Bureaucratic, Societal Roadblocks Hinder Mental Health Services on Plateau

Editor's Note: This is the first part of a two-part story looking at the issue of mental health on the Plateau, based on discussions that took place during the Enumclaw Regional Healthcare Foundation's 5th Annual Health Summit on Tuesday.

The Enumclaw Plateau area is currently lacking in resources to properly serve residents who are grappling with mental health issues and illnesses.

Though recent incidents of violence on the national stage have turned the spotlight on mental health as a potentially related issue, local leaders say the more fundamental problem is that vital community resources like first responders, police officers and medical staff get tied up in administrative processes when dealing with mental health cases, which pulls them away from their jobs serving the greater community. Meanwhile, the waiting is not serving the patient, either.

This was the issue that drew about 100 community members to the Enumclaw Regional Healthcare Foundation's 5th Annual Health Summit Tuesday to try and find solutions for this health care gap.

Representatives from every sector of the Plateau community including first responders, schools, city government, the medical community and social services shared their experiences and frustrations with trying to help those who need it but hitting a variety of societal and administrative roadblocks along the way.

Bureaucratic Roadblocks

King County bore the brunt of the ire from leaders including Enumclaw Police Chief Jim Zoll and St. Elizabeth Hospital Assistant Vice President of Patient Care Services Shelly Pricco.

Funding, in general, is problematic when it comes to mental health which is a huge expense, Zoll said. For Enumclaw, the problem is also geographic distance.

Patients and/or suspects who are brought to the hospital require a primary and secondary evaluation before they can be discharged to a dedicated treatment facility. The hospital oversees the primary evaluation, and the secondary evalution by a King County social worker can take between six to eight hours before someone will come down from Seattle, they said.

Meanwhile, officers have to stand by pending an evaluation for most, if not all of their shift, Zoll said.

And hospital staff also need to sit with the patient, Pricco said.

Zoll shared that on more than one occasion, the King County representative opted to interview and evaluate the officer about a particular patient rather than the actual patient. Similarly, he's been told several times a worker doesn't want to come to Enumclaw because they won't make it back home in time for dinner with their family.

County services to rural areas is a problem, he said. "The issue is we pay our taxes. I pay my taxes. I believe I deserve the same services and response as anyone else in King County."

Better cooperation with social workers and law enforcement, as he'd experienced while working in California, led to huge reductions in calls for service and violence in general. "I'm very passionate about this," he said.

Pricco shared that the frustration with King County also carries over into the primary evaluation process. The hospital has the ability to use Telehealth tools to teleconference with a mental health professional offsite to conduct a primary evaluation, which is effective in most cases, but the County doesn't accept it as a valid form of evaluation.

Consequently, St. Elizabeth sends for a social worker from Tacoma to travel to Enumclaw for that evaluation, which in itself can take a few hours.

Meanwhile, the patient waits, and even post-evaluation, it's not unusual for the hospital to hold a patient for 12 to 24 hours before a bed is available for them at a specialized facility.

In 2008, the state cut $135 million in funding for mental health and care providers are still leading with the aftermath, including not being able to provide property follow up and outpatient services, she said.

Gary Hemminger, Director of Enumclaw Youth and Family Services, said Medicaid is accepted along county lines meaning a resident on the other side of White River who lives much closer to Enumclaw than Good Samaritan in Puyallup, can only use their Medicaid benefits in Pierce County.

Additionally, insurance policies have changed such that "people have insurance but can't afford care," Pricco said.

That comment drew a few audible 'Amens' from the audience.

Societal Roadblocks

The social conversation about mental health has changed a lot in the last 50 years, said Ann Christian from the Washington Community Mental Health Council.

But the stigma associated with mental illness remains prevalent and is often what keeps someone from seeking help.

Christian said some of the more effective ways to encourage someone to get help is by enlisting friends, peers or other trusted individuals to intervene.

Hemminger shared that his office holds on average 75 counseling sessions per week, brought about because someone contacted them about a person they cared about.

Mental health, like physical health, is something that requires constant vigilance and maintenance. Just as a person tries to eat healthy and exercise, "mental health is something we all participate in daily in our own lives," he said.

Hemminger enforced a few realities about mental health therapy in hopes of making it seem less intimidating:

• The counseling is voluntary
• Treatment is designed around a particular patient's own goals
• There are no threats or coercion used
• All matters discussed are confidential

"It's OK to talk to a mental health professional," he said. "It doesn't mean you're crazy."

Aside from stigma, another roadblock he faces is the dearth of people willing and able to pay for the costly tuition to receive proper training in mental health services. With tuition hovering around $60,000 to obtain just the master's degree, and pay for mental health professionals being less that ideal, he has already lost two therapists this year to higher-paying jobs. And he doesn't blame them for leaving either, he said.

Part Two looks at some of the facts about mental illness and where the Enumclaw Regional Healthcare Foundation might start to tackle some of the identified service gaps in the community. Click here to read it.