Grading the States 2006: Idaho - Narrative
Idaho is one of the worst states in the nation when it comes to the adult public mental healthcare system. Leadership, commitment, and investment in the system are all low. The state has one of the lowest per capita spending rates on mental health services in the nation.
Governor Dirk Kempthorne recently proposed a Medicaid waiver to the federal government, in order to make significant changes in the state program. From background materials available in early February 2006, including the governor's concept paper, it appears that adults with serious mental illness will continue to receive the same benefits - but further information and analysis will be needed to fully assess the implications of what is a major reform initiative.
"Adult" is also an especially important distinction in talking about Idaho's system.
First Lady Patricia Kempthorne, wife of the governor, has devoted herself to mental health and substance abuse issues, but focusing primarily on the needs of children. She chairs the Governor's Coordinating Council for Families and Children- and has publicly spoken out about her own experience with depression. What can't be measured, except over time, is the degree to which she may have helped to reduce stigma - and opened the state's political community to broader dialogue on mental illness.
The Division of Family and Community Services (DFCS), located within the state's Department of Health and Welfare, is responsible for mental health services. Seven Regional Mental Health Authorities (RMHAs) provide community mental health services, and two state hospitals - North and South - provide inpatient care.
Low funding levels have been stretched even thinner by the state's large population growth over the past 15 years. New challenges include an increasing concentration of people of Latino heritage in the southern part of the state, and increasing population in cities and towns.
There is an astonishing shortage of mental health professionals in the state. According to the state's FY 2005 federal block grant application, within the public adult mental health system, there are only approximately nine psychiatrists, nurse practitioners, and physician's assistants across the entire state to supplement other clinical staff. The federal Health Resources and Services Administration (HRSA) has designated the state a Healthcare Professional Shortage Area (HPSA), but the state reports it has not undertaken a workforce assessment or designed a strategic plan to meet the need.
It only gets worse:
- Assertive Community Treatment (ACT) programs are the only evidence-based practice (EBP) in the state. ACT teams operate in all seven regions, but only four are fully staffed and able to meet model standards.
- No integrated treatment exists for individuals with co-occurring mental illness and substance abuse.
- No supported employment program.
- No supported housing services or plan to address long-term housing needs.
- Despite repeated recommendations from the State Planning Council on Mental Health (SPCMH), Idaho also has not pursued accreditation for State Hospital North from the Joint Commission on Accreditation of Healthcare Organizations (JCAHO).
- The state reports no Olmstead compliance plan to assure that individuals currently in institutions receive care in an appropriate setting.
- Workforce shortages affect access to inpatient care in the two state hospitals. Advocates report that beds lie empty because of a lack of staff.
The SPCMH has urged the state to create more opportunities for direct consumer and family involvement in policy and programs - including monitoring teams - but one of the few mechanisms for inclusion is representation on RMHA oversight boards.
Finally, the state legislature's continuing failure to pass mental health insurance parity stands as a symbol of apathy and shortsightedness—failing both to remove stigma and discrimination and to recognize the potential burden of mental illness on middle class families, and the eventual cost to taxpayers, when such families are forced to spend down assets and enter the public system.
Now for the good news (there is always some).
Partnerships between the legislature and criminal justice system are helping drive reforms. Mental health courts are spreading across the state, and judges involved with the courts have been advocates for increased funding for ACT teams to ensure community services for individuals they see in court.
To help reach the estimated one-third of the state's population that live in rural and mountainous areas, DFCS also is creatively using regional field offices,technology, and mobile treatment teams.
Nonetheless, Idaho has a long way to go before it even approaches the vision of a recovery-oriented system.
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