Few mental health options available here

Editor’s note: This is the first part in a multi-part story on mental health options in the region.

COEUR d’ALENE — Just keep driving south.

For area law enforcement agencies that has become the key to finding a bed for those who police have taken into custody because they are a danger to themselves or others.

When the beds are full at Kootenai Behavioral Health Center — North Idaho’s lone facility for involuntary police holds — the next nearest option is St. Joseph’s Hospital in Lewiston. Often, there are no beds available there, either.

What may have been the first step to addressing North Idaho’s mental health crisis has also gone south — 500 miles, to be exact. Idaho Gov. Butch Otter last month announced that Idaho Falls, in southeast Idaho, would be home to the state’s first mental health crisis center with funding from the Legislature’s 2014 session.

The center will be open around the clock and aims to take the pressure off hospitals, jails and courts by providing crisis and ongoing care to mental health patients and substance abusers.

Coeur d’Alene — competing against Boise and Idaho Falls — was said to be a frontrunner, but Otter announced Idaho Falls was chosen because of the “outstanding community and legislative support from the Idaho Falls area.”

Several North Idaho legislators voted against a bill that would have funded three centers. Though the bill passed, the Joint-Finance Appropriations Committee, or JFAC, voted to fund only one center and take a wait-and-see approach to funding the others.

Otter’s reference to “legislative support” has sparked questions about whether the needs of North Idahoans suffering mental illness and the agencies struggling to meet those needs were trumped by politics.

Meanwhile, Kootenai County is doubling its budget to more than $1 million for the cost of involuntary holds, and Emergency Medical Services and law enforcement continue to pay hundreds of thousands of dollars in overtime pay and other expenses travelling to facilities with bed space.

“There’s outrage among those who understand the problem that there wasn’t more understanding on the part of some legislators as how much this would have saved the taxpayers and citizens of our county,” said Rep. Luke Malek, R-Coeur d’Alene. “It’s an enormous problem. It’s a community problem.”

Doubling Down

The hard costs of North Idaho’s mental health crises are inestimable and borne by city and county taxpayers, hospitals and insurance companies, along with those being held involuntarily and their families.

Kootenai County’s costs for indigent police holds have sizably increased year to year. The budget for indigent police holds increased by about $60,000 from 2013 to $500,000 in 2014.

The dramatic budget increase in the coming year to $1 million results from a newly negotiated agreement between the county and Kootenai Health.

Kootenai County Deputy Clerk Pat Raffee said the contract between the county and hospital had not been revised since 2004. Under that contract, the county only paid for up to four days for police holds.

The hospital wanted the county to approve an unlimited stay, but reached a compromise with the county for the new contract. The four-day cap has been extended to seven days.

“The doubling of the budget was due to a combination of increased stays, increased police holds total and increased medical costs,” Raffee said.

Kootenai Behavioral Health has seen an increasing number of police holds over the past five years, from 529 in 2011 to 704 in 2013. Each county picks up the tab for indigent police holds whether the county’s sheriff’s office, city police or state police initiate a police hold.

The agencies bear additional costs.

Time and Travel

The Bonner County Sheriff’s Office has more than 100 police holds each year. The first call they make is to Kootenai Behavioral Health. If there isn’t room there, the sheriff’s office has two options, and both are costly.

There’s a lone room at Sandpoint’s Bonner General Hospital that is sometimes utilized, according to Bonner County Sheriff Daryl Wheeler.

“We pay overtime to have personnel sit with them and sometimes that can be three or four days,” Wheeler said. “It’s a real impact on our budget and it’s a real impact on our manpower.”

About half the time, Bonner County sends patients to Lewiston or Orofino. They hire a private company to do the transporting at a cost of $300 each way.

Kootenai County’s Emergency Medical Services provides transportation to out-of-town facilities. Though Spokane is closer and the shorter trip could save money, state law requires those placed in involuntary holds to be hospitalized in Idaho, according to EMS Chief Chris Way.

“The other day we went past Pocatello on a psychiatric transport,” Way said. “It was 11-1/2 hours each way. We lose that ambulance. You’ve got overtime for two people, you’ve got that crew going, you’ve got fuel, hotels, meals, expenses like that.”

Law enforcement must go along on every trip. One officer rides in the ambulance while another follows the ambulance in a police cruiser.

“It costs us thousands of dollars in overtime to treat someone who should be treated locally,” said Post Falls Police Chief Scot Haug. “Imagine taking someone who has high anxiety and something’s triggered their illness and now we’re taking them out of their comfort zone and out of the community they live in. When they’re done being treated, who transports them back home?

“To me, it’s not good customer service and not the way a community should be treating mentally ill people in their community.”