The Idaho Statesman and Boise State Public Radio explore the gaps in Idaho's mental health system, which is in flux. Many Idahoans cannot access treatment until they're in crisis, and others receive the wrong treatment. They go through a revolving door at jails, hospitals and shelters.
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GOT HEALTH COVERAGE CREDITS? YOUR REFUNDMAY SHRINK A6
WestAdabond Voters in theWestAda SchoolDistrict, formerlyMeridi-an SchoolDistrict,will takeup a $104million school constructionbond.Atwo-thirds vote isneeded forpassage.What’s in it? Twonewmiddleschools and anew elementary schooltohandle student growth, completionof the expansion andupgrading ofMeridianHigh School, andmoney tobuyproperty fornewschools.What’s the cost? If itpasses, taxbills for schoolconstructionbondswillrise$2.42per$100,000of taxablevalue.
A recall? MichaelLaw, aKunaschool board trustee, is up for a recallafter someparents becameupset thatheworked fordefeatof a supplemen-tal property-tax levy.NotusandWilder Notus SchoolDistrictwants $4.38million for anelementary school to replace the onebuilt in 1926.Wilderwants a $598,000two-year supplemental levy.Polling infoPolls are openTuesdayfrom8 a.m. to 8p.m.Go toIdahoStatesman.com for voterinformation.
VOTE TUESDAY WHAT’SONSCHOOLDISTRICTS’BALLOTS
ENTERTAINMENTWednesday:The five-day SpiritofBoiseBalloonClassic kicksoff inAnnMorrisonPark.Wednesday:It’s the finalAliveAfterFive of thesummer inTheGrove,withheadlinersAimeeMann andTedLeo asTheBoth.MOREEVENTS,L4
DON’TMISS ITINTHE STATESMAN
Thursday in IdahoOutdoors:Try a bike trail thatgives you anewviewofBogusBasin.
NATION/WORLDToday: Funeral forMichaelBrown Jr.,whowasshot by apolice officer inFerguson,Mo.MOREEVENTS,A6
SPORTSFriday:High school football seasonbeginsthroughout theTreasureValley.MOREEVENTS,S1
LOCALWednesday: 7p.m.Eva Schloss,AnneFrank’s step-sister, to speak atColonialTheater, 450AStreetin IdahoFalls.Cost: $25 for adults, $12 foryouth/students, and $75 forVIP tickets (cocktailreception at 6p.m.).Tickets at idahofallsarts.org.MOREEVENTS,A4
TRAFFICTROUBLE SPOT
BOISE:ColeRoad(eastside),BarristerDrive toDentonStreet :Lane andpedestrian restrictions startMonday for asphalt, concrete andutilitywork.Expected to be completedby Sept. 19.MOREROADINFO,A4
YOURWEEKAHEAD
PROTEINISTRENDYA lookat someofitshealthbenefits
LIFE, L1
BSU football opensseason vs.OleMissOURBRONCOBLITZPREVIEWSECTIONRETURNSTHURSDAY
The state’s effort to rein in Medi-caid costs has created deep frictionbetween small businesses thatdeliver behavioral-health services toMedicaid patients and a new con-tractorhired tomanage them.
Service providers across Idaho
have raised complaints over the last11months that the contractor,OptumIdaho, a unit of United BehavioralHealth, has created red tape and cutservicesneededby at-risk patients.
Now providers in the TreasureValley have raised anothercomplaint:Optum isn’t paying thempromptly, putting their businesses’survival and employees’ jobs at risk.
Optum says ithas fixedaglitch that
resulted in tiny claims payments tothe companies,which provide coun-seling and other behavioral healthservices to low-income and disabledadults and childrenonMedicaid.
Optum says it erroneously sentsmall checks totaling amounts like$.05, $.07, or $.11 starting Aug. 1 toproviders who care forMedicaid pa-tients who need behavioral-healthtreatment.
A contractor the state hired tomanagepayments issues checks worth pennies
SEEANEXAMPLEOFACLAIMPAIDBYOPTUM A9
Shoddy roads, bridges take toll on economy
BYDONLEELOSANGELES TIMES
PROVIDENCE, R.I. — Itwas a beautiful May after-noon when Donnel Gomestook his week-old silverMercedes for a spin into thecity. He turned onto BroadStreet, amain thoroughfare
downtown, and…kaboom!The car fell into a huge
pothole, blowing its righttire, ripping the front axleand knocking out the air-bag system.Cost: $3,800.
“It was awreck,” said the48-year-old electrician, al-though he reckoned he gotoff easy compared with amotorcyclist whom Gomessawthrown into theairafterhitting a crater on anotherdowntown street. “A damnminefield,” he said of tra-
versing many of Provi-dence’s roads.
Rhode Island has an un-usually large share of shod-dy highways, streets andbridges, but it’s not muchbetter in the rest of thecountry.
America’s transportationinfrastructure, once an en-gine of mobility and pro-ductivity, has fallen intosuch disrepair that it’s be-come an economic alba-tross.
Consumers shell out bil-lions of dollars for extra carrepairs every year. Insuffi-cientandpoorlymaintainedroads mean costly bottle-necks for businesses be-cause they discourage ex-pansion and hobbleAmeri-can companies competingin the global economy.
Congestion on major ur-ban highways costs theeconomy more than $100
Congestion, car repairsand lostbusinessopportunities costAmericansbillions.
old basketballcamp operator,plans to build a$40 millionsports complexinMeridian.
Designed byTVA Architectsin Portland, thetwo-story, 185,000-square-footSportsplex Idahowouldinclude 12 courts that couldbe used for basketball, soc-cer, lacrosse and othersports. The blueprints in-
clude space for classrooms,a privately operated sportsmedicine office and fitnesscenter, as well as other uses.Except forapractice field,allof the Sportsplex would beindoors.
An arena would house amain court and 3,200 seats,space that could be used forminor league sports, con-certs, conventions or otherlarge events.
The complex would beoperated as a nonprofit.Some space would be pri-vately operated by for-profitbusinesses and somewouldbe public.
Sofro plans to announceon Sept. 12 that SportsplexIdaho has purchased at least11 acres for the building in
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“(We) apologize for anyinconvenience caused bythis temporary error, andweinvite any provider withconcernsor questions tocallOptum Idaho,” Optum saidin a statement.
But some providers saythe problem actually beganlast September, when Op-tum took overmanagementof Idaho’s Medicaid behav-ioral health system.
Two of the Treasure Val-ley’s largest mental healthcare providers forMedicaidpatients say these tiny pay-ments have recurredthroughout Optum’s first 11months in Idaho.
OPTUMHIREDTOFIGHTWASTE
Idaho spends$10.5millionamonth on average for out-patient behavioral health,mental health and sub-stance-abuse programs foradults and children onMed-icaid.Optum can keep up to15 percent of that for admin-istration, the state says.Law-makers approved the man-aged-care systemin2013asaway to control costs andboost efficiency.
“Wehadone situationnotlong after Optum came onboard where they paid awide range of codes at onepenny per claim when theclaimswereasmuchas$200or $300,” said Tami Jones,theCEOof IdahoBehavioralHealth inBoise.Eachmentalhealth service or procedurehas a codenumber.
“Every single servicewe’veprovided,we’vehadatone time or another a situa-tion like this, where they’vepaid thewrong amount, andit’s always been a muchsmaller amount like 11 centson a $100 claim,” Jones said.
“They’ve told providersthey don’t know why it’shappening, andwhen it’sgo-ing tobe fixed,and theyhaveno ideawhenwe’ll start see-ing checks paid at the
regular amount,” saidAccessownerNikkiGeorge.
FULL PAYMENTCOMESAMONTHORMORE LATER
In George’s case, OptumIdaho has paid the small re-mittance within the 30 daysits state contract requires.Then the balance of theclaim is paid weeks, some-timesmonths, later.
For example,Optum senta remittance payment of$0.09 on Nov. 5, 2013, forservices Access BehaviorHealth performed on Oct.23. The $82.77 claim wasn’tpaid in full to Access untilDec. 3.
“Whatever we get fromOptum is the money we di-rectly use to pay our em-ployees,”George said. “Andifwe send in a claim for $60,we’re paying our employees$40 of that, and if we onlyget 5 cents, we don’t haveany money to pay our em-ployees.”
For patients of Access,services haven’t been affect-ed.
“We’re working for free,”George said. “WhenOptumhas stopped paying claims,or paid pennies per claim,we’ve taken out loans in or-der to continue to pay ouremployees and continue toprovide services for clients,so our clients won’t be im-pacted.”
But that’s not a sustain-able way to run a business,George said.
STATETOCONTRACTOR:SUE IF YOUWANT
George has filed formalcomplaints withOptum andhasmade the IdahoDepart-ment ofHealth andWelfareaware of thebilling issues.
The Health and WelfareDepartment says Optum isdoing a good job, and it hasno plans to fine or sue Op-tumover the payment issue.
In a recent email ex-changewithGeorge,Healthand Welfare’s Division ofMedicaid ContractMonitorCarolyn Burt told her, “As anetwork subcontractor withOptum, if the dispute andresolutionprocess identifiedbyOptum are not (meeting)your agency’s expectation,your next option is that youmay decide you need to takelegal recourse to help withthe resolution.”
George says she’s given alot of thought to suing Op-tum, but for now has con-cluded her small companywouldn’t stand a chanceagainst the corporate giant.
Optum Idaho has said ofitsmost recent glitch that 29of 1,725 providers have re-ceived the tinypayments, af-fecting less than 1 percent oftotal claimsmadeduring theweek ofAug. 11.
Thecompanysays it isop-erating well within its statecontract,which requiresOp-tum to pay 90 percent ofclaims “on time and accu-rately within 30 days.” AnOptum spokesman said inan
email that thecompany isex-ceeding that requirementwith a 99 percent accuracyrate. The Department ofHealth andWelfare agrees.
Providers have said Op-tum is failing in its duty toIdaho mental healthproviders and Medicaid re-cipients. Among their com-plaints are cutbacks in com-munity-based rehabilitationservices. Idaho PsychiatricRehabilitation Associationchairwoman Jodi Smith toldthe Post Register in IdahoFalls that Optum has cuthours for children withADHDand other behavioralissues. Providers say cut-backs will lead to increasedhospitalization rates.
Optum says community-based rehabilitation is notproved to be effective intreating some children’sdis-orders, based on nationalguidelines. Optum says evi-dence-based services forchildren have increased, useof individual therapy is up30percent, anduse of familytherapyhas tripled.
STATE:PROBLEMSARECOMMON INAMAJORTRANSITION
The department’s behav-ioral health administrator,Ross Edmunds, said glitchesare to be expected as thestate transitions from fee-for-service tomanaged care
throughOptum.“I would suggest to you
that every single state thathas implemented managedcare in theirMedicaid bene-fit has experienced chal-lenges in those first coupleof years,” Edmunds said.“We were told by Optum,andmany other peoplewhodo the same thing: Expectchallenges and problems inthe first fewyears.”
At Idaho BehavioralHealth, Jones says her com-pany has had to add peoplein its billing department justto ensure they’re getting ac-curately paid by Optum.LikeGeorge, Joneshas takenout lines of credit to stay inbusiness.
“This is really hurting thesmaller agencies,” Jonessaid. “The mom-and-popshops where mom’s doingthe billing? She now has notime togooutand seeclientsbecause she’s having tospend all of her time chasingthe pennies.”
ONEBOISEAGENCYCLOSES ITSDOORS
Small claims paymentsfrom Optum were one rea-son Clearwater Rehabilita-tion in Boise cited for goingout of business recently.Owner Karen Canfield saidshe took out two lines ofcreditover the last 11monthsin hopes of paying her bills
while waiting for Optum toreimburse claims.
“And thenwhen the reim-bursement wasn’t coming into pay those lines of credit,plus make rent, plus makepayroll, (it was) beating adead horse,” Canfield said.“How am I supposed to runa business?”
The claimspayment issueis reminiscentofwhenMoli-na Medicaid Solutions tookover Idaho’s Medicaid pay-ment system in 2010. TheCalifornia-based companydelayed payments to healthcare providersworkingwithMedicaid clients. Some Ida-ho providers who went twomonths without paymentswere forced to close.
“ThismessmakesMolinalook like fun,” said Jones,who is also amemberofOp-tum Idaho’s advisory board.“I understand the strugglesthat they’ve had coming inand learning a new system.But what we’re seeing hereis a disregard for providersandmore importantly a dis-regard forpatients.”
This story is a collaborativeeffort by Boise State PublicRadio and the Idaho Statesman.
OPTUMCONTINUED FROMA1
!SEE IDAHO’SDASHBOARDON
OPTUM’SCLAIMSHANDLINGIdahoStatesman.com
Provided byAccess BehavioralHealthOptumpaidBoise’sAccessBehavioralHealthServices9cents in response toan$82.77claimforpayment lastNovember.Optummadegoodon the restof theamountamonth later.
Sunday: 0.00"Month to date: 0.06"Normal month to date: 0.17"Year to date: 8.51"Normal year to date: 7.43"
Today Yesterday
Good Unhealthy Hazardous
Sunrise today 7:01 AM..............Sunset tonight 8:32 PM............Moonrise today 7:12 AM..........Moonset today 8:22 PM............ First Full Last New
Sep 2 Sep 8 Sep 15 Sep 24
31, Stanley
50s40s30s10s 20s0s-0s 90s80s70s 110s60s 100s
79 / 6079 / 60SeattleSeattle
65 / 4865 / 48BillingsBillings
70 / 5670 / 56San FranciscoSan Francisco
77 / 6577 / 65Los AngelesLos Angeles
93 / 7293 / 72El PasoEl Paso
98 / 7898 / 78HoustonHouston
86 / 7186 / 71AtlantaAtlanta
80 / 5680 / 56DenverDenver
91 / 7591 / 75ChicagoChicago
82 / 6082 / 60MinneapolisMinneapolis
86 / 7086 / 70DetroitDetroit
82 / 6482 / 64WashingtonWashington
84 / 6784 / 67New YorkNew York
100 / 76100 / 76Kansas CityKansas City
91 / 7991 / 79MiamiMiami
62 / 5362 / 53JuneauJuneau
T-StormsRain SnowIce StationaryWarmCold
-10s
Monday
82° 55°
Wednesday
89° 60°Sunny
Thursday
92° 63°Sunny
Friday
93° 63°Partly cloudy
Saturday
84° 54°Cloudy and
rainy
Sunday
81°Partly cloudy,AM showers
P. Cloudy, 63P. Cloudy, 72Ch. storms, 76
Daytime highs and overnight lows
Tuesday
85° 58°Mostly sunny
1 2 3 4 5 6 7 8 9 10 11 1240 minutes to burn
UV index is the risk ofoverexposure to the sun.0 to 2 minimal, 3 to 4 low,5 to 6 moderate, 7 to 9high, 10+ very highSource: Boise Valley Asthma andAllergy Clinic
111, Death Valley, Calif.
