The mentally ill have long been pushed to the periphery of health care, and the systems for delivering care have reflected that. It was only in the past decade that Congress and most states began adopting parity legislation that placed coverage for mental health treatment on equal footing with physical health.

A task force commissioned by President Bush in 2002 called the nation’s mental health care system “a patchwork relic” because it wasn’t centered on the early stages of mental illness, where big problems and big costs can be headed off.

The feds’ current focus on modernizing systems is laudable, but funding decisions need to be brought into the 21st century, too.

For instance, when the feds demanded that states return tens of millions of dollars not directly spent on Medicaid, they weren’t thinking of patients; they were thinking of short-term budget goals.

Many states, including Washington, used that money for mental health care for those not poor enough to qualify for Medicaid but not rich enough to afford insurance.

The National Association of the Mentally Ill says the economic cost of untreated mental illnesses is $100 billion a year – $70 billion because of lost productivity, $30 billion because of diverted resources from law enforcement, education, the health care system, etc.

Early detection and treatment would head off these costs to society. Advocates estimate that every dollar spent on the front end can save $4 later.

The opposite of an effective early detection system can be found in Idaho, one of the few states that have yet to pass parity legislation.

The Kaiser Family Foundation reports that the state spends $46 per capita on mental health care. Washington spends $88; Oregon, $97; Montana, $124. The average nationwide is $84.

So how does the state deal with people with mental illness? In part, it locks them up after they’ve acted out. It’s no coincidence that Idaho’s corrections budget is slated for a double-digit increase this year. That’s one of the reasons NAMI gave the state an “F” in its recent evaluation of states’ mental health systems.

Washington state is doing better, but it can hardly be called progressive. The state got a D, which is the average grade for the nation.

But there is hope that systems will be improved so patients can get better care. Washington was awarded a federal grant that mandates officials listen to patients and their advocates before revising the process. While that sounds elementary, the sad truth is that patients have routinely been relegated to the background of jurisdictional spats between providers and those holding the purse strings.

The state and Spokane County went through a dust-up last year that took months to resolve. The good news for patients is that the state has backed away from collecting fines, and the Legislature is going to deliver more money.

That outcome reflects a growing realization that for a health care system to be effective, all players must be working toward the same goal. It’s healthier for budgets; it’s healthier for patients.