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Few mental health options here

Cost of sending North Idaho patients elsewhere in the state for help are steep


COEUR d'ALENE - Just keep driving south.

For area law enforcement agencies that has become the key to finding a bed for those who police have taken into custody because they are a danger to themselves or others.

When the beds are full at Kootenai Behavioral Health Center - North Idaho's lone facility for involuntary police holds - the next nearest option is St. Joseph's Hospital in Lewiston. Often, there are no beds available there, either.

What may have been the first step to addressing North Idaho's mental health crisis has also gone south - 500 miles, to be exact. Idaho Gov. Butch Otter last month announced that Idaho Falls, in southeast Idaho, would be home to the state's first mental health crisis center with funding from the Legislature's 2014 session.

The center will be open around the clock and aims to take the pressure off hospitals, jails and courts by providing crisis and ongoing care to mental health patients and substance abusers.

Coeur d'Alene - competing against Boise and Idaho Falls - was said to be a frontrunner, but Otter announced Idaho Falls was chosen because of the "outstanding community and legislative support from the Idaho Falls area."

Several North Idaho legislators voted against a bill that would have funded three centers. Though the bill passed, the Joint-Finance Appropriations Committee, or JFAC, voted to fund only one center and take a wait-and-see approach to funding the others.

Otter's reference to "legislative support" has sparked questions about whether the needs of North Idahoans suffering mental illness and the agencies struggling to meet those needs were trumped by politics.

Meanwhile, Kootenai County is doubling its budget to more than $1 million for the cost of involuntary holds, and Emergency Medical Services and law enforcement continue to pay hundreds of thousands of dollars in overtime pay and other expenses travelling to facilities with bed space.

"There's outrage among those who understand the problem that there wasn't more understanding on the part of some legislators as how much this would have saved the taxpayers and citizens of our county," said Rep. Luke Malek, R-Coeur d'Alene. "It's an enormous problem. It's a community problem."

Doubling Down

The hard costs of North Idaho's mental health crises are inestimable and borne by city and county taxpayers, hospitals and insurance companies, along with those being held involuntarily and their families.

Kootenai County's costs for indigent police holds have sizably increased year to year. The budget for indigent police holds increased by about $60,000 from 2013 to $500,000 in 2014.

The dramatic budget increase in the coming year to $1 million results from a newly negotiated agreement between the county and Kootenai Health.

Kootenai County Deputy Clerk Pat Raffee said the contract between the county and hospital had not been revised since 2004. Under that contract, the county only paid for up to four days for police holds.

The hospital wanted the county to approve an unlimited stay, but reached a compromise with the county for the new contract. The four-day cap has been extended to seven days.

"The doubling of the budget was due to a combination of increased stays, increased police holds total and increased medical costs," Raffee said.

Kootenai Behavioral Health has seen an increasing number of police holds over the past five years, from 529 in 2011 to 704 in 2013. Each county picks up the tab for indigent police holds whether the county's sheriff's office, city police or state police initiate a police hold.

The agencies bear additional costs.

Time and Travel

The Bonner County Sheriff's Office has more than 100 police holds each year. The first call they make is to Kootenai Behavioral Health. If there isn't room there, the sheriff's office has two options, and both are costly.

There's a lone room at Sandpoint's Bonner General Hospital that is sometimes utilized, according to Bonner County Sheriff Daryl Wheeler.

"We pay overtime to have personnel sit with them and sometimes that can be three or four days," Wheeler said. "It's a real impact on our budget and it's a real impact on our manpower."

About half the time, Bonner County sends patients to Lewiston or Orofino. They hire a private company to do the transporting at a cost of $300 each way.

Kootenai County's Emergency Medical Services provides transportation to out-of-town facilities. Though Spokane is closer and the shorter trip could save money, state law requires those placed in involuntary holds to be hospitalized in Idaho, according to EMS Chief Chris Way.

"The other day we went past Pocatello on a psychiatric transport," Way said. "It was 11-1/2 hours each way. We lose that ambulance. You've got overtime for two people, you've got that crew going, you've got fuel, hotels, meals, expenses like that."

Law enforcement must go along on every trip. One officer rides in the ambulance while another follows the ambulance in a police cruiser.

"It costs us thousands of dollars in overtime to treat someone who should be treated locally," said Post Falls Police Chief Scot Haug. "Imagine taking someone who has high anxiety and something's triggered their illness and now we're taking them out of their comfort zone and out of the community they live in. When they're done being treated, who transports them back home?

"To me, it's not good customer service and not the way a community should be treating mentally ill people in their community."

Needs of the North

For 1st District Judge John T. Mitchell, geography and population justify a Mental Health Crisis Center in North Idaho.

There's also no question, Mitchell said, that this area is struggling to cope with a mental health crisis of epidemic proportions.

