In Crisis: Understanding Idaho's Fragmented Mental Health System

According to the National Alliance on Mental Illness nearly a quarter of Idahoans are living with a mental illness. Nearly 6 percent of those people are living with a serious mental illness like schizophrenia or bipolar disorder. In addition, Idaho has one of the highest suicide rates in the country. On average, Idaho's suicide rate is 48 percent higher than the national rate.

Shawna Ervin gets her blood drawn regularly to make sure her medication to treat schizoaffective disorder isn't damaging her body.
Credit Darin Oswald / Idaho Statesman

So, what's the state doing to turn around those statistics?

Boise State Public Radio and the Idaho Statesman have teamed up to better understand Idaho's fragmented mental health system. In a series we're calling "In Crisis," we'll explore why so many Idahoans aren't getting mental health care until they're in the middle of an emergency.

We'll show you how social workers have partnered with law enforcement to provide crisis care to people dealing with emergencies. We'll show you how hospitals and the court system have stepped in to fill the gap in mental health care. And we'll explain why people getting mental health care through Medicaid have watched their services change over the last year.

We'll introduce you to people who have gone through mental crisis, drug abuse, jail, hospitalization and personal struggles. Some of them are just starting their journeys to recovery, some are now helping other Idahoans navigate mental illness.

You'll find each piece of this multimedia reporting collaboration here.

Katherine Jones / Idaho Statesman

Shannon Guevara stood in a courtroom in front of her peers — a group of people who, like her, had committed felonies but whose severe mental illnesses made them eligible for a special court. She talked about her four kids, her husband, the classes she was mandated to attend after being convicted of a drug crime. And she beamed, because on this June afternoon, she was another step closer to a happy ending.

Frankie Barnhill / Boise State Public Radio

According to the National Alliance on Mental Illness, nearly a quarter of Idahoans are living with a mental illness. Idaho has one of the highest suicide rates in the country. Nearly 22,500 Idahoans receive mental health treatment through Idaho’s Medicaid program. 

It’s the access to services, and a web of service providers, that have proven difficult for folks in need of care.

All week Boise State Public Radio and the Idaho Statesman have been reporting on Idaho's fragmented, underfunded, and threadbare mental health care system.

We've learned that Idaho doesn't have enough psychiatrists or treatment facilities. It doesn't have enough resources for some of the state's poorest residents.

In Crisis: Idaho Medicaid In Flux Causes A Big Shift In Care

Oct 31, 2014
mental health, in crisis
Katherine Jones / Idaho Statesman

Nine-year-old Kendra sits in one of the private rooms on the second floor of Boise’s Downtown public library with her community-based rehabilitation services worker, Jennifer Beason.

Beason slides a workbook to Kendra. It is what she calls her feelings journal. “Do you know what relieved is?” she asked.

Without missing a beat, Kendra rattles off examples of feeling relieved.

Gary Raney, sheriff
Katherine Jones / Idaho Statesman

Idaho prisons, jails and courtrooms aren’t just parts of the criminal justice system. They also have been tasked with providing treatment to Idahoans with mental illness.

'WOW, THAT COULD HAPPEN TO ANYBODY'

Judge Michael Reardon started working at Ada County Mental Health Court seven years ago, in addition to his work as a family-law magistrate judge.

mental health, in crisis, shannon guevara
Darin Oswald / Idaho Statesman

It’s a sunny September afternoon, and the room is packed. It’s like a movie theater before the lights go down — the buzz of nervous energy, nattering about plans for the weekend, someone lingering in the aisle until the very last minute.

But this isn’t the movies. It’s a courtroom — one where the stakes aren’t just “jail” or “no jail” but are, for many of the people in the room, much deeper.

Idaho has 10 special mental-health courts, where adult felons diagnosed with one of four mental illnesses show up each week to talk to a judge.

mental health, in crisis
Katherine Jones / Idaho Statesman

Several people interviewed by the Idaho Statesman and Boise State Public Radio did not want to be named or quoted because of stigma surrounding mental illness. Shawna Ervin of Nampa believed the issue of mental illness in Idaho is important enough to share her story, despite concerns from a family member that doing so could hinder her job search. Shannon Guevara of Nampa did not seek treatment for decades for her bipolar disorder because of stigma around psychiatric disorders.

mental health, in crisis
Darin Oswald / Idaho Statesman

The voice started when Shawna Ervin was 16 years old, and it hounded her for two years.

It told her to hurt herself.

“It was relentless and wouldn’t stop laughing at me until I burned myself on my face,” she said.

When she finally did burn her face, the laughter turned maniacal. Then it stopped.

Ervin’s mental illness is not rare. She is one of thousands of Idahoans whose disorders can be severe enough to warrant hospitalization.

Philip Mazeikas, mobile crisis, mental health
Joe Jaszewski / Idaho Statesman

Two years ago, Philip Mazeikas answered the front door of his family home. The course of his life changed when he opened it.

At 24-years-old, Mazeikas found himself in the middle of his first psychotic episode.

He thought he'd been contacted by aliens who were using him in a scheme to control the world. He wasn't eating well. He was drinking his own urine.

mental health, in crisis
Joe Jaszewski | jjaszewski@idahostatesman.com / Idaho Statesman

Philip Mazeikas, now 26-years-old, started noticing signs of his mental illness when he was 18.

"I started thinking there was a prophecy about me rising to power, or being famous," he says. "Things turned worse when I was 23, when I started hearing voices."

By the time Mazeikas was 24, the Boise Police Department had been called to his home more than once. Mazeikas had become unpredictable and volatile. 

"He would sometimes say to us, 'Hey Dad I'm back, I've been gone a while'," Mike Mazeikas recalls.

In Crisis: How To Help Someone Needing Mental Health Care

Oct 27, 2014
telephone, buttons, hotline
Emilie Ritter Saunders / Boise State Public Radio

If you or someone you know is in crisis, here are some phone numbers to call:

  • Idaho Suicide Prevention Hotline: 1-800-273-8255
  • Idaho's 24-hour crisis line: 2-1-1
  • Medical or public safety emergency: 9-1-1

If someone you know is in emotional crisis and you worry they're in need of help, here are some warning signs to watch for from the National Suicide Prevention Lifeline and National Institute of Mental Health.

Katherine Jones / Idaho Statesman

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.

Becky diVittorio, Optum
Idaho Statesman

A federal agency is investigating whether the company Idaho hired to manage part of its Medicaid program has violated patient-privacy laws.

Optum Idaho, a unit of United Behavioral Health, took over insurance management for Idaho Medicaid's mental-health and substance-abuse patients last fall.

Local health-care providers who treat those patients say Optum has erroneously sent them reports meant for other providers. The reports show patient names and mental-health or substance-abuse services the patients received or were authorized by Optum to receive.

Darin Oswald / Idaho Statesman

The state’s effort to rein in Medicaid costs has created deep friction between small businesses that deliver behavioral-health services to Medicaid patients and a new contractor hired to manage them.

Service providers across Idaho have raised complaints over the last 11 months that the contractor, Optum Idaho, a unit of United Behavioral Health, has created red tape and cut services needed by at-risk patients.