A Step Forward For Mental Health

Idaho legislature address "The Black Hole"


A series of surprising initiatives reveal a new mood in the Idaho Legislature regarding treatment of the mentally ill. More than a dozen proposed bills are designed to facilitate the work of mental health courts (like HB716), set up a State Planning Council to review the state's provision of services (SB1389), provide Health and Welfare with more funds for psychiatric hospitalization (HB788), remove the cap on mental health benefits for victims of violent crimes (SB141), ease the sharing of mental health records among state agencies (HB430), and officially adopt a statewide suicide prevention plan (HCR31).

The centerpiece for all this legislation remains HB615, which establishes a three-year pilot program that includes equal insurance coverage for mental disorders for state employees and their families, with a financial report due to the Legislature in 2010. Sponsored by Reps. Kathie Garrett, Margaret Henbest, Nicole LeFavour and Elmer Martinez, and Sen. Tim Corder and Joe Stegner, the bill is due for the governor's signature and if signed, would finally place Idaho among the 48 other states and federal government that offer parity for physical and mental health problems.

Rep. Henbest (Dem-Boise) told BW that the Legislature's attention to mental health is "stunning." She said, "I think that there's such a heightened awareness that we have to do something that finally people are beginning to look seriously into what's been called 'The Black Hole,'" adding, "People know that we're doing a horrible job but no one knew where to start. We're finally moving off the dime. It's something that we as a society have ignored, obviously."

Encouragingly, HB615 even makes particular mention of the prejudice associated with mental illness that serves as a major barrier to seeking and receiving help. "Unequal health insurance coverage contributes to the destructive and unfair stigmatization of persons with serious mental illnesses that are beyond the control of the individuals in the same manner as cancer, diabetes and other serious physical health problems ... Left untreated, serious mental illnesses are some of the most disabling and potentially destructive illnesses affecting Idahoans."

Speaking of the parity issue in particular, Henbest said that the Legislature has officially estimated that it will cost some $1,890,000 but "that's high. We knew it was high but that's the actuarial figure. But the practical impact to Idaho will be half of that or much less, or pretty negligible," if the experiences of other states are any indication. Henbest noted that substance abuse is not covered and said, "I see that as a limitation, but I don't think we could have gotten our foot in the door if we had put that in there, too. We knew this was a baby step, but once you start the process and start calculating costs, then you can move forward with other things in the future."

The new legislation comes at a time when the National Alliance on Mentall Illness (NAMI) issues Idaho an "F" for overall performance for infrastructure, information access, services and recovery supports for the mentally ill. According to NAMI's calculations, Idaho ranks 49th for per capita spending on mental health, just edging out Arkansas. NAMI's recently issued survey rated the Unites States as a whole as earning a "D," with no states worthy of an "A," and with Idaho joining Iowa, Illinois, Kansas, Montana and both Dakotas as failures. However, NAMI does applaud First Lady Patricia Kempthorne for speaking out about her own experiences with depression. It also lauds the widespread use in Idaho of mental health courts and the development of locally based Assertive Community Treatment (ACT) teams.

NAMI's report also underscores the severe shortage of qualified mental health professionals at all levels, which it labels "astonishing," and low funding levels at a time of urbanization, a sharp population increase and the growth of Latino communities. The annual document calls for the establishment of some basics: integrated treatment for mental illness when coupled with substance abuse, supported employment and housing programs, and accreditation for the state-run psychiatric hospital in Orofino.

Henbest admitted that Idaho suffers from a lack of communication among provider services as well. "Right now it's sort of fragmented as to where all the state dollars go, to a variety of different departments. There's not a coordinated effort among departments, and in fact, there's not even a coordinated effort within Health and Welfare." One result of this disconnect is that "certain populations are carved out of coverage for services, which is pretty amazing." A Senate committee is now studying the advantages of "putting it all in one place so that the left hand can see what the right hand is doing," according to Henbest. "Ultimately, we don't put enough funding in there but there's a reluctance to increase the funding unless we have an administrative structure that's accountable and makes sense."

At the same time though, mental health activists worry about efforts such as HB750, proposed by Reps. Tom Trail and Pete Nielsen. If passed, it would criminalize harassment, intimidation and bullying within schools, as well as "conspiracy" to engage in such acts, to the level of misdemeanors. Opponents fear that students acting out from undiagnosed or untreated mood or personality disorders would enter the judicial and corrections systems instead of receiving appropriate treatment.

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