Chenopod: 50Sage: 444
SUN &MOON
Slight chance of storms andrain showers in the mountains.Partly cloudy. Highmid-80s.
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fer OAC on select models, Soul and Maz3 may not qualify for 0%. VIN Kia: KNDJN2A27E7727989 VINA. 0% of$10898.20, 39/MO MCS Lease. OAC. Kia #B1512 Mazda3 ISV**Kia Soul Price includes $334 Down plus 1st payment and DMV Fee, LEV of $10329.80. 39/MO KMF Lease. Mazda3 includes $888 down
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CORRECTION CurtisHomerwaschiefofpolice inNampa from2002to2007.APage 1storyWednesdayabouta registry for violentoffenderswas incorrect.
ACCIDENTAL DEATH INVOLVING CHILD,UZI SPARKS DEBATE NATION,A6
BIKINGBOGUSBASIN
Around theMountaintrail becomes a favorite
IDAHOOUTDOORS,S10
COMINGFRIDAYOur 24-pageTreasureValley
high school football previewsection6 LEAGUES •41TEAMS •96PLAYERSTOWATCH
Foothills cougarTheGerman short-hairedpointer is recovering followingtheconfrontationwith thecougarnearWestHillRoadandNorthCollis-terDrivebeforedawnWednesday,IdahoFishandGame reported.Caton theporchThe owner saidthe dogwent to thebackyardbeforedaylight, yelped and ranback intothe house through the dogdoor.Theowner looked outside and sawthe li-on crouchedon the back porch be-fore itdisappeared around the cor-nerof the house.Conservation offi-
cerBillLondon found evidence atthe scene to confirm the report.Outon itsown “It’s likely a yearlinglion, on itsown for the first time inits life,”London said. “Finding suffi-cient food canbe difficult, and younglionsoften viewdomesticpets aseasymeals.”Beon the lookoutThe cat’swhere-abouts areunknown.Fish andGameofficials advise owners to keep aclose eye onpets and report anymountain lion sightings to 465-8465,or to 377-6790 afteroffice hours.
Four-year-old Spencer Stone-hocker, heldbyhis grandmotherLaurie Spencer, covershis earsas apilot uses flames to raise theballoon “WizardsDawnTread-er”during the firstdayof theSpiritofBoiseBalloonClassiconWednesday atAnnMorrisonPark.An estimated 3,000 kidswere given rides.
Parentsandchildrenwait fora tethered ride intotheairduringkidsday.SEEMOREPHOTOSAT IDAHOSTATESMAN.COM
Idaho’s80mph bringsmore speeding,more tickets
MIXEDREACTIONSOnemonth ago, the Idaho
TransportationDepartmentincreased the speed limit onrural stretchesof Interstates84, 86 and 15. Some drivershave been eager to drive 80mph, even inching the nee-dle up a little higher, butother drivers are not com-fortable with the higherspeed, according to IdahoStatePolice.
SPEEDDEMONSSome troopers noticed
that as soon as the speedlimit went to 80 mph, somedrivers took that as a greenlight to go 90mph or faster.ISP reports it has issuedmore speeding ticketson thefaster freeway sectionscom-pared with the same periodlast year, but exact numbersweren’t available.
WHAT’SYOURHURRY?ISP says 80mph is plenty
fast and troopers will issuetickets to anyone caught go-ing faster— this is not unof-ficial permission to drive 85.“We are not giving people abreak on speeding tickets(once they’re over) the 80mph speed limit,” said ISPspokespersonTeresaBaker.
THINKQUICKFaster speedsmean driv-
ers need to adjust to a short-ened reaction time and beable to gauge other vehicles’distances. One other issue:Because drivers are nolonger traveling the samespeed— some are choosingto stickwith slower freewayspeeds, and others are eagerto zip along— a driver trav-eling80mphcominguponadriver traveling 60 mphneeds to react accordingly.
CRASHESDUE TOSPEEDThere are no official sta-
tistics yet, but anecdotally,
someofficers report seeingadifference on the freeway.ISP’s Jeromeofficeattributesthe higher speed limit to atleast two crashes. In both in-stances, drivers misjudgeddistance and reaction time,the ISP said.
FASTCOMPANYBesides Idaho, three oth-
er states now have topspeeds of at least 80mph—Utah, Wyoming and Texas,which set its limit at a swift85mph.
DON’TMESSWITHTEXASWhen averaging freeway
and highway maximumspeed limits, Idaho has thesecond fastest speed of 76.7mph. Texas has the fastest:78.3 mph. Delaware andAlaska have the lowest aver-age speed limits at 58.3mphand 55mph, respectively.
tigating whether the com-pany Idahohired tomanagepart of its Medicaid pro-gram has violated patient-privacy laws.
Optum Idaho, a unit ofUnited Behavioral Health,took over insurance man-agement for Idaho Medic-aid’s mental-health andsubstance-abuse patientslast fall.
Local health careproviders who treat thosepatients say Optum has er-roneouslysent them reportsmeant for other providers.
The reports show patientnames andmental-healthorsubstance-abuse servicesthe patients received orwere authorized by Optumto receive.
Emails obtained by theIdaho Statesman through arequest under the IdahoPublic Records Act showthat providers have com-plained toOptum Idaho, theIdaho Department ofHealthandWelfare, the Ida-ho attorney general and theU.S. Department of Healthand Human Services sinceOctober 2013 and as recent-ly as lastmonth.
“Wehave receivedmulti-ple authorizations forclients that are not ours
(were never ours),” aprovider, whose identitywas redactedby theDepart-mentofHealthandWelfare,wrote in January.
Optum says the viola-tions amount to about one-hundredth of 1 percent ofthe 1.3million claims it hasprocessed so far in Idaho,and that none has resultedin disclosure of patient in-formation outside the net-workof providers,who alsoare prohibited by law fromdisclosing it.
Idaho contracts with lo-cal mental-health and sub-stance-abuse treatmentbusinesses to provide
Optum Idaho says it isawareofaHIPAAinvestigation, ithas fixed theglitch,andtherewasnobreachoutside thenetwork.
Many Saddamofficersnow lead Islamic State
BYBENHUBBARDANDERICSCHMITT
NEWYORK TIMESNEWS SERVICEBAGHDAD — As fight-
ers for the Islamic Statecontinue to seize territory,the group has quietly builtan effective managementstructure of mostlymiddle-aged Iraqis, includingmanymilitary officers under Sad-dam Hussein, overseeing
At the topthe organiza-tion is the self-declaredleader of all Muslims, AbuBakr al-Baghdadi, a radicalchief executive officer ofsorts, who handpickedmany of his deputies fromamong the men he metwhile aprisoner inU.S. cus-tody at theCampBucca de-
tention center.He had a preference for
militarymen, so his leader-ship team includes manyleaders of Saddam’s long-disbandedmilitary.
They include formerIraqi officers such as Fadelal-Hayali, the topdeputy forIraq,who once served Sad-dam as a lieutenant colonel,
Thegrouphasbecome,in effect, ahybrid ofterrorists and an army.
See PROVIDERS,A8
See ISLAMIC STATE,A11
!READTHEHHSLETTERTOTHE
STATESMANIdahoStatesman.com
BOISE,WEHAVEACLASSIC LIFTOFF
AbuBakral-Baghdadi
MOTHEROFU.S.REPORTER INSYRIABEGSFORHISLIFEA11
FRIDAYCOMING The5ASouthern IdahoConferenceexpands to a 12-teamfamily thishigh school football seasonwiththe addition ofNampa andColumbia.
counseling, psychiatric careand other services to itsMedicaid patients. IdahohiredOptum last fall to bet-ter manage the program’srising costs.
The patient-informationerrors are the latest in a se-ries of actions by Optumthat have angered somemental healthcareproviderswho must now have theirservices and payments ap-proved by Optum. Someproviders say Optum hascreated red tape and cutservices needed by at-riskpatients. Some say Optumhasn’t paid them promptly,putting theirbusinesses’ sur-vival, employees’ jobs andpatients’ ongoing care atrisk.
Providers said in com-plaints and interviews that,while theycandestroy infor-mation on a document theycan hold in their hands, theycan only view much of Op-tum’s misdirected informa-tion online and lack the ac-cess todestroy it.
One provider’s ownercalled Idaho Health andWelfare in October report-ing that “one of his competi-tors (said) they received fivepages of patients’ informa-tion and a sizable checkfrom Optum,” according toan internal departmentalemail fromOctober.
HealthandWelfare said inJuly that it had received sixcomplaints related to theHealth Insurance Portabilityand Accountability Act —the federal law more oftenknown as HIPAA, that gov-erns privacy for patient in-formation.Thedepartment’sprivacy officer reviewed thecomplaintsanddecided theyweren’t “reportable”breach-esof theprivacy law.
STATE:DISCLOSURESINADVERTENT
Department spokesmanTom Shanahan said the dis-closures fall under an ex-emption for “inadvertentdisclosure of protectedhealth information” bysomeone who’s authorizedto access that information toanother person who’s au-thorized toaccess it, “or (an)organized health care
arrangement in which thecovered entityparticipates.”
But the U.S. Departmentof Health and Human Serv-ices’ Office for Civil Rights— the agency tasked withenforcing theHIPAA law—is investigating the com-plaints Idaho providerslodged againstOptum.
“The subject matter ofyour request is the subjectofanopenandongoing investi-gation,” the department saidthis month in a letter re-sponding to a Statesman re-questunder the federalFree-domof InformationAct.
Releasing the documents“could seriously compro-mise the integrityof thatpar-ticular investigation, and ...such a release, in general,woulddamage theprocedur-al integrity of the investiga-tiveprocess,” the letter said.
ONEPROVIDER’SEXPERIENCE
Dozens of the complaintsunder review are from twoBoise providers, Idaho Be-havioral Health and AccessBehavioralHealth.
Chris Culp, chief opera-tions officer for Idaho Be-havioral Health, said hiscompany has filed 25 federalcomplaints about receivingpatient information for peo-plewho aren’t its clients.
Optum asked Idaho Be-havioralHealth to file a for-mal complaint with Optum,he said.
“And what typically hap-pens is I’ll send an email, I’llprovide the information —exactly what happened —and then Iwill get a formlet-ter back within 10 days thatsays ‘I’ve receivedyourcom-plaint andwewill do our in-vestigation and we will letyouknowwhat the resultsofthat are,’ ”Culp said.
ButCulpsaidhe’s receivednofollow-upletters fromOp-tumabout the resultsorwhatthe company is doing to cor-rect any problems with pri-vacyprotection.
“And if that’s the organi-zation that’s in charge of ourhealth care here in Idaho,that’s kind of concerning tome,”he said.
ASECONDPROVIDER’SEXPERIENCE
AccessBehavioralHealth,an outpatient clinic inBoise,has filed 11 complaints to the
Office forCivilRights.Matthew Montoya, the
clinic’s billing specialist, de-scribed incidents similar tothose reported by Idaho Be-havioral Health. Montoyawould receive paperworkmeant for other providers,with enough detail to easilydecipher what kind of be-havioral-health treatmentthat provider’s patient wasreceiving.
Optum responded to aMarch complaint by Access
Behavioral Health with atwo-page letter that detailedan “Improvement ActionPlan” thatOptum had takenin response.
Optum wrote that its re-sponse included conductingan audit and giving threepeople “refresher trainingand post-training job shad-owing to assure compliancewith retraining.” The com-pany told Access it alsoplanned to do “ongoingcoachingonall identifieder-
rorsassessedvia randomau-dit” and continue to makesure all shared informationis “appropriatelymitigated,”amongother things.
“It just really didn’t solveanything,”Montoya said.
OPTUM:WE FIXEDTHE PROBLEM
Optum Idaho ExecutiveDirector Becky diVittoriosaid her company has con-firmed 134 instances of in-formation being incorrectlysent toproviders.
“We investigateall privacyconcerns thatare reported tous,” she told the Statesman.“We do not be-lieve that the in-cidents that wehave investigat-ed resulted inbreaches pur-suant toHIPAA,as therewas lowrisk that the in-formation at issuewas com-promised. Providers also(must comply with) HIPAArules and regulations ... relat-ed to safeguardingpatient in-formation.”
DiVittorio said that, be-cause Optum’s internal in-vestigation foundnobreach-es, it has not notifiedMedi-caidmembers.
“Consumer informationwas not compromised out-side of the health system,”she said.
In April and May, AccessBehavioral Health sent newcomplaints to Optum offi-cials, sayingAccess was stillgetting information aboutpatients who weren’t underits care.
“This goes back to the in-tegrity of their data,” Mon-toya said.
DiVittorio disputed that,saying Optum takes “theprotection ofmembers’ datavery seriously, and we havestringentpolicies in place.”
She said the company hasput in additional safeguards,such as training, to preventfuture errors.
SENSITIVEINFORMATIONTami Jones,CEO of Idaho
BehavioralHealth, said psy-chological treatment infor-mation is more sensitiveeven than medical records,so it should be more closelyprotectedbyOptum.
“It’s your insurance com-
pany who’s now sendingyour name, your diagnosiscode, and the services thatyou received — all that in-formation — off to some-body that you’venevergivenpermission to provide serv-ices for you,” Jones said.
INVESTIGATIONSNOTCOMMON
An investigation does notmean there has been a viola-tion of HIPAA law. The Of-fice for Civil Rights com-plaint process starts with areviewthatcan lead tooneofthree things: investigation in-to possible criminal viola-tion, investigation intopossi-ble privacy or security ruleviolation,orno investigation,if thecomplaintclearlydoes-n’t meet the legal require-ments tobe aviolation.
Most complaints do notprompt an investigation, ac-cording to Office for CivilRights statistics. The officereceived almost 13,000 com-plaints last year, and about9,830 of them nevermade itpast the initial screening,be-cause they weren’t eligiblefor investigation and en-forcement.
