From inside Allumbaugh House, which served 864 men and women in 2016, the "outside" world can seem trivial. When confronting life-threatening addiction, something like the current political climate is just a small addition the merry-go-round of melodrama. For patients at the detox and mental health crisis center, managed by Terry Reilly Health Services, it's all about making it to tomorrow.
"I had reached my breaking point," said one female patient [names are being withheld to protect confidentiality]. "I had always been too afraid to ask for help. Addiction is something I never thought would happen to me."
Another patient had a similar experience.
"I felt stupid and embarrassed and just plain down on myself," she said. "As soon as I walked through the doors, I didn't feel judged."
Heidi Hart, CEO of Terry Reilly, said she's still stunned at the overwhelming need despite having served thousands of patients since 2009.
"When we were building Allumbaugh House, I'm not sure we knew the magnitude of need that existed within the community," she said. "It's a steady pressure of people needing to get in, so we're constantly balancing a waiting list. I don't want to say we have exceeded our expectations, because if you think of it, that's sad, but the demand has [been] greater than I ever anticipated."
Getting the doors open, let alone getting Allumbaugh House built, brought on a decade-long debate among local governments over who should shoulder the cost. In one particularly nasty bit of tension, Ada County even threatened to pull its contribution to Allumbaugh House during a 2010 kerfuffle over the magistrate court services it provides to regional cities. After some hardline negotiating, a so-called Joint Powers Entity was formed, which includes the Idaho Department of Health and Welfare, Ada County and the cities of Boise, Eagle and Meridian.
"I've been involved on this project since 2006. Discussions were happening as early as 2003," said Gina Westcott, Southwest Hub administrative director for IDHW. "There are a lot of things that the Department of Health and Welfare does for behavioral health; but I'm particularly proud that we participate in Allumbaugh House."
IDHW's annual funding contribution to Allumbaugh House is close to $1 million, approximately 48 percent of the facility's operating budget. That's followed by Ada County (14.5 percent), the city of Boise (14 percent) Saint Alphonsus Regional Medical Center (12 percent), St. Luke's Health Systems (9 percent) and the city of Meridian (3 percent). Allumbaugh House provides critical services to hundreds of individuals from other communities across the Treasure Valley as well, leading some to question why those cities haven't contributed to its annual budget.
"We just made a presentation to the Eagle City Council Aug. 22. They will definitely be 'in,'" said Diana Lachiondo, the city of Boise director of Community Partnerships. "We're also set to present to the Garden City Council, and Kuna. Star is the only community that hasn't yet been responsive to our request to make a presentation."
Update: According to Lachiondo the City of Garden City, as of this week, has committed to being a funding partner for Allumbaugh House.
Lachiondo added it's challenging to seek more funding participation while also holding onto commitments from existing JPE members.
"This is a little bit like trying to keep a band together," she said.
Boise Mayor Dave Bieter has heard that tune before.
"'Keeping the band together' is a perfect analogy," he said July 18 during a Boise City Council workshop session. The mayor doubled down on the metaphor by quoting from one of pop music's most famous bands.
"A 'Long and Winding Road,' that's what this has been," Bieter said. "I remember how difficult it was just to get two of three Ada County commissioners to agree to the original partnership. "
Boise City Councilman Ben Quintana said participation in funding Allumbaugh should be a no-brainer.
"Am I missing something? I know some people can get emotional about this, but there is [a] direct economic benefit," he said at the July 18 workshop. "If Allumbaugh House goes away, costs go up. There's no argument. Why are we even struggling with this?"
"I share your frustration," replied Lachiondo. "I can't pretend to know what some of the thinking is, other than some fatigue about [what] some people's preconceptions are about real prevention. We absolutely know that these folks have no place to go."
Who Goes to Allumbaugh House?
Everyone who goes to Allumbaugh does so voluntarily—no one is admitted unless they are referred by a healthcare provider, law enforcement or have undergone an in-person screening.
"We get a number of direct phone calls, about 3,000 calls a year, from families, friends and the individuals themselves. About 45 percent of our patients are self-referred. They call and say, 'I need help.' And, yes, sometimes we have to call them back when they're not as intoxicated," said Allumbaugh House Program Director Cindy Miller.
More often than not, she added, the person in need of services is near or at the bottom of the economic ladder.
