joe Valentine says in recent years they have taken a similar tact to Optum, more often using "community programs" to treat people instead of sending them to the Western State Hospital in Lakewood.
- 2007: 67 attempts, 60.3 rate (per 100,000 residents)
- 2008: 83 attempts, 73.1 rate
- 2009: 103 attempts, 94.9 rate
- 2010: 96 attempts, 86 rate
"Rather than immediately detaining people, the goal of the system is to treat people within the community," Valentine says. "Our board of directors wanted to move in that direction, and the state wanted to move in that direction."
The shift in strategy is borne out by hard numbers. Although less pronounced than in Pierce County, data from the state Department of Social and Health Services shows the North Sound RSN has had fewer "detentions" (individuals committed for up to 72 hours in local mental health facilities) and "revocations" (individuals commited to a state mental hospital for 90 days or more) since 2008.
DetentionsValentine declined to speculate on whether there's a correlation between the decline in hospitalizations and the increase in suicide attempts. He notes that the North Sound RSN faces geographic challenges (i.e. it can be difficult access to mental health care when you're stranded on one of the San Juan Islands), and was hit hard by state budget cuts.
"There's nothing there that would give us any data about what could be driving increased suicide attempts," Valentine says. "My guess would be as good as yours as to how much is related to the economic collapse."
Intriguingly, according to the Department of Health, even though the rate of suicide attempts in Skagit County was quite high, there were only 19 successful suicides there in 2010, a rate of 16.3 per 100,00 population, which is relatively low compared to the rest of the state.
For the record, the most suicidal county in Washington is Skamania, a mostly rural area that skirts Mt St Helens in the southwest part of the state. There were eight suicides in Skamania County in 2010 (the most recent year with data available online), a rate of 72.3 per 100,000 residents. That nearly doubles the runner-up, Asotin County, which had 8 suicides for a rate of 37. King County led, by far, in the total number of suicides (226 total in 2010) but the rate was just 11.7.