On average, for roughlyone-third of the complaintsthat do require an investiga-tion, the office finds no vio-lation.The other two-thirdsresult in enforcement,withahospital or health care planmaking a change to itspriva-cypractices, for example.
It is “not extremely com-mon” for theOffice forCivilRights to open an investiga-tion intoHIPAAcomplaints,said Kim Stanger, an attor-ney forHolland andHart inBoise who specializes inhealth care law includingHIPAAbut isnotworking inany capacity on the OptumIdaho complaint issue.
“I personally don’t thinkit’s something that wouldkeepmeup atnight if it’s go-ing to a provider and thatprovider is going to destroyit,” Stanger said, adding thatasmore health care transac-tions and records go online,misdirected information is“a real risk.”
AudreyDutton: 377-6448,Twitter:@IDS_Audrey.
This story is a collaborativeeffort by the Idaho Statesmanand Boise State Public Radio.
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BYBRIANBENNETTANDJOSEPHTANFANI
TRIBUNEWASHINGTON BUREAUNUEVO LAREDO, Mexico — It was a
familybarbecue inaparkon theRioGrande,a belated birthday party for GuillermoArevaloPedraza’s wife,Nora LamGallegos,and their two daughters, Mariana andPriscila, ages 9 and 10.
Arevalo and his buddy, Josue Gonzalez,
were lighting the coals and the girls wereplaying by thewater’s edgewhen they heardthedeafening roarof aBorderPatrol airboat.
They watched it turn in the fast currentandpullbeside aman in the river.An agitat-ed crowd soon gathered on the Mexicanshore and began shouting at the two agentsto lethimbe.
Gonzalez and Arevalo ran toward thecommotion, the girls closebehind.Gonzalezcouldseeoneof theborderagents try tosnagthe swimmerwith a longboathook.
The state is changingMedicaid and local organizations are trying new approaches toaddressmental illness, but will it help themany Idahoans falling through the cracks?
A family outing, then a deadly shootingAnewspaper investigation revealsdoubts aboutwhether aBorderPatrolagent’s actions in2012were justified.
ENTERTAINMENTWednesday:HankWilliams-inspiredneo-traditional countrysingerWayneHancockvisitsNeurolux.Friday:It’sHalloween!Puton a costume andbangyourhead toheavymetalband InThisMoment attheRevolutionCenter.MOREEVENTS,L4
DON’TMISS ITINTHE STATESMANThursday in IdahoOutdoors:Get set for elk hunting.Sunday:Don’t forget thatDaylight SavingTimeends at 2 a.m.Nov. 2—and you’ll have to setyour clocks back anhour.
NATION/WORLDTuesday: FederalReservepolicymakers begin atwo-daymeeting to setinterest rates.Thursday:FreddieMacreleases weeklymort-gage rates.
SPORTSTuesday:TheNBA seasonbeginswithdefendingchampion SanAntoniotaking onDallas at 6p.m.MOREEVENTS,S1
LOCALToday: “Wilderness:Past,Present andFuture,”2 to 4p.m.,FrankChurchRoomon the secondfloorofAlbertsonsLi-brary atBoise StateUni-versity.Professor Saman-thaHarvey speaks aboutthe 50th anniversaryoftheWildernessAct.Free.Thursday: “BeyondBoundaries:Building theBench,” 6 to 8p.m., 3200Cassia St.,Boise.Histori-ans JimDuran,AngieDavis andBarbara PerryBauer trace the historyoftheBench.Attendees arewelcome to bring relatedfamilyphotos, artifactsandotherBench-relateditems to share.Free.MOREEVENTS,A4
RoyVopal didn’t expect to liveDowntown at a Boise RescueMission shelter this year.But the60-year-old had a serious kneeinjury, then surgery that he saidleft him unable to work for thefirst time in his life.
Vopal says his service in theMarines during theVietnamWarleft him with post-traumaticstressdisorder.
“There were times when Iwantedmy life toend,”Vopal said.
He attempted suicide in his 30sandused drugs.
Decades later, Vopal is receiv-ing mental health servicesthrough the homeless shelter.
Across the city in a quiet neigh-borhood,awomannamedDanielleremembers a day six years ago
whenher sonattackedher.“My husband left forwork, and
my son was being perfectlycharming ... ‘Bye, Daddy, I love
you,’ ” she said. “The door shuts,we hear the lock click. My sonturns around, at the age of 3, andsays, ‘Now I’m coming after you,Mommy.’ ”
There are now alarms on theboy’s bedroom door andwindow,and Danielle has taken classes tolearn how to physically restrainhim.She isdesperate togethimin-to a residential therapyprogram.
Vopal and Danielle’s son aretwo of Idaho’s thousands of resi-dentswithmental illnesses.
Idaho’smental health system isthreadbare. It lacks resources —
KATHERINE JONES/ [email protected], right, isacertifiedpeer support specialist fromBoise. She talkswithTedBrown,an investigator forFederalDefenderServicesofIdaho,andMissyBrown,whoworks for the schooldistrict, duringamental health firstaid training in IdahoCity.Optum Idaho— thecontractorpaidbyIdahoDepartmentofHealthandWelfare tomanageMedicaid’soutpatientmental health services—provides the firstaid trainings to small groupsaround the state.The two-day trainingsare freeandopen to thepublic.
Stallings facesuphillbattleagainstSimpson
BYBRYANCLARK(IDAHO FALLS) POST REGISTER
The last time these two lockedhorns, itwasadifferentmillennium.
Incumbent Republican Rep.Mike Simpson and Democraticchallenger Richard Stallings, him-self a former congressman, are vy-ing to represent Idaho’s 2nd Con-gressionalDistrict inNovember.
When the two faced off for theseat in 1998— Simpson’s first timerunning for the office — Simpsonwon by an 8 percent margin. No
primary or general election chal-lengerhas come that close since.
Simpson has built a reputationas a governance-oriented conser-vative who is willing to compro-mise inorder topush throughpoli-cies he favors.He overcame a pri-mary challenge inMay from IdahoFalls attorney Bryan Smith, whogained substantial backing from
national tea party-linked groups,includingClub forGrowth.
Butnobodyhas come closertobeating the incumbentcongressman than thecentristDemocrat.
Today: Idaho’s fragmentedmental healthsystemleavesmanybehind.Tuesday:Policeandmobilecri-sisunits respond tomentalhealthemergencies.Wednesday: Idahoansdon’tget the right treatment for theirillnesses,so theyenduphospi-talized.Thursday: Courtsand jailsaresomeof Idaho’s largestmentalhealthproviders.Friday:Optum Idaho,anewMedicaidcontractor,clampsdownonservices.
too few psychiatrists, too few op-tions for Medicaid patients, toofew 24-hour highly skilled treat-ment facilities forpeoplewith seri-ous issues. And, while Medicaidrolls swelled after the recession,Idaho didn’t increase its spendingon mental health. The overall De-partment of Health and Welfarebudget skyrocketed,while mentalhealth got a smaller share.
WHERE WE STANDWhen Idahoans withmental ill-
ness go untreated and their disor-ders spin out of control, they endup in crisis care at an emergencyroom,a statehospital or a local jail.
The state’s behavioral healthprogram, which is separate fromMedicaid, serves some of thosepeople.
Local businesses are trying tocatch some of the people who’vefallen through the cracks. A newhospital-run program in Caldwelloffers help for people with issuesthat are hard to treat. A homelessshelter in Boise offers residentsmental health screenings and care.Hospitalsare starting todo telepsy-chiatry to reach rural patients.
But that hasn’t been enough tosolve the problem. Idaho still hasone of the country’s highestsuicide rates—on average, 48 per-cent higher than the national sui-cide rate.
About 13 percent of impover-ished Idaho adultswho lack healthinsurance have a serious mentalillness, such as schizophrenia orbipolardisorder.
About half of the chronicallyhomeless Idahoanswho seek shel-terat theBoiseRescueMissionarethere “as a direct result of an un-treated mental illness andchemical dependency and alcoholabuse, because many people withan untreated mental illness willself-medicate with alcohol andother drugs,” said the Rev. BillRoscoe, president and CEO of theBoiseRescueMission.
The reason they’reuntreated?“Mostly, it’s because they don’t
have access tomental health care,”Roscoe said.
CHANGING THE SYSTEMState lawmakers and agencies
are making big changes to Idaho’sfracturedmental health landscape—with the goal of creating amoreefficient system. Some front-lineproviders and mental health con-
sumers are skeptical aboutwhether the changeswillwork.
Last year, the IdahoDepartmentof Health and Welfare hired Op-tum Idaho to takeover thenonhos-pital portion ofMedicaid’smentalhealth services— such as therapyandpsychiatry appointments.
At the same time, Idaho is in-vesting $45,000 in regional boardsto linkmental health patients withcommunity resources.
The most tangible effort thestate ismaking is a new crisis cen-ter in Idaho Falls. State officialswanted toopen three of those cen-ters this year, but only got enoughmoney from the Legislature forone— a kind of pilot project.Thecrisis center is expected to openthis fall. Its data will be closelywatched by state officials.
In its first year, Optum Idaho’stakeover of Medicaid outpatientcarehasbeenfraughtwithpaymenterrors, problems with claims andlong wait times. It also has meantthat people who relied on certainservicesunder theoldwayofdoingthings aren’t offered those sameservices today. But the companysays it has opened new doors forIdahoans with mental illness —pumpingup the rosterof providerswho will take Medicaid patientsand offeringmental health first aidtraining to thepublic, forexample.
Expanding Medicaid under theAffordable Care Act would allowmore peoplewith untreated men-tal illness to pay for treatment.State lawmakers are unlikely,though, to take up a Medicaid ex-pansion bill in the next legislative
session.The legion of homeless men
who come through the Boise Res-cueMission’sdoors are among themost likely tobenefit from such anexpansion. They can’t access pre-ventivemental healthcarenowbe-cause the state doesn’t offerMedi-caid tomostpoor, childless adults.
More than 22 percent of unin-sured adults who don’t qualify forMedicaid now—butwould, if Ida-ho expanded the program undertheAffordableCareAct—were in“serious psychological distress”over a one-year period, accordingtoa2013 report from theSubstanceAbuse andMentalHealthServicesAdministration.
NOT ENOUGH HELPDanielle didn’t want her last
name published because she’sworried a public spotlight wouldpile extra stress onto her children,including her son.Hewas adoptedas an infant and developed severalpsychiatric disorders — opposi-
tional defiant disorder, attentiondeficit hyperactivity disorder,PTSD, reactive attachment disor-der and a conduct disorder,whichmeans it’s hard for him to followrules and he is driven to misbe-have, sometimes violently.
Danielle is frustratedby the lackofoptions forchildren likeher son.Children with very severe mentalillnesses oftenmust be sent out ofstate for residential care. Daniellehas been trying to convince IdahoMedicaid to pay for that level ofcare, which costs upwards of$10,000 to$14,000amonth.Sheac-knowledges that it’s expensive,butshebelievesher sonwill soon startcosting taxpayers more — in thecriminal justice system.
“I think I vacillate betweenanger and sadness, because I thinkwe can do better by these chil-dren,” Danielle said. “Our systemis flawed. Itneedsmorecontinuity,especially with these kinds ofkids.”
Sunday: TraceMonth to date: 0.40"Normal month to date: 0.60"Year to date: 9.93"Normal year to date: 8.68"
Today Yesterday
Good Unhealthy Hazardous
Sunrise today 8:14 AM..............Sunset tonight 6:42 PM............Moonrise today 11:57 AM........Moonset today 9:49 PM............ First Full Last New
Oct 30 Nov 6 Nov 14 Nov 22
17, Antero Reservoir, Colo.
50s40s30s10s 20s0s-0s 90s80s70s 110s60s 100s
5566 // 550056 / 50SSeeaattttlleeSeattle
5500 // 228850 / 28BBiilllliinnggssBillings
7700 // 555570 / 55SSaann FFrraanncciissccooSan Francisco
7788 // 661178 / 61LLooss AAnnggeelleessLos Angeles
7777 // 559977 / 59KKaannssaass CCiittyyKansas City
8822 // 772282 / 72MMiiaammiiMiami
3399 // 331139 / 31JJuunneeaauuJuneau
T-StormsRain SnowIce StationaryWarmCold
-10s
Monday
56° 35°
Wednesday
66° 44°Mostly cloudychance ofshowers
Thursday
70° 47°Partly cloudy& breezy
Friday
71° 47°Partly cloudy& breezy
Saturday
59° 49°Mostly cloudy,
chance ofshowers
Sunday
55°Mostly cloudychance ofshowers
M. Sunny, 38M. Sunny, 47Clear, 50
Daytime highs and overnight lows
Tuesday
61° 42°Mostly cloudy,
chance ofshowers
1 2 3 4 5 6 7 8 9 10 11 1240 minutes to burn
UV index is the risk ofoverexposure to the sun.0 to 2 minimal, 3 to 4 low,5 to 6 moderate, 7 to 9high, 10+ very highSource: Boise Valley Asthma andAllergy Clinic
Mazeikas answered thefrontdoorofhis family’sEastBoise home.Thecourse of his lifechanged when heopened it.
At 24 years old,Mazeikas found himselfin themiddle of his firstpsychotic episode. Hethought he’d been contacted by alienswhowere using himin a scheme to control theworld.
Hewasn’t eatingwell.Hewasdrinking hisownurine.“I was storming around the house, really angry, when I
heard a knock at the door,”Mazeikas recalls. “I rememberthinking tomyself, stay cool, act normal,whatever you do,don’t say anything about aliens,because they’ll thinkyou’recrazy.”
WASHINGTON— In a rarepublic account-ing of its mass surveillance program, the U.S.Postal Service reported that it approved nearly50,000requests last year fromlawenforcementagenciesand itsown internal inspectionunit tosecretly monitor the mail of ordinary Ameri-cans for use in criminal and national securityinvestigations.
The number of requests, contained in a lit-tle-noticed 2014 audit of the surveillance pro-gram by the Postal Service’s inspector general,shows that the surveillance program is moreextensive than previously disclosed and thatoversightprotectingAmericans frompotentialabuses is lax.
The audit found that in many cases thePostal Service approved requests to check onan individual’s mail without adequately de-scribing the reason or having proper writtenauthorization.
In addition to raising privacy concerns, theaudit questioned theefficiencyandaccuracyofthe Postal Service in handling the requests.
