Guest column: Medicaid Primer - Idaho’s mental health crisis

Medicaid expansion, far more than any other step the state could take, would offer hope for ongoing management of our mental health crisis, writes Dr. Kenneth Krell.

Idaho citizens with serious mental health issues live from crisis to crisis, caught in a system unable to deliver ongoing services for these chronic diseases, a system designed and funded to deal with little else than crisis management. Even the new $350,000 pilot center in Idaho Falls is named "The Behavioral Health Crisis Center."

But mental illness affects those individuals every day of their lives, not just during crisis, and Medicaid expansion, far more than any other step the state could take, would offer hope for ongoing management and treatment.

Thirteen per cent of impoverished Idaho adults who lack health insurance have a serious mental illness. Medicaid coverage currently is limited to those who are "seriously and persistently mentally ill" according to Ross Edmunds, Administrator for Behavioral Health in the State Department of Health and Welfare.

According to the advocacy group Disability Rights Idaho, of the 41,000 Idahoans who have a serious and persistent mental illness only 9,000 adults are currently eligible for Medicaid. About 10,000 more get treatment each year from the Dept. of Health and Welfare, but only if their illness becomes so severe they pose a serious threat to themselves or others, or if services are ordered by a court.

The gap coalition states 14,723 Idahoans with serious mental illness are enrolled in Medicaid, but another 13,503 with severe mental illness are currently Medicaid ineligible, living in the gap.

"The preventative side of medicine is key to preventing negative outcomes," Edmunds explains, and 93% of the population the department now serves would qualify for expanded Medicaid.

What difference would Medicaid expansion make? "It's huge," Edmunds explains, "that continuum of care, with hospitalization and medication management. We don't have the continuum of care we could achieve if we could match that 90% with an array of services." Edmunds is careful to point out that as a state administrator he is not taking sides on whether Medicaid should be expanded. That's for the Legislature and governor to decide.

In the meantime Idaho's suicide rate at is 48% higher than the national average. Idahoans committed for hospitalization because they were an imminent danger to themselves or others increased from 2200 in 2007 to 4800 in 2013, more than doubling in six years.

Most of these patients combine drug and alcohol abuse, self-medicating when treatment options are not available and fill Idaho's ten mental health courts, as well as the drug courts.

One-half of the chronically homeless in the state are there "as a direct result of untreated mental illness, chemical dependency, and alcohol abuse" according to the Rev. Bill Roscoe, President and CEO of the Boise Rescue Mission.

And the mentally ill die at an alarming rate. As Edmunds points out "People with severe mental illness die 25 years earlier in life. The reason they're dying is that they struggle every day with their mental illness and also struggle with their chronic medical illness they can't manage."

So the mentally ill die of heart disease and diabetes and cancer, just like the rest of us, but are caught in a catch 22 where, unless their mental illness is treated, they can't pay attention to their chronic medical conditions. Those who don't qualify for Medicaid have nowhere to turn for treatment of either condition.

Can we provide the care these citizens need? Edmunds answers with a resounding yes. "We'll struggle with providers, especially psychiatrists, but the infrastructure is there." The structure of community mental health clinics exists, and could be coordinated with other community primary care providers.

With Medicaid expansion we have the means of providing care to this most vulnerable segment of our population. Now we just have to find the will.