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Mental health offices feel budget pinch

Alex Miller
Shane Macomber/vaildailyAn ambulance backs into the emergency room of the Vail Valley Medical Center Saturday to drop off a patient.
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EAGLE COUNTY – “Don’t get sick” may be the only health plan for millions of Coloradans, and they might add “don’t get depressed or hooked on drugs” for more comprehensive coverage.Those seeking free or inexpensive mental health care in Eagle County may not know much about the budget battles going on in Denver, but they may experience the result of the cuts firsthand at local clinics. That’s because reduced state funding to clinics such as those run by nonprofit Colorado West Mental Health have been forced to reduce staff and services.Colorado West operates mental health clinics in 10 counties in western Colorado, including facilities in Vail and Eagle. For many, it is the only affordable option, since Colorado West supports Medicaid patients as well as those who can’t afford to pay anything.”In the past three or four years, we’ve lost about a third of the state funds we used to get to support the indigent,” said Ken Stein, Ph.D., executive director of Colorado West. “So there’s fewer people to provide services to folks with no insurance, but we still have the same obligation to be available. It’s a situation we cannot tolerate indefinitely.”While nonprofits like Colorado West are typically cash-strapped, Stein said today’s climate is tough to bear.”We’re seeing the erosion of a system that was minimally adequately funded,” he said, referring to the indigent services. It’s worse, he said, for programs that address substance abuse. “That was never adequately funded, so anything we lose it tantamount to disaster.”Pay now or pay laterThe result of having inadequate resources to treat mental illness has ramifications that go far beyond depression or suicide rates and the costs they have on society. Jeanne Rohner, executive director of the Mental Health Association of Colorado, said the burden of treatment is shifted to other agencies at a much higher cost when mental health facilities are underfunded.

“You can treat someone (outpatient) in a mental health center for about $3,600 a year,” she said. “If that same person ends up in a correctional facility, the average is more like $68,000 a year. Wouldn’t you want to pay the smaller amount?”Rohner said the number of adults with mental illness entering state correctional facilities increases by about 1 percent each year. For juvenile offenders with mental issues, she said the number has jumped from 24 to 40 percent. What she hopes lawmakers struggling with the budget in the state capitol will understand is that cutting programs to save money actually costs more in the long run.”Where do you want to pay for it?” she said. “At the less expensive level, or do we want to see people on the streets, committing suicide, or in corrections? Not only is it more expensive, that’s not the mission for corrections.”Stein said a simple illustration explains the efficacy of early intervention.”Say there’s a mom in the family showing early signs of depression,” he says. “If we can intervene with a combination of outpatient therapy and medication, we can be 85 to 90 percent effective. That’s a much better average than with many physical illnesses.”But if mom goes untreated, the problem only grows worse.”She loses her job,” Stein said. “She’s not there for the kids, marital problems lead to divorce.” All of that adds to a higher cost in simple dollars, he said, not to mention the human price. There are physical health issues as well, he said, a result of the emotional problems.”She winds up coming to the emergency room, or using other expensive medical solutions,” he said. “So it really comes down to pay now or pay later.”

Running dryEagle County Sheriff Joe Hoy said he’s aware of the issue but said he wasn’t sure how many people in the county jail have mental problems.”It’s not a daily occurrence with us,” Hoy said, referring to mental “holds” at the jail. “We usually will transport them to the hospital in Pueblo or Grand Junction where they can get treatment.”It’s not always apparent, though, whether someone who lands in jail might have avoided it by earlier intervention.Krista McClinton, who runs Colorado West’s Eagle County offices, said she believes a lot of people who might have benefited from her agency’s services end up instead in jail or at the emergency room.”They feel they can’t afford to come in for services, for maintenance, so they then use those emergency services for free,” McClinton said, adding that her offices used to have more funds for helping people who can’t afford to pay.”We also had a program for people to get prescription medications for free, but we had to cut that,” she said. “There just aren’t a lot of resources for indigent services.”

The TABOR effectFor Jeanne Rohner, the obvious reason for the cuts in mental health services is that the need isn’t as apparent to lawmakers. She refers to TABOR, the so-called taxpayer bill of rights in Colorado, which voters approved in 1992. The bill, which was designed to restrict government growth, is considered by many to have had unanticipated negative effects on the state budget and the programs funded by it. Legislators are currently discussing ways to minimize TABOR’s effects.”What we’re really seeing are decisions being made because of TABOR,” Rohner said. “The state is in a bind to balance the budget, so they cut programs that are actually less expensive than the programs being capped. You have to pay for corrections, but not for mental health. But you actually do wind up paying for it.”Rohner said she spoke recently to a nurse at a Front Range hospital who said she sees over 400 people with mental health disorders in the emergency room every month.”There’s really no place else to send them,” Rohner said. “So they end up in the ER, or on the street or in corrections. The cycle just continues.”Assistant Managing Editor Alex Miller can be reached at 949-0555, ext. 615, or amiller@vaildaily.com.Vail, Colorado


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