Governmentmonitoring includes casesof vague reasoning andno authorization.
Mammoth bonesfound in Idaho
THEASSOCIATED PRESSAMERICAN FALLS — A portion of a
Columbian mammoth skull and tusks havebeen uncovered in southeastern Idaho, and ex-perts say a rare complete findmight be buriedthere.
Experts estimate themammothwas about 16yearsoldand lived from70,000 to 120,000yearsago inwhatwasa savanna-likecountrypopulat-edwith largeplant eaters andpredators.
The skeletonwas spotted earlier thismonthbya fossil hunterworkingasavolunteer for theU.S. Bureau of Reclamation near AmericanFalls Reservoir. It was partially excavated bystudents and instructors from Idaho StateUni-versity.
But the team had to postpone their workOct. 18 as the reservoir’s water level rose, com-pleting some of their tasks while standing inwater.They plan to return next summer whenthe reservoirdrops.
“It gives us a little more time to prepare ifthis is a complete mammoth, to get the fundstogether,” saidMary Thompson, IdahoMuse-umofNaturalHistorycollectionsmanagerandauniversity instructor. “This isgoing tobe sub-stantial to go out and excavate a completemammoth.”
She said more bones and tusks remained in
Race low-key for Idaho’s 1stCongressionalDistrict
BYBETSYZ.RUSSELLSPOKESMAN-REVIEW
In his two terms in theHouse, Idaho congressman
Raul Labrador says he’s beenpushing big ideas such as im-migration and sentencing re-form and has become the “go-to” person on immigration is-sues among House Republi-cans.
NothingLabradorhas spon-sored has become law, but acouple of measures on other
issues — extending grazingleases, easing regulations ongeothermal test wells and au-thorizing community forestmanagement projects on fed-eral land — have passed theHouse once or even twice.Among the 291 bills he has co-sponsored, the largest numberby farwere to repeal all orpart
of the national health care re-formlaw.
“That’s been the issue thathas been most pressing inCongress,”Labrador said.
His community forest proj-ect bill and his grazing billbothpassed this year.
Which lots?Threeparcels that have drawnsome interest include6.5 acres southeast ofMain andWhitewaterPark, 1.5 acres on 25thStreet and Fairview, and1 acre on thewest sideof 24th Street betweenI-184 and Fairview.Anydeals in theworks?Nothing firmyet, but the citywants
to be ready tomove un-derused land it ownsinto private hands if theopportunity arises, cityspokesmanVinceTrim-boli said.Whysomuch focushere? It’s a focal pointfor agencies looking torevitalizewhat wasonce a bustling businesscorridor. It’s inBoise’snewest urban renewal
district, andAdaCoun-tyHighwayDistrictrecently completedWhitewaterParkBoule-vard.Is itbearing fruit?Some:A two-story,21,000-square-footmedical buildingwentup this year on thesouthwest corner ofWhitewaterParkBoule-vard andMain Street.
BOISE CITY-OWNED LOTS PREPARED FOR SALECOMPANIESSNIFFINGAROUNDWESTOFDOWNTOWN
On the other side of thedoor stood Teresa Shack-elford and Ellie Merrickfrom the Idaho DepartmentofHealth andWelfare’sMo-bile Crisis Unit. Two policeofficerswere there, too.
“Philip was very friendlyand talkative at first,”Shack-elford remembers. “Butwhat he was talking aboutwas very bizarre and disor-ganized. He was havingsome disturbing delusionsandhallucinations.”
Shackelford said somepeople can functionwell de-spite delusions, butMazeikas wasn’t one ofthem.
Mazeikas’ parents, Mikeand Deanna, felt they wereout of treatment options fortheir son. Insurancehadcov-ered some therapy sessionsbut had run out. They hadcalled police a handful oftimeswhenPhilip’sbehaviorbecame toovolatile.
On the third police visit,an officer told MikeMazeikas about the MobileCrisisUnit.He and his wifedecided itwas time to call.
DE-ESCALATIONFIRST,MENTALHOLDSSECOND
Idaho has mobile crisisteams scattered throughoutthe state. They work withlaw enforcement and firstresponders to connect fami-lies like theMazeikaseswithservices to treatmental andbehavioral illnesses.
Often,mobile crisiswork-ers are called to a home tode-escalate a conflict or po-tentiallydangeroussituation,and to evaluate the mentalstateofaperson.Theevalua-tion determines if a personqualifies for amental holdoran involuntary commitmentto a treatment facility.
Amental hold is typicallyrequired when a personlacks a grasp on reality andrefuses to seekhelp.Last fis-calyear, 5,095 Idahoanswereplaced on mental holds.That’s nearly a 40 percentincrease since 2008.
“The day I called Teresa(Shackelford), Philip wascompletely out of it,” his fa-ther said. “I told him wewere going to the hospital,andhe said ‘no.’ ”
As they stood at theMazeikases’ front door twoyears ago,Shackelford askedPhilip basic questions to un-derstand if he was takingcare of himself, or to see ifhisdelusionshad so affectedhis everyday life that hewasadanger tohimself.
“We were pretty con-cerned about his health,”Shackelford said. “He hadlost a great deal of weightand was engaging in behav-iors that justweren’t safe.Hejust wasn’t able to take careof himself or make rationaldecisions at all.”
Shackelfordwent back toher office and filled out thepaperwork to sendMazeikasto the state hospital againsthis will. A judge signed theorder, and Philip began thefirst of two stints at IdahoState Hospital South inBlackfoot.
“The first time, I didn’tchange my mind about mybeliefs,”Mazeikas said. “Thesecond time I went to thestate hospital, I startedthinking maybe it’s notaliens, andmaybe it is schiz-ophrenia.”
It’s that return to realitythat health professionalshope for when they respondto crisis calls.
CRISIS TEAMS:ARESPONSE TODEFUNDING?
Sgt. David Cavanaughmanages Boise Police De-partment’s Crisis Interven-tion Team, which is essen-tially law enforcement’s ver-sion of the Mobile CrisisUnits the state health de-partmentdeploys.
Since 2007, Cavanaughhasbeendeveloping and im-plementing a collaborativeplan that gives policeofficers the tools they needto better respond tomental-health crisis calls.
“Youshouldbeable tocall911 and someone will comehelp,” Cavanaugh said.“We’re not mental-healthprofessionals, but we dowant tohelp people.”
Cavanaugh said all policeofficers in Idaho receivesome basic training in howto de-escalate a potentiallydangerous situation. Of theBoise Police Department’s286 sworn officers, about aquarter have had 40 addi-tional hours of crisis-inter-vention training.
Crisis InterventionTeamsand Mobile Crisis Unitshave become the responseto the defunding of mentalhealth care across the coun-try, said Laura Usher, a pro-gram coordinator at theNa-tionalAllianceonMental Ill-ness.
“Mostpeoplearenot real-ly getting good diagnoses orgood services— sometimesfor years or decades afterthey start to experiencesymptoms,” Usher said.“That’s because our systemis so underfunded, frag-mentedanddifficult forpeo-ple tonavigate.”
LACKOFPREVENTION,INTERVENTION LEADSTOCRISES
Instead of early interven-tion, or preventive mentalhealth screenings, too oftenpeopleenter the systemonce
they’re in themidstofacrisis.“It’s like if we didn’t
screen for high blood pres-sure, and we didn’t screenfor high cholesterol, andwejust waited for people tohave heart attacks and thensaid, ‘OK, I guess thispersonhasheartdisease,’ ” she said.
Of Idaho’s $2.5 billion De-partment ofHealth andWel-fare budget, 7.5 percent wenttomental health programs inthelast fiscalyear.That’sade-cline from11percent in2006.
State spending formentalhealth crisis and treatmenthas declined most yearssince a peak in 2008. At thesame time, the agency’s totalmental health spending, in-cluding federal Medicaiddollars, has increased steadi-lyduring the lastdecade.
Usher said crisis teamsare adept at handling initialencounters, but it’s impor-tant the care doesn’t stoponce the officer or socialworkerdrives away.
“There are a lot of oppor-tunities where a person canfall through the cracks,” shesaid. “The spirit of collabo-ration is something that real-lyneeds tohappen.
CRAFTING IMPROMPTUACTIONPLANS
At the Idaho Departmentof Health and Welfare’s Re-gion4headquarters inBoise,social workers and mental-health care providers in anopen-concept bullpen calm-ly answer incoming crisiscalls.
“This is JohnwithMobileCrisis inBoise,” JohnGreenequietly said to a caller. “Hey,we’re trying to figure outwhat’s going on with yourbrother. Is he doing OK to-day?”
Greenewas responding toan unfolding crisis situationin a small town outsideBoise.
“He actually did shootneighbors’ cats?” Greeneasked, “At neighbors cats.Gotcha.”
When Greene hangs up,he turns to his supervisor,Shackelford, and Merrick.The three devised an actionplan.
In less than 20 minutes,after several phone calls,Merrick and Greene wereon the road to meet policeofficers at the home of thecaller’s brother.
After speaking with him,the officers and socialwork-ers agreed that while theman needed mental healthcare,hedidn’tmeet the strictguidelines foran involuntarymental holdorcommitment.
“Hisdelusionsdon’t seemto be overtaking every areaof his life,” Merrick said tothe officers.
“Lots of time people needhelp,and theydon’twant that— and we can’t make themdo that,” Merrick explainedlater. “The bar for civil liber-ties is intentionally high, andshouldbe thatway.”
The group agreed to con-tinue monitoring the situa-tion, but their task, for now,was finished.
THEGOALS: STAYOUTOF JAIL,AVOIDEMERGENCYROOMS
The ultimate hope of lawenforcement and mental-health crisis workers re-
sponding to calls is to keepthe person away from jailsand hospital emergencyrooms. At its best, thesystem is intended to en-courage people in crisis toseek long-termhelp throughservices the professionalscan recommend.
ForPhilipMazeikas, it tookbeing held against his will inthe Blackfoot hospital tocome to the realization thathe needed medication andongoing care to live ahealthylifewith schizophrenia.
“At this very moment, Ifeel kindofnostalgicand sadremembering all of this,”Mazeikas said. “ButbasicallyI considermyself prettyhap-py. I do feel like maybeeveryone has some delu-sions in their life, but I’mpretty certain the TV isn’tsending me secret mes-sages.”
Mazeikas is now onMed-icaid, the state-federal healthinsurance program for low-income and disabled chil-drenandadults.He isn’tabletowork, but he is volunteer-ing at the Department ofHealth and Welfare and re-cently began the certifica-
tion process to become apeer-support specialist. Hemay eventually help otherIdahoansnavigatemental ill-ness.
“My survival has been de-pendent on others becauseof my illness, and I’m reallythankful for that,”he said.
JoinBoiseStatePublicRadioand the IdahoStatesmanat6p.m.Wednesday forapaneldiscussionon Idaho’smental healthsystem.
Guests include theRev.BillRoscoe,ofBoiseRescueMission;TamiJones, of IdahoBehavioralHealth;andRossEd-munds,administratorofIdahoDepartmentofHealthandWelfare’sDi-visionofBehavioralHealth.
Monday: Idaho’s frag-mentedmental healthsystemleavesmanybe-hind.Today:PoliceandMobileCrisisUnits respond tomental healthemergen-cies.Wednesday: Idahoansdon’tget the right treat-ment for their illnesses,sotheyenduphospitalized.Thursday: Courtsandjailsaresomeof Idaho’slargestmental healthproviders.Friday:Optum Idaho,anewMedicaidcontractor,clampsdownonservices.
INSIDETODAY “Ithas tobehush-hush.” BRADLEY VALLERIUS, an Illinois attorney, aboutmedical pot growers trying to acquire their first seeds to plant NATION,A11
WORLD SERIES: ROYALS CRUSH GIANTS, FORCE GAME 7 SPORTS, S1
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Obama saysquarantines
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Monday: Idaho’s fragmentedmentalhealthsystemleavesmanybehind.Tuesday:Policeandmobilecrisisunitsrespond tomentalhealthemergencies.Today: Idahoansdon’tget the righttreatment for their illnesses,so theyenduphospitalized.Thursday:CourtsandjailsaresomeofIdaho’s largestmentalhealthproviders.Friday:Optum Idaho,anewMedicaidcontractor,clampsdownonservices.
Earlyvoting endsFriday Vote8 a.m. to 5p.m. at theAdaCountyElec-tionsOffice, 400N.BenjaminLane,Boise, orCanyonCountyElectionsOf-fice, 1102E.ChicagoSt.,Caldwell.See theballot A sampleballot ap-pears onpagesB4-5 in today’spaper.The listof polling places is onB6.5p.m. today Deadline to request anabsenteeballot.Forms are available atidahovotes.gov and inperson fromyour county clerk.ElectionDay Polls are open 8 a.m. to8p.m.Absenteeballotsmust be re-turned to clerks’offices by 8 p.m.
Postage If an absenteeballot ismailedwith insufficientpostage,AdaCountywill pay the extra cost.Register tovote During earlyvotingoronElectionDay at yourpolling site.On theballot Three federal offices,all statewide offices and legislativeseats and several countyoffices andare at stake alongwith a statewideconstitutional amendment, a $17mil-lionBoise firebond, and smallerlevies andbonds inCanyonCounty.
Aboutone in five Idahoanshasamentalillness of some kind, according to federaldata.About one in 20 has a seriousmentalillness like Ervin’s. Tens of thousands ofIdahoans consider suicide each year. Ida-ho’s rate of mental illness is among thehighest in the country.
Butmany Idahoans aren’t getting help.Some don’t seek psychiatric care. Or
they can’t find a treatment center or psy-chologist to help them. Many Idahoanssimplycan’taffordhelp.More than20per-centof Idaho adultswho lackhealth insur-ance are in serious psychological distress,according to federal data. Idaho mental
A chronic shortage of care puts some Idahoansinto a vicious cycle of hospitalization
DARINOSWALD/ [email protected], ofNampa, hasblooddrawn for testingbyphlebotomistChristyCookatSaintAlphonsusMedicalCenter inNampa.Somepsychiatricmedicationscarry the riskofdamagingaperson’sbody.Ervin sayshercurrentdoctor foundaperfectprescription-drug regimen forher,but thedrugClozaril requiresher tohaveblooddrawnonceaweek to screen for signsofharm.
An autopsy Wednesday morning, includ-ing fingerprinting, should determine theman’s cause of death and confirm hisidentity, said Ada County Coroner ErwinSonnenberg. “We have an idea” of who themanwas, he said.
