Mental-health funds waning

Some days, Martha would stand dangerously close to traffic, feeling nothing but numb.

Other days, she would cry for hours.

It was called depression, but all she knew back then was that she would rather not be alive.

Then the people at Asian Counseling and Referral Service got her on medication.

They put her into a support group. They met with her every few days and called her at her Seattle home when she was feeling particularly down.

"Without that, I would not have gotten through," said Martha, an immigrant from China, who agreed to be interviewed only if her real name was not published.

But Martha is likely to lose all her mental-health services because her benefit has run out.

The county has announced that it can no longer afford to fund new outpatient mental-health services for hundreds of clients like Martha who are ineligible for Medicaid.

King County Executive Ron Sims on Thursday publicly blamed the change on an "unjustifiable and unfair" state decision that shifted $7.4 million last year from King County to rural areas that he says don't need it as much.

He called on the state Legislature to approve an extra $7.4 million in emergency funding for King County as soon as the session opens on Monday.

"This is an issue of basic fairness," Sims said in his announcement Thursday. "We should not have to put our residents on a bus to Vancouver or Yakima to be able to access treatment services."

King County has more than 29 percent of the state's mentally ill people but is getting 23 percent of the state's funding for non-Medicaid clients, according to county figures.

And those people are mostly immigrants, homeless people and the working poor.

The funding decision was made last year by the Governor's Office and the legislative leadership, which includes some lawmakers from King County.

State officials pointed out that other large counties, including Pierce and Spokane, also lost state money for non-Medicaid mental-health care.

The redistribution of funds was meant to help people in rural areas such as Grays Harbor County and northeastern Washington, which needed more support, state officials said.

The hope was that improving services in rural counties would ease the load on larger counties such as King, which says it draws mentally ill people from all over the state.

"The truth is that statewide, funding for mental health has not kept up with the cost of it," said Dave Daniels of the state's mental health division, part of the Department of Social and Health Services. "And King County, particularly, feels it."

Rep. Helen Sommers, D-Seattle, who chairs the House Appropriations Committee, said the Legislature should certainly look into the situation, but all counties are suffering to some extent.

"There's no doubt that we could use more funding for mental health," said Sommers. "But then, we need more funding in many areas."

Funding at a crisis

Mental-health providers in King County say the funding issue has reached a crisis.

Under the current mental-health system, "regional support networks" give state and federal money to local providers to take care of people with serious mental illnesses, from schizophrenia to suicidal tendencies.

For the past several years, those networks used leftover federal Medicaid funding to help non-Medicaid patients — people who don't qualify for Medicaid but can't afford private care.

But recently, federal rules changed and the networks were no longer allowed to do that.

The state Legislature agreed to spend $80 million to make up for most of the lost federal money. That's the money the regional networks are now fighting over.

But county officials say that the larger issue is that mental-health funding hasn't kept pace with demand in recent years. And they said that in a time of financial crisis, the county must cut outpatient services for non-Medicaid patients first. Other services, such as residential treatment and crisis services, are too critical to cut.

"We have to pay for that," said Amnon Shoenfeld, director of the county's Mental Health, Chemical Abuse and Dependency Services Division. "We have no choice."

The county already has significantly scaled back support for non-Medicaid services.

In the first quarter of 2001, for instance, King County funded about 2,098 non-Medicaid clients. In the first quarter of 2005, it was able to serve 264.

Agencies that serve immigrants have been particularly hard hit because many of their clients have not lived in the U.S. long enough to qualify for Medicaid.

For example, Consejo, a Seattle nonprofit agency that supports Latinos, once served 300 non-Medicaid clients. But it has watched that number drop to about 60.

The agency turned away as many as 250 new clients last year for lack of funding.

This year, because of King County's decision, Consejo will close its doors entirely to new non-Medicaid clients.

"The likelihood that these patients are going to end up in Western State Hospital, or in King County Jail, or in Harborview Medical Center is very high," said executive director Mario Paredes.

Agencies argue that the public ultimately pays more for untreated mentally ill people because of the high costs of housing them in mental hospitals or jails.

As funding has diminished, some providers have tried to send clients to other, better-funded agencies. They might send a domestic-violence victim, for instance, to a nonprofit that focuses on that issue.

They speak her language

But Martha relies on the staff at Asian Counseling and Referral to speak Chinese. And she trusts Winnie Tsai, her mental-health counselor, who has been there for her from the start.

Martha came in more than a year ago, terrified by her mental condition, convinced she had done something wrong. She could not stop crying.

She had left her husband, a man she met years earlier in China. The abuse began months into their marriage in the U.S. When he came home from work, she shook. When he left the next day, she cried.

"There was no way I could go back to China that way," she said. "And there was no way I could stay here."

It took some convincing to get Martha on medication. She had been a teacher, a cultured woman who knew literature and opera. Mental illness was not something she wanted to recognize in herself.

Now that she is on medication, her paranoia has died down. The delusions are mostly gone. She can listen to music and read books.

She says now she can see the good things in life, and she finally feels free. But it has taken a lot of work to get to this point: Nearly 10 different variations of medication. Monthly monitoring by a doctor at Asian Counseling and Referral. Weekly counseling sessions, and support groups.

Tsai warned her recently the support may end soon.

"I don't even want to think of it," Martha said.

Martha still has her bad days, when she believes her husband has hired an assassin. And there are other serious strains, from the expiration of her green card during the summer to the divorce that keeps dragging on.

"I just can't close her case," said Tsai.

For now, Martha will make the weekly bus trip, three hours round trip, to her counselor's office, where she feels safe.

She will do that until someone tells her to stop.

Cara Solomon: 206-464-2024