Report absolves mental health contractor

Top officials with Spokane County’s public mental health system wrongly blamed a local contractor for spiraling fines at state psychiatric hospitals, according to a strongly worded white paper released by Spokane mental health providers Thursday.

The panel found “no relationship” between millions of dollars in fines and the performance of a Spokane Mental Health team that handles involuntary commitments for the county.

Earlier this year, Community Services Director Kasey Kramer proposed severing Spokane Mental Health’s contract, saying the contractor had been slow to change even as the county system accrued more fines than any other in the state. The state’s Mental Health Division assesses the penalties, known as liquidated damages, if the county sends too many patients to Eastern State Hospital. The fines are part of a concerted effort to encourage counties to care for the mentally ill in community housing rather than institutional settings.

In a Feb. 18 memorandum, Kramer argued Spokane Mental Health contributed to the problem by involuntarily committing a large number of psychiatric patients to the hospital. County commissioners recently formed a task force to examine Kramer’s proposal to strip Spokane Mental Health’s contract.

The providers’ panel, which produced the report for the task force and county commissioners, found “no direct causal relationship between involuntary detentions and … liquidated damages.”

“The basic assumption was that there was a direct link” between Spokane Mental Health’s performance and the state fines, said Bob Faltermeyer, executive director of Excelsior Youth Center, and a panel member. “We felt that hypothesis was flawed. If you really dig deep, there really is no connection.”

Kramer did not return phone calls Thursday. Edie Rice-Sauer, administrator of the Spokane regional support network, which oversees public mental health programs, said she had not viewed the report. Rice-Sauer said she has continued to work with the task force to review the issue.

The county proposal surprised many in the mental health community, including Spokane Mental Health, which has held the contract since 1974 and said it received no warnings that the agreement was in trouble.

“What Kasey had characterized to the commissioners didn’t fit with what we knew,” said Wayne Rounseville of the Children’s Home Society of Washington, and a member of the panel. “It seemed to be working pretty darn well. Why are we fixing something that’s not broken when we have so many other problems?”

The white paper was endorsed by mental health experts from across the county, representing Catholic Charities, Lutheran Community Services Northwest, Sacred Heart Medical Center and Spokane Public Schools.

The paper was also endorsed by Spokane Mental Health, the agency whose contract is in jeopardy. Executive Director David Panken did not return a call seeking comment.

The white paper, dated April 25, blamed the penalties on state and federal policies that decreased resources for the mentally ill, failed to develop adequate community resources and created a payment structure that may reward the state hospital system for keeping patients committed.

The state’s Mental Health Division collects the fines from the county and passes the money on to the hospital. An Eastern State Hospital official said the money is used to bring in additional staff to care for the patients, but only covered the increased cost.

For Spokane’s public mental health system, those fines have on occasion topped $150,000 a month.

Last year, mental health workers placed more than 1,400 people in psychiatric holds after determining they were a threat to themselves or others, or were so sick they could not care for themselves. In 2002, a decade-long study concluded Spokane County hospitalized children at a higher rate than any other mental health system in Washington.

But the civil psychiatric commitments have also decreased 11 percent in the past five years. This was achieved, the panel said, even as the Bush administration’s crackdown on Medicaid spending resulted in the loss of public mental health care for 1,300 low-income county residents in the past two years.

The lack of resources in rural areas also makes Spokane a hub for people with mental illness, according to the panel’s paper.

The panel said the decrease in care resulted in patients who were sicker by the time mental health workers intervened, and required more intensive and costly care than in the past.

The paper also states that “there does not appear to be any data that would support the conclusion that detentions have been inappropriate or problematic in recent years.”

The panel said the county’s mental health system, known as the Spokane County regional support network, has instituted “significant changes” in recent years without the collaboration of providers in the community. Several of those decisions, the panel stated, “have later proven to be infeasible to implement.

“We believe it is in everyone’s interest to work collaboratively in an environment of open and honest communication and mutual trust,” the panel concluded.