LesscertainTuesday—at leastpublicly—was how the man died. Boise police said heappeared tobe thevictimof foul play,andpo-lice questioned amanwho “may have someinformation thatwas related to thisor anoth-er crime,” Lt. Ron Winegar said. No arresthadbeen reportedbyTuesday evening.
Awitness says theman found alongAmericanaBoulevard looked like hehadbeen in a fight.
Six years ago, Boise attorney and devel-oper Scot Ludwig received the city ofBoise’s approval for a 160,000-square-footoffice and parking building on the east sideof 4th Street between Myrtle and Broadstreets.
When theGreatRecession tookhold,Lud-wig backed away from the project and let ap-proval lapse.Now,with the surroundingCen-tral Addition neighborhood “ready to ex-plode,” Ludwig is asking Boise forpermission to build virtually the same proj-ect.
He said Tuesday he’s negotiating a leasewith Cradle Point executives that wouldmake the six-story building the tech firm’s
CradlePointmaybe a tenant at thenew4th andMyrtlebuilding,whichcouldbreak ground inDecember.
Lobbyists go towork on state attorneys general
BYERICLIPTONNEWYORK TIMESNEWS SERVICE
When the executives who distribute5-Hour Energy, the popular caffeinated
drinks, learned that attorneys general inmore than 30 stateswere investigatingalle-gations of deceptive advertising — a seri-ous financial threat to the company — itmoved quickly to shut the investigationsdown, one state at a time.
But successdid not come in courtor at anegotiating table.
Instead, it came at the opulent LoewsSanta Monica Beach Hotel in California,
with its panoramic ocean views, wheremore than a dozen state attorneys generalhadgathered last year forcocktails, dinnersand fundraisers organized by the Demo-cratic Attorneys General Association. Alawyer for 5-Hour Energy roamed theevent, setting her sights onAttorneyGen-eralChrisKosterofMissouri,whose office
Some say the amount that is goingon is creating an appearanceofundue influence andunderminingthe credibilityof theoffices.
healthcentersoften takeMedicaid,but the state-run program won’tcovermost adults.
Asa result,agrowingnumberofIdahoans get help only when theyreach a crisis point — attemptingsuicide, getting arrested, having adangerous psychotic episode orendinguphomeless.
For Ervin, the crisis point hasbeen a refrain: She becomes suici-dal and ends up in the hospital.
The past year has been life-changing forher. She just emergedfrom a new program, paid for bycobbling together health-insurance plans.
NOT ACCEPTING STATUS QUOErvin’sparents thoughther self-
harmwas justaphase, that shewasdoing it for attention, she says. Sothere was no medication or psy-chotherapy or counseling whenshe first became ill.
After shemoved out of her par-ents’houseat 18, thehallucinationsthat told her to burn herself wentdormant.
Over thenextdecade,Ervinmether husband and welcomed herfirst baby to the world. It was ahappy time, a break in the cloudsthat gave Ervin the time to growinto the type of person whosevoice sounds confidentevenwhenit’s cracking under a suddenwaveof emotion.
But her depression eventuallycame roaringback,bringingwith itthehallucinations,anxietyand sui-
cidal thoughtsof old.Ervin, now 40 and living in
Nampa, is one of the first patientsand a recent graduate of a newpartial hospitalization program atWest Valley Medical Center inCaldwell.
Shehopes theprogram—ayearold thismonth—willbreak the re-volving-door cycle she shareswithmany Idahoans: sitting in apsychi-atric hospital room several times ayear, getting stableand leaving, on-ly toendupback in theemergencyroom after a crisis or suicide at-tempt.
“I think a lot of people figurethat that was probably status quoforher— that shewouldalwaysbein and out of the hospital, and thatwas all thatwecould expect,”AmyHicks, program manager, said asErvin graduated from theprogramon a late-September afternoon.
THE ILLNESSCOMESBACKIt was during Ervin’s second
pregnancy, at age 27, that she re-members the illness creepingbackinto her life. It was a rough preg-nancy, and Ervin spent six weeksin the hospital trying to keep thebaby inside. But her son arrivednineweeks early.
“While hewas in theNICU andI was home, I remember going tomyclosetand seeing thematernityclotheswith tags still on them, andcrying because I never got towearthem,” she said.
Ervin’s postpartum depressionmade it hard for her to bondwithhernew child.When theboy start-ed talking, he called Ervin’s hus-band “moddy” — mommy and
daddy.It took about a year for the de-
pression to lift.Ervin finished her 20s in a good
placementally, and had a third ba-by without any postpartum de-pression.
But the illnesscameback,worsethanever, inher 30s.That’saroundthe time that Ervin and her hus-bandpackedup the family tomoveto Idaho from San Diego, eager tolive in a placewhere they could af-ford to buy ahome.
It went all right at first. Then, acousin killed himself, and Ervin“really took on his feelings. ...A lotof my suicidal feelings came fromthinking abouthim,” she said.
She didn’t just internalize hercousin’s feelings; she also couldn’tleave work at work. Ervin has abachelor’s degree in social science
and decided to put her degree towork as a psychosocial rehabilita-tionworker. She still has copies ofglowing reviews of her work, andshe lovedwhat shedid.But shebe-gan dwelling on her clients’ prob-lems.
“That’swhenmy full-ondepres-sion (returnedwith) voices, suici-dal thoughts, suicide attempts,everything — just, it was full-blowndepression,” she said.
In amanic episode,Ervin insist-ed on walking across the countryto a friend’shouse inNorthCaroli-na. It was the middle of summer.She’dpacked a bag andhad $120 inher pocket. Her husband realizedhowsevereher illnesshadbecomeand took her to the hospital.
‘WAITANDSEE’Ervin has lost track of how
many times she’s beenhospitalized since moving to Ida-ho.
Three times at SaintAlphonsusRegionalMedicalCenter’s psychi-atric inpatient unit.
Four times at State HospitalNorth, the state-run psychiatrichospital inOrofino.
Twice at IntermountainHospi-tal,which also has a partial hospi-talization program.
She’s not sure howmany timesshe’s been atWestValleyMedicalCenter for 24-hour psychiatriccare. It’s around 30.
She always tookmedications asprescribed, but they didn’t alwayswork.
“Mykidswouldcomehomeandask me if they could go to a birth-day party next week.And Iwouldsay, ‘We have towait and see,’ ” shesaid. “They didn’t knowwhy ... butI used to say that because I didn’tknow if I was going to be in thehospital.”
The day after Christmas lastyear, Ervin joined the new WestValley partial hospitalization pro-gram,which she calls “thePHP.”
NOTENOUGHHELPPeople on the frontlines of Ida-
ho’s mental health system have aplethora of theories about the ris-ing need for hospitalization. Hereare fourof thebiggest:
Inadequate state funds. Idahospent $37 per capita on mentalhealth services in fiscal year 2010,according to theNationalAssocia-tion of State Mental Health Pro-gramDirectorsResearch Institute.The only place in the U.S. with
MENTALILLNESSCONTINUED FROMA1
2008 2009 2010 2011 2012 20130
1,000
2,000
3,000
4,000
5,000
2007
StatewideAda County41 other countiesCanyon CountyKootenai County
INVOLUNTARY COMMITMENT CASES IN IDAHOCA
SESFILED
FISCAL YEAR Source: Idaho Supreme Court
4,686
1,912
867
1,365
542
Mental-commitment hospitalization cases filed in magistrate and district court.
the Idaho Statesmandid notwanttobenamedor quotedbecauseofthe stigma surrounding mentalillness. Shawna Ervin, ofNampa,believed the issue of mental ill-ness in Idaho is importantenoughto share her story, despite con-cerns from a familymember that
doing so could hinder her jobsearch. ShannonGuevara, also ofNampa, did not seek treatmentfor decades for her bipolar disor-der because of stigma aroundpsychiatricdisorders.
Stigma can keep an undiag-nosed person from seeking treat-ment, and it can result in discrim-ination against peoplewithmen-tal illnesses, amongother things.
What can you do to reduce thestigma?Here are three importantthings:
USEDIFFERENT LANGUAGEWords such as “crazy,” “nuts,”
“psycho” and “wacko” reinforce
stereotypes and discrimination.One mother of a man withlifelong mental illness said shewishes Idahoans talked aboutschizophrenia and other mentaldiseases the same way they talkaboutdiabetes.
FOCUSONTHEPERSON,NOTTHE ILLNESS
Kelly Jennings, coordinator ofthe Ada County Mental HealthCourt, recommends away to im-prove Idaho’s mental health sys-tem that costs nothing and thateveryonecando: “Talkaboutpeo-ple, don’t define them by their di-agnosis,” she said. “How? Use
person-first language. Ratherthan saying ‘He’s schizophrenic,’say ‘he’s a person living withschizophrenia.’
“The first phrase focuses onthe illness and defines a medicalcondition, not a person.The sec-ond ... recognizes that a human,just like other humans, is livingwith amedical condition.
“It can be cumbersome, but it’samazing how quickly focusinglanguagemore carefully supportsthe kind of change that makespeople feel freer to ask for helpand to identify themselves assomeone livingwith amental ill-ness.”
CHALLENGEPERCEPTIONS INTHEWORKPLACE
The jobless rate among peoplewith serious and persistentmen-tal illnesses is 90 percent, higherthan the 50 percent rate forpeoplewith physical or sensorialdisabilities, according to the Sub-stance Abuse andMentalHealthServicesAdministration.
But employers who hired peo-ple with mental illness say thoseemployeeshavebetter-than-aver-age attendance and punctualityand that their motivation, workqualityand job tenure isat leastasgood as other employees, theagency says.
What we can do to reduce the stigmapatients feelThree ideas forhelpingpeoplewithmental illness inone-on-one conversationsand in theworkplace.
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without change“Progress is impossiblewithout change“Progress is impossible
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a final deal here in the near fu-ture,” said Ludwig, who alsofounded the law firm LudwigShoufler Miller Johnson in1994.
Cradle Point, maker ofwireless routers, began inBoise in 2006. In the past fewyears, the companyhas grownquickly, more than doublingthe number of workers on itspayroll. It inhabits space inseveral Downtown locations,including the Idaho Inde-pendent Bank building, an-other Ludwig property justnorth of the lot where the
Cradle Point building wouldgo.
A representative of CradlePointdeclined to comment forthis story.
Ludwig’s plan goes beforeBoise’s Planning and ZoningCommission. The developerneeds the city to grant an ex-ception to rules that restrictbuilding heights in the area to35 feet.TheCradlePointbuild-ingwouldbe 98 feet tall.
Boise already is reworkingits Central Addition masterplan,and less restrictiveheightlimitsareunderconsideration,design review manager SarahSchafer said.
If crews break ground onschedule in December,Ludwig said, the project willbe done by late 2015. In addi-tion to80,000square feetofof-fice space, the Cradle Pointbuilding will incorporateabout 200parking spaces.
Idaho also spent the least in thecountry — in sheer dollars — onmental health care. Montana out-spent Idahobyalmost 300percent;Wyomingoutspent Idahobyabout30percent.
“Themain shortage rightnow iscare for poor people — for Medi-caid,” said Dr. Charles Novak,medical director at IntermountainHospital, Allumbaugh House andSage Health Care in Boise and apsychiatrist leader at SaintAlphonsus. “It’s just gotten busierandbusier asprogressively, slowly,more peoplewho can’t access out-patient care get ill and end up inthe ER. ... If they don’t end up injail.”
Too few places to get treatment.Idahohasananemic supplyofcarefor patients who need round-the-clock attention frommental healthproviders.
“SaintAl’s inpatient (behavioralhealth) unit runs full all the time,”Novak said.
For juveniles in crisis, there arealmost no options. IntermountainHospital recently cutback its inpa-tient services for teens,which “ob-viously has set up a shortage ofpsych beds for teens,”Novak said.Asked where local parents cansend young childrenwho need in-tensive 24-hour psychiatric care,Novak said, “There is no suchthing” in this area.
A shortage of psychiatrists. It’stwiceaseasy foran Idahoan to finda radiologist to read an X-ray as itis to find a psychiatrist to craft theperfect cocktail of medications toget someone back to being func-tional.
A shortage of psychologists. Dr.Ninon Germain, a Boise psychia-trist, says psychologists are bestequipped todeliver therapy forde-pression and anxiety.
“Iwill discharge teenagers fromIntermountain Hospital with de-pression/anxiety — they’ve cutthemselves, theywant todie,”Ger-main said. “The medication is theeasypart.Thehardpart is trying tofind a therapist whowill get themwell quickly and effectively ... andthen get themon theirway.”
Between 1percentand 3percentof Idaho teens have tried to killthemselves and needed medicalattention for their suicideattempts,according to federal data.
It’s not just that psychologistsare in short supply. It’s also thatMedicaid — which covers thou-sands of Idaho children, includingthose with severe psychiatricproblems—doesn’tpay enough.
“What frequently happens is(adolescents) go to therapy, theyvent, family may be pulled in forsome of it,” Germain said. “Butwhen I ask if there’s actual familytherapy going on, usually the an-swer is no — because that’s diffi-cult, and it requires a level of train-ing (beyond)whatMedicaid’swill-ing to pay for. So, young peopletypically have a revolving door.They get discharged from the hos-pital, they come back, they get dis-charged from the hospital, theycomeback.”
THE REVOLVING DOOROptum Idaho has said it’s trying
to change that. Optum, acontractor paid by the IdahoHealth and Welfare Department,says family therapy has increasedsince it took over part of Idaho’smental health Medicaid systemlast year.
Optum Idaho says thechanges itis making to Medicaid have keptpatients from being repeatedlyhospitalized.
Local mental healthworkers in-terviewed by the Statesman dis-agree.
Dr. Lawrence Banta, who runsthe behavioral health program atWest Valley, said the switchoverlast year to a privately run systemforMedicaid patients withmentalillness is not helping to ease thecrisis. Instead, more people areshowingupwithpsychiatricemer-gencies.
“Quite a few of the ones we hadto send out (to get care in the newsystem) have become frequent
fliers thatweren’t before,”he said.
AN UNMET NEEDPatients in “partial hospitaliza-
tion” stay in thehospital all day fortwoweeks to two months— busywith group therapy from 10 a.m. to3 p.m., plus individual therapy, arttherapy and medication. They gohome at night, where they do thehomeworkofnavigating their liveswith anew compass.
