In Crisis: Idaho’s Fragmented Mental Health System Leaves Many Behind

Oct 27, 2014

Roy Vopal didn’t expect to live at a Boise Rescue Mission shelter in Downtown Boise this year. But the 60-year-old had a serious knee injury, then surgery, that he said left him unable to work for the first time in his life.

“Mentally, it’s a mind-screw” to be out of work, Vopal said. “It definitely twists the brain.”

Vopal says his service in the Marines during the Vietnam War left him with post-traumatic stress disorder.

“There were times when I wanted my life to end,” Vopal said. He attempted suicide in his 30s and used drugs.

Decades later, Vopal is receiving mental-health services through the homeless shelter.

Across the city in a quiet neighborhood, Danielle remembers a day six years ago when her son attacked her.

“My husband left for work, and my son was being perfectly charming ... ‘Bye, Daddy, I love you,’” she said. “The door shuts, we hear the lock click. My son turns around, at the age of 3, and says, ‘Now I’m coming after you, Mommy.’”

There are alarms on the boy’s bedroom door and window, and Danielle has taken classes to learn how to physically restrain him. She is desperate to get him into a residential therapy program.

Vopal and Danielle’s son are two of Idaho’s thousands of residents with mental illnesses.

Idaho’s mental-health system is fragmented and threadbare. It lacks resources — too few psychiatrists, too few options for Medicaid patients, too few 24-hour highly skilled treatment facilities for people with serious issues.

And, while Medicaid rolls swelled after the recession, Idaho didn’t increase its spending on mental health; the overall Department of Health and Welfare budget skyrocketed, while mental health got a smaller share.

WHERE WE STAND

When Idahoans with mental illness go untreated and their disorders spin out of control, they end up in crisis care at an emergency room, a state hospital or a local jail.

The state’s behavioral health program, which is separate from Medicaid, serves some of those people.

Some organizations are catching Idahoans who’ve fallen through the cracks — courts, hospitals and even homeless shelters started new programs, especially for people who don’t have insurance.

But that hasn’t been enough to solve the problem.

Idaho still has one of the country’s highest suicide rates — on average, 48 percent higher than the national suicide rate.

About 13 percent of impoverished Idaho adults who lack health insurance have a serious mental illnesses, such as schizophrenia or bipolar disorder.

Credit Data: Centers For Disease Control

About half of the chronically homeless Idahoans who seek shelter at the Boise Rescue Mission are there “as a direct result of an untreated mental illness and chemical dependency and alcohol abuse, because many people with an untreated mental illness will self-medicate with alcohol and other drugs,” said the Rev. Bill Roscoe, president and CEO of the Boise Rescue Mission.

The reason they’re untreated?

“Mostly, it’s because they don’t have access to mental health care,” Roscoe said.

CHANGING THE SYSTEM

State lawmakers and agencies are making big changes to Idaho’s fractured mental-health landscape — with the goal of creating a more efficient system. Some frontline providers and mental-health consumers are skeptical that the changes will work.

Last year, the Idaho Department of Health and Welfare hired Optum Idaho to take over the non-hospital portion of Medicaid’s mental-health services — like therapy and psychiatry appointments.

At the same time, Idaho is investing $45,000 in regional boards to link mental-health patients with community resources.

The most tangible effort the state is making is a new crisis center in Idaho Falls, giving people in crisis a place to go that isn’t an emergency room or jail cell. State officials wanted to open three of those crisis centers this year, but only got enough money from the Legislature for one — a kind of pilot project.

ARE THOSE CHANGES MAKING A DIFFERENCE?

The Idaho Falls crisis center is expected to open this fall. Its data will be closely watched by state officials.

In its first year, Optum Idaho’s takeover of Medicaid outpatient care has been fraught with payment errors, claims problems and long wait times. It also has meant people who relied on certain services under the old way of doing things aren’t offered for those same services today.

Ted Brown, left, a federal public defender investigator, and Missy Brown, who works for the school district, attend a mental health first aid training put on by Optum Idaho in Idaho City. Michelle Hochhalter, right, from Boise, is a certified peer support specialist.
Credit Katherine Jones / Idaho Statesman

But the company says it has opened new doors for Idahoans with mental illness — pumping up the roster of providers who will take Medicaid patients and offering mental-health first aid training to the public, for example.

Expanding Medicaid under the Affordable Care Act would allow more people with untreated mental illness to pay for treatment. State lawmakers are unlikely, though, to take up a Medicaid expansion bill in the next legislative session.

The legion of homeless men who come through the Boise Rescue Mission’s doors are among the most likely to benefit from such an expansion. They can’t access preventive mental-health care now, because the state doesn’t offer Medicaid to most poor, childless adults.

More than 22 percent of uninsured adults who don’t qualify for Medicaid now — but would, if Idaho expanded the program under the Affordable Care Act — were in “serious psychological distress” over a one-year period, according to a 2013 report from the Substance Abuse and Mental Health Services Administration.

NOT ENOUGH HELP AVAILABLE

Danielle didn’t want her last name published because she’s worried a public spotlight would pile extra stress onto her children, including her son. He was adopted as an infant and developed an alphabet soup of psychiatric disorders — ODD, ADHD, PTSD, RAD and a conduct disorder, which means it’s hard for him to follow rules and he is driven to misbehave, sometimes violently.

Danielle is frustrated by the lack of options for children like her son, who often must be sent out of state for residential care. She has been fighting the state to be willing to pay for that level of care, which costs upwards of $10,000 to $14,000 a month.

She acknowledges that it’s expensive, but she believes her son will soon start costing taxpayers more — in the criminal justice system.

“I think I vacillate between anger and sadness, because I think we can do better by these children,” Danielle said. “Our system is flawed. It needs more continuity, especially with these kinds of kids.”

"In Crisis" is a series exploring Idaho's mental health system. The reporting has been a collaboration between Boise State Public Radio and the Idaho Statesman.

Connect with reporters @EmilieRSaunders and @IDS_Audrey on Twitter.