While Idaho has the sixth-highest suicide rate in the country, North Idaho's is the highest in the state, with 25 out of 100,000 people taking their own lives each year.

Mitchell was one of many widespread supporters who wrote letters in an effort to convince decision makers that Coeur d'Alene should be home to the state's first mental health crisis center. The judge has presided over the county's Mental Health Court for 10 years and, for more than two years, has presided over a Juvenile Mental Health Court.

In his letter to the Department of Health and Welfare, Mitchell said his experience has made him "painfully aware" of the "deplorable current state of access to and delivery of mental health care here in my native North Idaho."

The lone provider of acute psychiatric care for the 235,000 residents of Idaho's five northern counties, Mitchell said, has 22 beds available.

"A crisis center would save dollars and resources for counties," Mitchell said. "Law enforcement would have another option rather than the hospital emergency room to assist with individuals in crisis."

All of North Idaho's law enforcement agencies wrote letters in support of the center. Wheeler, who serves on the Region 1 Mental Health Board and on the Behavioral Health Board, is the liaison between local law enforcement and other agencies when it comes to mental health issues.

"The mental health problems, because they've not been funded by the state, have been put on the backs of law enforcement," Wheeler said.

Haug said the problem becomes more pronounced as the area's population grows.

"It's not uncommon for us to have repeat visits to people's houses," Haug said. "We're just doing triage. We're getting there and putting a band-aid on the problem. They're in and out of Kootenai Health in a short amount of time. In my opinion, they're not getting the treatment they need."


When Otter said Idaho Falls was chosen because of "community and legislative support," those from North Idaho who had wholeheartedly lobbied for a center in Coeur d'Alene knew this area lacked only one of those.

Several legislators from Kootenai County voted against the bill funding mental health crisis centers. The county also cast more votes for Otter's opponent in the May primary election.

"We find it interesting that somehow or other, only the area of the state that voted for Otter is what got (the crisis center)," said Rep. Vito Barbieri, R-Dalton Gardens, who voted against the funding. "It's difficult for me to say what is driven by politics and what isn't these days."

Otter's office has not returned calls from The Press. The newspaper has submitted public records requests seeking documents and correspondence related to the location decision.

According to Idaho's Department of Health and Welfare, the department made the decision.

"The committee scored the proposals (from the communities) and came up with a determination and then we worked with the committee and the governor's office to make a final decision for where the center would go," said spokeswoman Niki Forbing-Orr.

Forbing-Orr said she didn't know the exact scores, but that they were close.

"I don't know which one came out on top," she said.

She said the department is hoping data and information from the Idaho Falls center will be used to guide decisions about future centers.

"We would all very much like to see these in every community that needs one," she said. "The need is there throughout the state."

Malek said the earliest Coeur d'Alene could secure funding for its own mental health crisis center would be after the next legislative session.

Barbieri is confident it will happen - against his hopes and wishes.

"Now that this bureaucracy is created, the north will get a facility; it will come," he said. Barbieri said North Idaho law enforcement and others don't need to "panic or specifically worry."

"Law enforcement will get what they need," he said. "If it turns out that there's as dire a need here as opposed to somewhere else in the state, they'll get it. ... Of course, with a bureaucrat, they all need it right away."

Barbieri said he believes there is already plenty of help available without the crisis centers and that instead of "post-issued, post-adult treatment," the root of the problem should be addressed.

"This explosion is all due to the way the culture treats people who are not conforming to the system," he said. "We're not dealing with the causes, we're dealing with the more expensive outlying of treatment."

On their own

The five northern counties tried a couple of years ago to create a regional mental health center on their own.

"I have a $35,000 line item in my budget to help pay the cost for that center," Wheeler said. "We were trying to go out and get a grant which has not been fulfilled."

When the Legislature approved funding for the mental health crisis centers, Wheeler said hopes were high.

"We've been looking for answers to this problem and we were hoping this center was going to be it," Wheeler said.

More than two years ago, the Post Falls Police Department took measures of its own - in lieu of treatment - to help individuals who had threatened suicide.

"Every customer who calls who has threatened suicide, we go out and pay them a visit," Haug said. "Our chaplains go out and try to give them some resources, faith-based or otherwise, to let them know there's hope. We have not had anyone commit suicide after we've had that intervention."

Haug said there's no one fix-all for the area's mental health concerns and it's not a problem everyone empathizes with or understands.

"It's not a sexy thing to talk about," Haug said. "When you've been through it or you have family who has been through it you realize how real it is and how serious of a problem it is and how it needs to be addressed."

By The Numbers

- Police holds at Kootenai Behavioral Health Center for Idaho's five northern counties:

* 2011 - 529

* 2012 - 578

* 2013 - 704

* 2014 (to date) - 371