West Valley launched the pro-graminOctober 2013, saying itwasresponding to the gap in servicesbetween “make an appointment tosee a doctor or therapist” and “behospitalized.”
“The need is simply there,” saidGlenda Nelson, a registered nurseand director of behavioral healthservices.
Nelson has worked in the inpa-tient psychiatric unit since 1994.She says patients with mental ill-nesses usually spend five to sevendays in the hospital. The bill typi-cally goes to some taxpayer-fundedprogram.
At the end of their stays,patients leave with referrals inhand. West Valley calls within aday to check on how a patient isdoing, she said. (Fewer thanhalf ofIdaho’s mental health treatmentcenterscheck inwithpatientsafterdischarging them back to the out-sideworld.)
But there are patients, such asErvin,who end up back in the ER,sometimes after attempting sui-cide.
While Ervin was a willing pa-tient, Idaho is in the midst of aspike in emergency, involuntaryhospitalizations — court-orderedcommitmentsofpeopledeemed tobe a danger to themselves or oth-ers, or “gravely disabled” by theirmental illnesses.
According to the IdahoSupremeCourt, Idahocourtsover-saw more than 4,500 cases of in-voluntarymental commitments infiscal year 2013, up 82 percent
since 2008.Hospitals also have been flood-
ed with patients in crisis, and thenumber of people heldtemporarily during psychoticbreaks, extremedepressionoroth-er mental health crises rose fromabout 3,600 in 2008 to more than5,000 last year.
It had been a longer journey forher, compared with most of theprogram’s graduates so far. Ervinwas hospitalized twice, which in-terrupted her progress andpromptedherprivatehealth insur-ance to cutheroff.
Another of Ervin’s insuranceplanspickedup the restof thepro-gram.Hicksnotes thatErvin is for-tunate to have good health insur-ance coverage, which is not thecase formany Idahoanswithmen-tal illness.
The week after Ervin’s gradua-tion from the partial hospitaliza-tion program, shewas adjusting todaily life again.
“I reallymiss thePHP,” she said.“The PHP is still there forme. I’vecalled them a few times, and I’vestoppedby and gotmyhugs.”
Apublichealth teamnowdropsby Ervin’s house twice a week tocheck on her, make sure she’s “notthinkingbad thoughts”and remindher about doctor appointments,she said.
For the first time in years, Ervinishopeful.
“She’s married, the mother ofthree and is not the stereotype ofmental health issues— but she re-ally is.She’swhowenormallysee,”Hicks said. “It’s everybody.Mentalillness affects everyone.”
Like almost every person inter-viewed by the Idaho Statesmanand Boise State Public Radio forthis series,Ervin has felt alone andharshly judged as a person with a
seriousmental illness.Just spending hours in group
therapy with other patients —where nobody blamed or doubtedher—madeadifference inher life,she said.
“For nine years, I have lived inmy house and have not reachedout to anybody,” she said on hergraduation day. “Being alonewas abig thing. And there’s only somany people you can call. And itgets lonely.”
Ervin’s and her husband’s chil-dren are teenagers now, and assummer vacation drew to a closeand the kids returned to school,Ervin decided to make a change:Shewould reachout.
“So Iwent tomyneighborswhowere ‘hello and goodbye’ neigh-bors,” she said. “I invited them to
coffee, andwewent to themovies.And this Saturday, I went to thetrain stationwith one ofmyneigh-bors. I started socializing,which isveryunusual forme.And I learnedthose skills here at the partial hos-pitalization program. I neverwould have done itwithout it.”
She also has been applying forjobs — not as a mental healthworker this time— and looks for-ward toworking again.
This year, Ervin began to envi-sion a futurewhere shewon’thaveto tell her kids, “We’ll wait andsee.”
AudreyDutton: 377-6448,Twitter:@IDS_Audrey
“InCrisis” is a collaboration betweenthe Idaho Statesman and Boise StatePublic Radio.
If someone you know is in emotionalcrisis:Call the IdahoSuicidePreventionHotline at 1-800-273-8255.Warning signs towatch for:ÆTalking aboutwanting todie.ÆLooking for away to kill oneself.ÆTalking about feeling hopelessorhaving no reason to live.ÆTalking about feeling trappedor inunbearable pain.ÆTalking aboutbeing aburden toothers.ÆIncreasinguseof alcohol ordrugs.ÆActing anxiously, agitatedlyorrecklessly.ÆSleeping too little or toomuch.ÆWithdrawing or isolating oneself.ÆShowing rageor talking aboutseeking revenge.Æ Extrememood swings.
Other things you can do to help:ÆDonot leave theperson alone.ÆBedirect.Talk openly andmatter-of-factly about suicide.
ÆListen.Allow expressionsof feel-ings.Accept the feelings.ÆBenonjudgmental.Don’tdebate.Don’t lectureon the valueof life.ÆDon’t act shocked.Thatwill putdistancebetween you.ÆDon’tbe sworn to secrecy.Seeksupport.ÆOfferhope that alternatives areavailable,butdonotofferglib reas-surance.ÆTake action.Removemeans, suchasguns, sharpobjectsor stockpiledpills.ÆGethelpby calling thehotline orvisitingSuicidepreventionlifeline.org.ÆTake theperson to anemergencyroomor seek help from amedical ormental-healthprofessional.
DARINOSWALD/ doswald@idahostatesman.comShawnaErvincuddleswithcatsMatthewandAshleyanddogMax.Ervin said the family’s “furbabies”helpher unwindatherNampahomeandoffercompanionshipduring thedaywhileherchildrenareawayat school.Ervinhasbattled feelingsof isolationasan Idahoanwithamental illness.But in thepast fewmonths, she started socializingwithneighborsandmakingnew friends,aswellasventuringout into the jobmarket.
The old Idaho Penitentiary’scemetery lies on a patch of hillsideon the grounds of the IdahoBotan-icalGarden.There’s a stark beautyto the place — the dry grass, themany stones marked “unknown.”Historiansestimate that close to60men were buried there betweenthe 1880s and the 1960s. Causes ofdeath range fromnatural to suicide
to execution.Though technicallyopen to any-
onewho enters the BotanicalGar-den, Old Pen staffers don’tadvertise the cemetery.
For the first time, it will be opento VIP ticket holders for Friday’sand Saturday’s Frightened FelonsHalloween fundraiser. The toursquickly sold out.
Amber Beierle, visitor servicescoordinator, said she hopes the
is pleased to announce the association of
Ron FriezeVice President/Investments
Stifel, Nicolaus & Company, Incorporated | Member SIPC & NYSE | www.stifel.com
What is it?The debatewill pitRe-publicanGov.ButchOtter againstDemocratic challengerA.J.BalukoffandLibertarian candidate JohnBujakon IdahoPublicTelevision.You alsocan listen onBoise StatePublicRadio,91.5FM.What’s the format?MelissaDavlinof IdahoReportswillmoderate,withapanel of Idaho reporters askingquestions. It is scheduled to run for90minutes. Itwill be the third timethe twomajor candidateshave debat-ed face-to-face.
Anyotherdebates?RepublicanLt.Gov.BradLittle andDemocratic chal-lengerBertMarleywill debate for ahalf-hour at 8:30p.m.The lastof thesevendebates IPTV ishosting is Sun-day,when the candidates forCon-gress in the 2ndDistrictmeet at 7p.mWhoare the sponsors?TheLeagueofWomenVoters, the IdahoPressClub, IPTVandBoise StateUniversi-ty.At IdahoStatesman.comMore onall the candidates in ouronlineVoterGuide.
amovie theaterbefore the lights godown— thebuzzof nervous en-ergy, natteringaboutplans for theweekend, someone lingering in theaisleuntil the very lastminute.
But this isn’t the movies. It’s a courtroom, one where the stakesaren’t just “jail”or “no jail,”butaremuchdeeper formanyof thepeo-ple in the room.
Halloween tourbringsOldPen cemetery to lifeThe staff cleaningup the sitehopes the attention leads tomore care and less vandalism.
Idaho and BannockCounty granted mil-lions of dollars in tax incentives to get thefrozen vegetarian food maker Amy’sKitchen to come toPocatello.
Gov. Butch Otter said the company willhire 200 people in the coming months towork in the formerH.J.Heinz plant,whichclosed in June as Heinz’s new owner cutcosts.Fourhundred jobswere eliminated.
The new jobs will paymore than $33,000ayear, slightlymore thanBannockCounty’saverage wage of $32,407, the governor’s of-fice said.
Otter touted thenewsasavictory for Ida-hoand itsnewtax incentiveprogram,whichtheLegislature passed this year.
“The reopening of this state-of the-art fa-cility in Pocatello by a family-owned com-pany that extends its family-style atmos-phere to its employees is exciting news forboth the community and the state,” Ottersaid.
Two Idaho economists reacted with
Economists are critical of the typeofdealAmy’sKitchen received aspartof the state’splans to land jobs.
Review:Healthsystemnot readyforEbola, crises
BYJEFFDONNANDGARANCEBURKETHEASSOCIATED PRESS
TheU.S. healthcareapparatus is shortonresources and unprepared to deal with thedeadly Ebola virus, according to anAssoci-ated Press review of hospitals and othercomponentsof themedical network.
Experts broadly agree that awidespreadnationwide outbreak is extremely unlikely,but they also concur that it is impossible topredict, since other Ebola epidemics havebeen confined to remote areasofAfrica.
AndEbola isnot theonlypossibledanger.Experts sayotherdeadly infectiousdiseases— ranging from SARS to a newstrain of theflu to more exotic plagues such as Lassafever— could crash the health care system.
Even small clustersof cases couldbeoverwhelming, anAPanalysis shows.
DARINOSWALD/ [email protected] sitemanagerAmberBeierleclearsgrowth fromagravestonemarked “Unknown”onWednesday. In theback-ground, historianAnthonyParryhelpsprepare thegrounds.
SeeMENTALCARE,A4
SeeCEMETERY,A5
SeeAMY’S,A9
See EBOLA,A7
Before they can receive care, someIdahoansmust enter the justice system
DARINOSWALD/ [email protected] teaseeachotheratdinnerabout their favoriteNFL teams'performances.ShannonGuevara isnowgettingpsychiatriccareaftera felonyarrestandwaiting tohearwhether she’ll goback to jail orget fully intoacourtprogram.
INCRISISA SPECIAL REPORT ONIDAHO’S FRAGMENTED
MENTAL HEALTH SYSTEMFOURTHOFAFIVE-PARTSERIES
Monday:Manygetleftbehind.Tuesday:Police,crisisunits respond.Wednesday:Need-ing treatment,manyjustwindup in thehospital.Friday:Optum Idaho,anewMedicaidcon-tractor,clampsdownonservices.
Idaho has 10 special men-tal health courts, whereadult felonswith one of fourmental illnesses show upeachweek to talk to a judge.
“What are you learning intherapy?” the judgewill like-ly ask. “Tell me why youmissed a drug test,” he’ll say,or, “I hear yournewmedica-tions areworking?”
Afterabrief interview, thejudgemight send the personto jail for aweekend fornon-compliance or offer praiseand a promotion to the nextphase of mental healthcourt’s demanding two-yearprogram.
Caldwell’s mental healthcourt is where you’ll findShannon Guevara, 34, aNampa housewife andmotherof four.She’sbeen toprison twice. This is herchance to keep frommakinga third trip.
Guevara was arrested inJuly for holding an emptymeth baggie— themetham-phetamine residue on it wasenough for a drug charge—and for violating probation.The mental health courtteam welcomed Guevara,who has bipolar disorder,but she’s waiting to find outwhether a sentencing judgefor her drug and probationcharges will decide to sendher toprison.
“When I got arrested, tome, it was a blessing,” Gue-vara said. “I felt a load liftedoffmy shoulders. I know I’mfacinganewcharge,andyes,Imay end up back in prison.But in the long run, I’msober. And maybe, if thejudges allow it, I’ll get thehelp through the mentalhealth court, and I thinkthat’llbe the help Ineed.Butat least I’m not using any-more. And I didn’t followthrough with the plans Ihad.”
Those plans were to killherself, she said.
Mental health court is de-signed to rehabilitate Ida-hoans whose severe mentalillnesses get them in troublewith the law—whether it’sstealingmoney tomaintainadrug habit, committing afelony during a psychoticepisode or getting caughtwith the uppers or downersthey abuse to self-medicate.
CRIME AND ILLNESSIdaho’s courtrooms, jails
and prisons are full ofpeople whose mental ill-nesses are linked to theircrimes.
When the U.S. began to“de-institutionalize” peoplewith mental illness in thelate 20th century, placingthem in communities in-stead of in hospitals, thosepeople increasingly endedup in the criminal justicesystem, according to theNa-tional Institute of Correc-tions.
Many Idahoans withmental illness use drugs oralcohol to drown out hallu-cinations, stoppanic attacks,numb post-traumatic stressor ease depression. Someend up committing crimeswhile drugged ordrunk.
Ada County Sheriff GaryRaney said about 10 percentof his jail’s population havechronicmental health disor-ders, and 20 percent haveacutemental illnesses.Manyhave stopped taking theirmedications.
“The pattern for our in-mates has been repeatedthousands of times,” Raneysaid. “People who suffermental illness begin to de-compensate and, partly be-cause of a lack of supportservices in the community,they continue to spiral untilthey act out in a way thatconstitutes a crime. Law en-forcement is called and be-causewe have nowhere else
to take them, they end up injail.
When we wait untilsomeonewithmental illnesscommits a crime before wetake action, we’re not onlydoing them a disservice byhousing them amongst acriminal population, but at$88 per day, it is some of themost expensive housing wecould put them in.”
One in three Idaho in-mates has mental healthneeds, according to the Ida-ho Department of Correc-tion. When those prisonersare released, they have amuch harder time findingwork, staying on the goodside of the law and gettingcare than other ex-convictsdo.
A national study will re-lease findings this year onwhether giving offendersMedicaid upon releasekeeps them from falling intocrime and unemployment.Idahodoesn’tofferMedicaidto most adults, and Gov.Butch Otter and the IdahoLegislature have balked atexpanding the program un-der theAffordableCareAct.
ATROUBLEDCHILDHOOD
Guevara grewup inCald-well in the 1980s and 1990s.Hermother was addicted toheroin, and Guevara triedcrank— a form of metham-phetamine— andmarijuanaas a teenager when peopleoffered it to her at parties.But shenever gothooked.
