OPINION: Idaho's mentally ill told to suffer in silence

April 04--Nearly 30 years ago, Jane Pritchett of Moscow sought out help for mental illness. As the Tribune's Chelsea Embree noted Sunday, she quickly ran into barriers.

Not much has changed. In Idaho, people struggling with mental health are confronted with one excuse after another:

"Sorry, but we have a severe shortage of psychiatric staff in this state. You'll have to wait."

"Sorry, but there's not a lot of money to help you pay for your medications."

"Sorry, but now that you've been released from the hospital, clinic or jail, we can't afford to provide you with adequate follow-up care."

Never a wealthy state, Idaho can barely pay for everything from public schools to highway maintenance. So it's no surprise that Idaho spends around $36.64 per capita on community mental health programs, the lowest amount in the country. Or that until recently, it relied on people outside the state to man Idaho's suicide hotline.

And for much of the past three decades, Idaho may have had little choice.

No longer.

Idaho's GOP-led Legislature has made the deliberate decision to leave 80,000 low-income adults out in the cold. These are the people who make too little to qualify for subsidized private health insurance under Obamacare.

That's a bad deal for Idaho taxpayers, who wind up losing $50 million a year to cover the cost of providing health care to medically indigent people -- many of them in some form of mental health distress.

But it has truly awful consequences for 20,000 Idahoans with persistent mental health problems who would qualify for Medicaid.

They're caught in a Catch-22. Because they're ill, many have trouble getting and holding higher-income jobs. Because they're poor, they can't afford treatment. So they spiral from one health care crisis to the next. From one ER visit to the next. From one encounter with the criminal justice system to the next. From one potentially debilitating episode to the next.

Factor in the higher risk of suicide, the side effects of medication and the chronic toll mental illness takes on a person's physical health. It adds up to an average life expectancy of 54 -- 25 years lost.

Expanding Medicaid is no panacea. As Embree reported, the state has a severe shortage of mental health care providers. For instance, north central Idaho has one psychiatrist for every 26,000 people -- far fewer than the recommended ratio of one psychiatrist per 17,000.

But if you're going to start somewhere, let it be with Medicaid expansion.

If nothing else, it gets people suffering from mental illness into the primary health care system. Regular checkups, screenings and counseling can compensate for gaps elsewhere in the system.

It also provides the means to provide a steady, reliable flow of medications to those who need it.

And the ability to insure 20,000 people may help provide enough financial incentives to attract more psychiatrists, psychologists and other providers to the Gem State.

That's why the Idaho chapter of the National Alliance for the Mentally Ill calls expanding Medicaid "the most important change that the Legislature could make this year to improve the mental health system in the state of Idaho."

It's why two of three doctors serving in that Legislature, Rep. John Rusche, D-Lewiston, and Sen. Dan Schmidt, D-Moscow, last week urged their colleagues not to go home without addressing Medicaid expansion.

And it's why Schmidt compared the mental health advances Idaho has sought -- such as opening behavioral health crisis centers, first in Idaho Falls and next in northern Idaho -- to filling a trunk with spares when you're riding on bald tires.

"Come on, buy new tires," he told the Tribune's Kathy Hedberg.

But Republican leaders fear the wing of their party in the throes of Obama Derangement Syndrome. Just the same, they can no longer hide behind Idaho's finances. They've chosen to abandon the mentally ill. -- M.T.

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