"We have a number of people who are employed but don't have insurance that covers substance abuse treatment or even mental health treatment, or their medical deductible is too high," said Miller. "I can't tell you how many people are trying to get by with a $10-per-hour job and a $7,000 deductible on their insurance."
An even more common scenario, she added, is the individual doesn't even have have a roof over their head.
"Right now, about 55 to 60 percent of our total population is homeless," said Miller. "Obviously, being homeless, uninsured and without a support system creates a particular challenge to someone in terms of moving toward recovery."
Many are struggling with alcohol.
"Generally speaking, about 60 percent of our patients would be here with alcohol as the primary substance of abuse. That's followed by opiates and methamphetamine, but what has really made things more complicated is poly-substance abuse—heroin addicts who take meth or people who drink when they're feeling badly. It's really rare now to see someone who just abuses alcohol. That has been a significant change since we opened seven years ago."
Meanwhile, the referrals to Allumbaugh House grow each year.
"In many of these cases, these are individuals who didn't end up in an emergency room or a jail," said Miller. "So, this is really the diversion piece that is so valuable to the whole community."
"Diversion" means keeping someone out of the hospital, which comes at a much higher cost to taxpayers.
"The average cost in a hospital for someone who needs help with detox and/or mental health issues is about $1,500 per night—not including any lab work or medication," said Lachiondo. "Compare that to an average cost at Allumbaugh, which is about $400 per night, and that includes labs and meds. We're talking about a nearly $1,110 savings per client. Based on the level of admissions and length of stay, we're estimated that it totals to about a $5.8 million annual savings."
Taking It to the Street
Another significant goal is keeping individuals out of the Ada County Jail.
"We all are trying to serve the same population. But I must tell you, at first, we had to overcome some misperceptions that Allumbaugh House didn't have a direct impact to the sheriff's office and the jail," said Kate Pape, Health Services administrator at the Ada County Sheriff's Office. "But what we're really talking about here is keeping people from getting arrested or coming to jail in the first place."
That's why, for instance, Pape said there's an increasing need to identify substance abuse issues before someone risks being locked up.
"The average length of stay for someone who has a mental health issue or chronic health care condition, they're in jail 50 percent longer than those without," she said. "We see folks who come into the jail and they're detoxing and we know that's not the appropriate place for them to be."
That leaves it to cops on the beat to identify a problem before it becomes a felony.
"The No. 1 type of call to Boise police is a so-called welfare check," said Lachiondo. "A neighbor calls about some erratic behavior next door. They're not sure what's going on. Maybe the situation doesn't call for a mental hold at a hospital, so the police officer can make a referral for that individual to get some help sooner than later. So, if it's voluntary, that's a great solution."
Walking through the door of Allumbaugh House for the first time is probably the biggest step in an addicted person's life.
"Sometimes, I put myself in the position of somebody who's coming into Allumbaugh. They're thinking, 'Who are these people that I'm being entrusted to? Do I have to be vulnerable and tell all my intimate secrets to 20 people that I've never met before? All I really want to do is go throw up or go crawl into a bed,'" said Hart. "I think that's one of the things that the staff at Allumbaugh works really hard at: Creating a sense of safety. We know you're apprehensive. But we want you to trust us and take that risk anyway."
Contrary to popular belief, the greatest concern for most patients is not about coming to Allumbaugh—it's about leaving.
"Quite often, they're going right back to the environment they came from," said Miller. "But it's our job to engage them into recognizing that change is possible and we can help them make those small steps, and then give them lots of reassurance about their after-care plan."
The 16 beds at Allumbaugh House are nearly always full, with most patients leaving the facility after five or six days. The alternative of more people struggling with addiction ending up at the county jail is economically unsustainable.
"We've been averaging about 1,000 inmates lately, so our goal very much is to keep people who should not be in jail out of jail," said Pape. "That said, when you're talking about a criminal offense, community safety is a difficult balance."
"But if we were to say, 'We're just going to put these folks in jail and they'll detox there, then we're talking about building bigger jails," responded Lachiondo. "And then we have to ask ourselves if that's an appropriate use of taxpayer resources."
Which is why Lachiondo will be busy over the coming months, trying to secure new funding partnerships from the cities of Garden City, Eagle, Kuna and Star. Meanwhile, Hart said the success rate at Allumbaugh House is reason enough for duplication.
"I'd love to see a facility in the western part of the valley," said Hart. "Maybe Allumbaugh House West."