Guevara says she wasraped multiple times beforeage 15.Afterward, she beganhaving symptoms of a psy-chiatricdisorder, though shedidn’t know that’s what washappening at the time. Shejustknewshedidn’t feelOK.
When Shannon was 15,she married Roman Gue-vara, a pipefitter andwelderwhowas 35 at the time. Hermother, who knew shecouldn’t take care of Shan-non, signed off on the mar-riage.
“Hewas a lotolder,buthewas willing to take care ofme, and he offeredme a bet-terhome thanwhat I’ve everhad,” she remembers. “Andsince then, we were togeth-er.”
Throughout their 20-yearmarriage, Shannon Guevarahas hadmood swings—de-pressed episodes that trapher in bed for a week, andmanic episodes of cleaning-and-shopping binges thatlast a few days.RomanGue-vara says he long suspectedsomething was wrong withhis wife’s brain chemistry
but didn’t want to acceptthat she could have amentalillness.
“The way I was raised,you don’t get depressed,”she said. “Youdoyourdutiesas a mom and wife, andthat’s just — you just dealwith it.”
THEBREAKINGPOINTSLike many families, the
Guevaras took a financialtumble in 2009. They hadmortgages on two houses,sank too much money intostarting a boxing club, gotsued after theirdog attackeda postalworker— and thenRomanGuevara got laid off,eliminating their sole sourceof income.
Shannon attempted sui-cide and was hospitalized.Doctors told the Guevaraswhat was wrong: Shannonhasbipolardisorder.
But Roman Guevarafought the doctors.
“I was mad, (saying)‘She’s not gonna stay here.She’scominghomewithme.She’s not crazy,’” he said. “Itell her now, if anybody is toblame, it’sme.”
When she got out of thehospital, Shannon took thelithiumpills thedoctorspre-scribed her, “but they mademefeel likeazombie,” so shequit taking them.
TheGuevaras couldn’t af-ford for Shannon to see adoctor to fix the medica-tions, and a friend suggestedmeth as a way to “keep upwith everything,” Guevarasaid.
Shannon tried meth andimmediately gothooked.
“I didn’t realize how ad-dicting it could be,” she said.“During that time, wheneverythingwas happening, Iwas starting to get really de-pressed and feel suicidal.”
She couldn’t stop usingeven when it disgusted her.She spent the family’s sparsecash on drugs, lied to herhusband, sold drugs to payfor her habit and wascharged with battery for afight.
She was busted in 2009after a drug deal — her firstfelony arrest — and sent tothe state women’s prison inKuna for eightmonths. Theprison sentence only madeher illnessworse, she said. Itwas an easy place to ignoreher deteriorating mentalhealth, because her fellowinmates didn’t trust the doc-tors, and Guevara couldsleep all day. There was noreason to get better.
Shewas released, then re-lapsed and went back toprison fordrugs in 2010.
Then she got clean againfor almost three years.
On Easter this year, hersister came to a barbecue atthe Guevaras’ house withmeth. Shannon couldn’t re-sist.
Embarrassedandangry atherself for turning to drugsonce again,Shannonwantedto die. She planned to driveher car off a cliff. The onlything stopping her, Shannonsays, was that Roman knewshe was on meth and
suicidal again, and he’dtaken awayher car.
Roman Guevara calledpolice. The officers foundShannon on a Monday inearly July, wandering in aNampa subdivision near herhousewith the meth baggiein herpocket.
Roman immediately filedfor divorce. He was fed upand couldn’t predict whatShannonwould do next.Hedidn’t want to be liable forhiswife’s erratic behavior.
Like everyone in mental-health court, Shannon Gue-vara got another chancewhen a judge wondered ifher crimes stemmed fromanuntreatedpsychiatricdis-order.
LACKOF FUNDINGATHREATTOSUCCESS
Mental health courts aresmall, intense, “problem-solving courts” with defen-dants who have pleadedguilty to felonies and beendiagnosed with bipolar dis-order, schizophrenia,schizoaffective disorder ormajor depression with psy-chotic features.
Defendants spend 18 to 22months in a kind of mental-health boot camp. They at-tend classes. Go to 12-stepmeetings. Take psychiatricmedication. Change theirdeep-rooted habits.
“I didn’t realize howmar-ginalized peoplewere in so-ciety who had seriousmen-tal illnesses until I startedworking here,” said KellyJennings, coordinator forAda County Mental HealthCourt. “Noteverybodygrad-uates with anA+, not every-body sails through the pro-gram—in fact, that’s rare—but getting through the pro-gram ... that’s a big accom-plishment, especially forsomebody struggling withmental health issues.”
Many of the people Jen-nings has shepherdedthrough the program in thepast nine years end up therebecause they ran out ofmoney formedications, shesaid.
The courts are runthrough the Idaho SupremeCourt, but the programdraws resources from alaundry listof stateagencies,with most of the hands-ontreatment provided by theIdahoDepartment ofHealthandWelfare.
The courts have a suc-cessful record.Not a perfectrecord — about 20 percentof the Ada County court’sgraduates commit newfelonies within two years—but that’s “much more suc-
cessful” than straight proba-tion, Jennings said. The re-cidivism rate for all IdahoDepartment of Correctionprobationers is about 31 per-cent.
Ada County’s court cantake about 40 people at onetime. Canyon County’s hasspace for about 25.
Health and Welfare onceprovided six full-time staffforAdaCounty’scourt.Nowit’sdown to four.
Thoseemployeesare “do-ing an amazing job of stillcranking out assessmentsand still providing classhours,”despitebudget-relat-ed staffing cuts, Jenningssaid. “At some point in time,if you go from six people tofour people ... there’s not asmany staff hours in the day.”
Another funding gap thatdrags on the potential suc-cessofmental healthcourt isa $55 to $60 monthly fee —meant to cover utilities andoverhead — that the defen-dants must pay to gain ac-cess to a pool of housingmoney.
They aren’t allowed towork in the early stages ofthe program, so finding $55or $60 each month can beimpossible.
“Thatmightmean that in-stead of being placed inhousing for six consecutivemonthswhile theirmeds arebecoming stable and they’regetting used to the program,theyendupata shelter,” Jen-nings said. “Health andWel-fare has some funding thatcan pay for that. It’s notavailable for everyone everytime, and once that particu-lar pot of money dries up,there’s literally nowhere toget thatmoney.”
A woman in the AdaCounty program just losthousing because her familycouldn’t afford to pay herhousing fee anymore, Jen-nings said.She endedup in ahomeless shelter.
TheRev.BillRoscoe,whoruns Boise Rescue Mission,confirmed that his organiza-tion routinelyhousesmentalhealth court participants.Nobody is allowed in theprogramwhile living on thestreets, so themission’s shel-ters are a fallbackwhile par-ticipants just released fromjail get their lives back in or-der.
“It’s a big problem foranybody in any situation tonot have housing,” Jenningssaid. “But to have a seriousmental illness and be tryingnot to use (or) fall into yoursubstance abuse pattern,while you don’t have a roofover your head, or you don’thave a place to put yourclothing or take a shower—is aproblem.”
‘NEVERBEENCOMFORTABLEINMYOWNSKIN’
Curtis O’Daniel, 41, livesat one of the sober-livinghouses that requires one ofthe $55 housing fees.
O’Daniel, a Boise native,was diagnosed at 13with de-pression.Thatmorphed intomajor depressive disorderwith psychotic features.Now, he is diagnosed withschizoaffective disorder— amix of bipolar disorder andschizophrenia.
He’s been sent to Idahojails and psychiatric hospi-tals “too many times tocount,” he said. But being atthe sober-living house inWestBoisemayhelpcementhis recovery from drug ad-diction, he said.
One reason?He canwalka few steps from his roomand be at an AlcoholicsAnonymousmeeting.
WhenyoumeetO’Daniel,you might notice the short-cropped silver hair. Or hisblack clothes. Maybe you’llnotice how long it takes forhim tomake eye contact.
MENTALCARECONTINUED FROMA1
DARINOSWALD/ [email protected] ison thephonewithherhusband,Roman,asherchildrenarrivehome from school in lateSeptember.Heryoungestchild, 12-year-oldMercedes, helps fixdinner forherselfand threeolderbrothers.Mercedes,whogoesby “Mercy,”likes to skateboardand rideherbike.She said shehopes thatmental healthcourtwillbea fresh start for the family.
Idahoprisonsand jailsaren’t justplaces for incarceration.They’realsomental healthproviders.
TheAdaCounty Jail,whereseveral people interviewedfor thisserieshavespent time,hasapsychiatristandpsychi-atricnursepractitioneroncall24/7.The jailalsoemploysthree full-time licensedclinicalsocialworkers.
“The jail isaplacewhere thecommunity isprotectedfromdangerouspeople,andsomeof thosepeoplehavemental illness,” saidAdaCountySheriffGaryRaney. “How-ever, themajorityof thementally ill in theAdaCounty Jailarenotdangerousand, ifmonitored,posealmostno risk.”
Hesaid “thevastmajority”of inmateswhocome into thejailwithamental illnessare releasedwitha treatmentplan.But theyhave “little tonoongoingsupport” tohelp themcontinue their treatment,so theyendupback in jail.
Onanygivenday,about6percentof theAdaCounty Jailpopulationhasa “mental healthchronic-carealert,”mean-ing the inmatehasasevereorpersistentmental illness, isnotadaptingpsychologically to the jail orhasmadeaseri-oussuicideattempt in the jail.
The jail had375 inmateswith those issues in2011,saidsheriff’s spokesmanPatrickOrr.Those inmatesendeduphavingamuchhigher reoffense rate thanaverage.About75percentwereback in jailwithin twoyears— thehighestrecidivism rateofanygroupofoffenders,Orr said.
Bycomparison, the reoffense rate for Idaho’sprisonsovera three-yearperiod isabout35percent,according to theIdahoDepartmentofCorrection.
JAIL: A PSYCHWARD?
JudgeMichaelReardonstartedworkingatAdaCountyMentalHealthCourt sevenyearsago, inad-dition tohisworkasa family lawmagistrate judge.
Reardonsays thepeople inhiscourtroomare “byand largeaprettyvulnerablepopulation.”Oneofhisgoals is todemonstrate thatapersonwithgreatauthority is invested intheir futuresandwants tosee themsucceed.
Hecallsdefendantsby their firstnames.Heknowstheir familytragediesand theirpets’ quirks.Dur-inga recenthearing, he talkedaboutguitarchordswithonemalepartici-pant, offeredasecondsomepointerson fixingabike flat, thengavea third
eighthoursofcommunity service formisbehavior.
Q:Whatmadeyouwant todothis job?
A: Idevelopedasympathetic in-terest in itasa fairlyyoungprosecu-tor ina robberycase Ihad.
From thatpoint, I think I’vealwaysbeensensitive to the issueofmentalhealthandhow itcanchangepeo-ple’s lives.
Q:Whydopeopleendup inyourcourtroom?
A: It seemsobvious tome,maybebecause Isee itall the time.Butpeo-plewhohavemental health issuesanddon’tget the treatment tend toseekotherwaysofaddressingwhat
A: Someof it ispeopledon’thavethe resources toaccess treatment.
Someof it isa lackofawareness.Theyknowsomething iswrong; theydon’tknowwhat it is.TheirUncleBobhad thesame thingandnobodyever figuredoutwhat thatwas.
Or theyhavebeendiagnosed.
Theyhaveundergonesome treat-ment. Itdidn’t feel good to them,sotheyquit following the treatment.
Oneof theadvantagesofhavingsomebody inasupervisoryenviron-ment—someplacewherecondi-tionscanbeplacedonhowthey in-teractandwhat they’resupposed todoandwhatmedications they take—is thatwecanenforce thebehaviorthatwewant them tocarry forward.
The transformation thatoccurs inthecourseof thecourt’s fourphasesis: first they’re resistant, then they’reambivalent, then they’re interested,and then they’reenthusiasts.
There’sa light thatgoeson formost folkssomeplacearoundPhase3 that says, “Oh,wow,my life’sbet-ter.Thisstuffworks.OK, now, howdoIdo that formyself?”
FROMTHE BENCH
SeeMENTALCARE,A5
FROMTHEFRONTPAGE
ButO’Daniel’smost strik-ing feature ishis senseofhu-mor.During amental healthcourt hearing in September,O’Daniel told the judge thathe’s been going on “fieldtrips— that aren’t jail.”
O’Daniel is in the earliestphase of mental healthcourt.He started in June andmoved into the sober livingcenter amonth later.
“I’ve never been comfort-able in my own skin. I’ve al-ways been sort of restless,felt out of place, didn’t quitefit in,” O’Daniel said. “Ilearned how to self-medicate at an early age.”
He says the hospital stayswould always help at first,but then he’d be releasedand on his own. He alwaysreturned todrugs.
“I’ll start having a panicattack, and I can see two-di-
mensional thingson thewalllike demons and skeletons,”he said. “It just reminds meof a bad acid trip.”
‘I DESERVEMYCHANCETOOVERCOME IT’
O’Daniel ended up inAdaCounty Jail after a three-daymeth binge that ended in afelony arrest.
Now, he sees a psychia-trist twice a month throughmental healthcourt.Hispre-scriptions are a shot of anantipsychotic every twoweeks, anotherdrug toman-age the antipsychotic’s sideeffects, an antidepressantand amedication that helpshim sleep.
O’Daniel still has frequentthoughts of suicide but callshismother or a suicide hot-line when he’s feeling verylow.
“Mental illness is like be-ing alone all the time,” he
said. “But when you have allthis outside influence tohelp you get better ... you re-alize, I’m not alone, I’m notunique, there’s other peoplebeforeme that had the sameobstacles.Theywere able toovercome it. I’m a humanbeing, I deserve my chanceto overcome it. I know intime, if I keepmy head right,I’ll be there.”
If he completes mentalhealth court, he can avoidgoing to prison— a big mo-tivator to stick with it, hesaid.
“Igot sevenyearshangingovermyhead for residue inapipe,”he said.
He is encouraged by hismother, Patsy McGourty,who spent her career incourtrooms where peopleare involuntarilycommitted.McGourty eventuallysought to have her ownmother and son, O’Daniel,
committed.McGourty is quick to
praise the mental healthcourts, as well as the invol-untary psychiatric hospitalcommitments that run atbreakneckpace through Ida-ho’s courts. She just wishesIdaho would invest in pre-vention — to pre-empt themental health crises thatstretch the limits of Idaho’scourts, jails andprisons.
“We don’t punish peoplefor having diabetes. Youknow?” she said. “And(men-tal illness is)nodifferent.Ex-cept it causes a lot of havocin our society.”
CHASING AWAYTHEMONSTER
Roman Guevara hasdropped his divorce lawsuit.Shannon said she hasn’tused drugs since July.
Shannon visited a court-appointed psychiatrist for
the first time in years a fewweeks ago. Before the ap-pointment, she fretted.
What if the drugs madeher feel like a zombie again?
Would shemiss the ener-gy from manic episodes —energy that created nothingbut havoc butmade her feellike a superwoman?
What ifmedschangedherpersonality?
Would she disappear?A few days after her first
appointment, she smiledand laughedwith relief.Thepsychiatrist gave her a newdrug, Latuda, that wasn’tknocking her out. It madeher feel like the Shannonwho cooks dinner, sleepsthrough the night, takesshowers, doesn’tcravemeth,doesn’t go on shoppingsprees. The “regular” Shan-non.
Now, theGuevaraswait tohear what comes next —
whether Shannon will endup in prison or mental-health court.
Roman hopes for a freshstart with the woman heloves, without the illnessthat throws their lives intochaos.
“I’ve always said thatthat’sanotherperson inher,”Roman Guevara said. “Thatother person, I call a mon-ster. ... I truthfully hope forthis to control that monsterand keep it away from her,because that person is notShannon.”
AudreyDutton: 377-6448,Twitter:@IDS_Audrey
“InCrisis” is a collaborationbetween Boise State Public
with the Treasure Valley’smentally ill have plenty ofideas of how to better servethe growing number of un-dertreated people needingcare.Butmostof those ideasrequire Idaho to increasespending on its strained sys-tem.
A four-member panel
fielded questions about thesystem’s problems and pos-sible solutions Wednesdayat Boise State University’sRon & Linda YankeResearchParkbuilding.
Tami Jones, president andCEO of Idaho BehavioralHealth, was one of severalpanelists frustrated thatmental health spending inIdahohas been cut.
“What strikes me is howbureaucratic it’s become,how it’s becomemore aboutnumbers rather than thehealth of the people,” Jonessaid. “So many times, we’renot able to help people be-
cause there just aren’t re-sources. That’s heartbreak-ing tome.”
The other panelists wereRoss Edmunds, administra-tor for the IdahoDepartmentofHealthandWelfare’sDivi-sion of Behavioral Health;Boise police Sgt. David Ca-vanaugh, who manages thedepartment’s Crisis Inter-vention Team; and the Rev.BillRoscoe,whoworks withthe homeless as CEO ofBoiseRescueMission.
Thepanelwas anoffshootof theongoing “InCrisis” se-ries of articles, radio storiesand videos produced by the
Idaho Statesman’s AudreyDutton and Boise State Pub-lic Radio’s Emilie RitterSaunders, who moderatedthepanel discussion.
Roscoe said his missionprovides limited mentalhealth services for homelesson a $45,000 annual budget.He seesmore homeless suf-fering from problems thanhis facility can treat, includ-ing vulnerable single moth-ers.
“When we have a personin crisis, the only place to gois jail or a few beds at SaintAl’s,”Roscoe said. “It’sswimmingupstreamalready.
People are in and out, in andout, back in their pain andmisery.”
Cavanaugh said police of-ficers responding to inci-dents involving mentally illpeople are stuck with pooroptions: hospital or jail.
“Or worse yet, they don’tmeet requirements, so wehave to leave them like wefound them — in crisis, butwith no real solution,” hesaid.
Several panelists said ex-panding Medicaid in Idahowould broaden the pool ofpeople qualifying for careand would provide funding
for services and treatment.The GOP-dominated Legis-lature has been unwilling toexpandMedicaid, inpartbe-cause it doesn’t want to ap-pear to support PresidentBarack Obama’s AffordableCareAct, Jones said.
Edmunds said more law-makersare seriousabout ad-dressing the system’s prob-lems than in previous years,butprogress is slow.
“Sometimes,we get in theway of helping people,” Ed-munds said. “That, likemanyother things in thesystem,re-liesheavilyonpolitics.”
ZachKyle: 377-6464
Police andhospitals areleft to respond towhatis anongoing crisis.
ing the investigation of a possible homi-cidewas seen fightingwith thedeceasedearlier in theweek.
But Scotty Dale Turnbull, 24, hasn’tbeen charged in the death ofRussell “Rusty”Bitton, 37.Rather, prosecutors accusedhim Wednesday of attackson another man and awoman, all in the area ofDowntown Boisewhere theConnector crosses overAmericana Boulevard. The
city has been trying to break up a home-lesscamp theredubbed“HoboHangout.”
What isTurnbull accused of?Turnbull, who law enforcement said
has no permanent address,was chargedwith felony aggravated battery andmis-demeanor battery and arraignedWednesday afternoon. Scott Bandy, anAda County deputy prosecutor, said theaggravated battery charge comes froman attack on a woman Monday night,while the misdemeanor stems from theattack on aman.
The woman is in intensive care,Bandy said, with a 3-inch skull fractureand various other injuries. Turnbull al-legedlybatteredher and thenkickedherin theheadwhile shewason theground.
Online court records showthatTurn-bull has a lengthy criminal recorddatingtowhen hewas a juvenile.He has beenconvicted of theft, illegally carrying aconcealed gun, drugs andpoaching.
What is the connection toBitton’sdeath?
According to Bandy, witnesses saw
Turnbull fighting Bitton around thesame time as the other attacks.
Bandy described Bitton as a “thirdvictim” in court. But he emphasized inan email to the Statesman that thematter is still in thehandsofBoisepoliceand that he was only relaying thewitness reports.
A couple of witnesses in the areaTuesday suggested to the Idaho States-man that aman connected to the deathhad also battered a woman Mondaynight, and police examined multiplecrime scenes Tuesday — including thereported site of a recent fight near theCorpusChristiHouse homeless shelter.
What happened toBitton?Bitton was found dead when police
and paramedicswere called to the sceneat 10:30 a.m. Tuesday. The Ada Countycoroner formally pronounced him deadnearlyanhour later.TheCoroner’sOfficesaidWednesday thathedied from “bluntforce traumaof theheaddue to assault.”
Investigators haven’t publicly ad-dressedwhether it was a fight involvingTurnbull or some other incident. OnTwitter,Boisepolice saidWednesdayaf-ternoon that the investigation isongoing, but that they wouldn’t releasemore information so as “not to jeopard-ize the case.”
What’s next forTurnbull?His bond was set at $1 million. Judge
Daniel Steckel also prohibited him fromcontacting the two battery victims fortwo years.
He’s next set for a preliminaryhearing Nov. 12. That hearing, if it goesforward, will determine whether hisfelony case should advance to districtcourt for trial.
Sven Berg contributed.
AudreyDutton: 377-6448,Twitter:@IDS_Audrey
Boisepolice continue to investigatethedeathofRustyBitton.
ScottyTurnbull
tours will educate peopleabout the cemetery’s signifi-cance and its vulnerability tovandals.
Earlier this year, someoneknocked over the 1914 stonemarking the grave ofmurderer Ulysses Bearup.Bearup had wrested a gunfrom a sheriff’s hand and shothim twice in the chest.Hewaskilled trying to scale theprisonwalls.
His is one of the largerstones in the yard, and not thefirst instance of vandalism.Thieves havemade offwith atleast two grave markers sincean inventory taken in the1970s. The Old Pen operatedfor a century before closing in1973.
Thoughno inmatehasbeenburied in the cemetery sincethe 1960s, it is stillanactive re-search site for historians andfamily members trying tolearn more about peoplewhodied behindbars.
Cross-referencing burialmaps and newspaper stories,researchers are slowly identi-fying the men buried underthe stonesmarked “unknown.”
Earlier this year — aroundthe timeBearup’s gravemark-er was broken — Beierlehelped awoman locate her fa-ther’s grave in the cemetery.
STORIESUNDERTHESTONES
The timing is good formoreappreciation of the old ceme-teryasanendangeredsite.TheRotary Club of Boise East re-cently raised $5,000 throughKickstarter tobeginrenovatingnearbyTableRock in hopes ofcurbing vandalism and inspir-ing people to protect vulnera-ble historic sites.
Beierle said that if theFrightened Felons tours aresuccessful, theOld Pen mightdo more educational pro-grams at the cemetery. Beier-le’s past lectures on the ceme-teryhave drawn a crowd.
“We understand that thescary, creepy aspect of thecemetery is interesting,but it’snot even the best part,” saidBeierle.
It’s the stories buried therethat reveal asmuch about our
cultural history as they doabout specific crimes, shesays.
ALMOST FORGOTTEN,BUTNOTUNKNOWN
Some of the inmates whodiedwhile serving time at theOld Idaho Penitentiaryweren’t buried in the prisoncemetery. That includesDar-rell “Scoop”Thurston.
The talented first basemanon the prison baseball teamtheOutlaws,Thurstonwantedto be buried anywhere but theprisoncemetery.Afterhediedin the 1930s, inmates pooledtheirmoney to bury Scoop ina city cemetery.
The Seventh-Day Adven-tistspaid toburygubernatorialassassin Harry Orchard atMorrisHill thanks to his con-version to the religion.
Troy Powell and ErnestWalrath, hanged in 1951 after
killing a grocer in Boise’s EastEnd, are buried atMorrisHill.Thieves in search of macabrekeepsakes have stolen theirgravemarkers frequentlyoverthe decades, saidBeierle.
Six of the 10 men executedat the Old Pen are buried intheprisoncemetery, includingmurdererRaymondSnowden,who was hanged in 1957. Helies beneath one of the “un-known” markers. It’s likelythat wooden stakes originallymarked many of the gravesand that the anonymousstones were put in place afterthewood decayed, said stafferAnthonyParry.
Other graves are clearlymarked, includingRossDrap-er’s, though his name is writ-ten “Draper Ross.” He was agay man arrested in CanyonCounty on charges related tohis lifestyle in the 1930s. Theprison collection includes let-ters from his niece that insistshe loves him and does notjudge him.Her letters contin-ued after his 1938 death; shedidn’t knowhe haddied.
A court sentenced RufusRoy Liggins, a black man, tofive to 10 years for writing abad $20 check. Liggins got aPurpleHeart inWorldWar II.A military headstone markshis 1956 grave at the edge ofthe cemetery.
AnnaWebb: 377-6431
CEMETERYCONTINUED FROMA1
!READMOREABOUTTHEOLDPENAND
THEFELONSEVENTIdahoStatesman.com
DARINOSWALD/ doswald@idahostatesman.comAmberBeierleandAnthonyParryuncoveranameat thebaseofoneof theoldestgravestones.WilliamR.Trentwasburied in 1880afteranescapeattemptand shootout.Records showTrentalsowasknownby the lastnameReese,Beierle said,and they foundthename “Reece”carvedat the footof the stone.
Leaning leftor rightThink yourpolitical beliefs arise from logic andreason?Maybe not.A teamof scien-tists found that they could tellwhowas conservative andwhowas liberalbased onhowtheir brains respondedtodisgusting pictures.Howdid thiswork?The findings,published inCurrentBiology, showthat thebrainsof liberals and conser-vatives arewireddifferently.A teamledbyVirginiaTech scientistshad 83volunteers take a test todeterminewhat theirpolitical leaningswere.
While sitting in anMRImachine,they looked at 80 images— 20 eachofdisgusting, threatening, pleasantorneutral images.The researcherswatchedhowthe participants’brainsreacted to eachof those images.And the results?When shown adisgusting image— such as amutilat-ed animal body— the conservatives’brains reactedmore strongly, and indifferentways, than the liberals’.However, the neural responsesoftendidn’tmatch the conscious ratingsthatparticipants gave the pictures.
WHAT’SONYOURMIND? POLITICSREALLY ISDISGUSTING
Final debatefor governorfull of livelyexchanges
BYKIMBERLEEKRUESITHEASSOCIATED PRESS
RepublicanGov. ButchOtter,Demo-cratic challenger A.J. Balukoff and Lib-ertariancandidate JohnBujakagreedonlittleThursdaynight—not surprisingly— and the result was the most heatedexchanges yet.
The hot topics were education, theeconomy, same-sex marriage and theprison scandal, and the candidatesweren’t shy about going on the attack.
Balukoff started the debatewith crit-icism of Otter’s handling of the 2013scandal involvingCorrectionsCorpora-tion of America wrongly telling thestate that guards were working shiftsthatwere actually left vacant.The com-pany later announced that it would pullout of Idaho, and Otter’s top staff be-came involved in finishing a nearly$1million settlementwith the company.
Otter,Balukoff andBujak ofteninterrupt themoderator and apanel to respond to zingers.
Campaigningon one-partyrule in states
BYMONICADAVEYNEWYORK TIMESNEWS SERVICE
AITKIN,Minn.—Ashe steps tofrontdoors along the winding roads here inhis rural House district, state Rep. JoeRadinovich of Minnesota announcesthathe is there to introduce himself, and“in case you want to yell at me aboutsomething.”
There is reason to anticipate yelling.Radinovich andhis fellowDemocrats
won control of this state’s governmenttwoyearsagoby flippingbothlegislativechambers, and pushed through tax in-creases for thewealthiestMinnesotans,acceptance ofMedicaid expansion, andapproval of same-sexmarriage.
Now Radinovich, 28, is facing thesame Republican rival he defeated byjust 323 votes in 2012, and his opponentismounting a blunt campaign accusingDemocrats of overreaching.
Thoseof the reigning politicalpersuasion say it gets thingsdone,while opponents call forbalance.
Nine-year-oldKendra sits in one of theprivate roomson the second floorofBoise’sDowntownpublic librarywithhercommunity-based rehabilitation servicesworker, JenniferBeason.Beason slides aworkbook toKendra. It’s
what she callsher feelings journal. “Doyou knowwhat relieved is?” she asks.
Withoutmissing a beat,Kendra rattlesoff examplesof feeling relieved.“Like you forgot to bring home apaper,
a really, really importantpaper, and thenyoubrought ithome,but you left it in yourbackpack and you thought you left it atschool,” she said. “And then you’re re-lieved you still have it.”
stopped in front of Phil UlmenJr.’s North End house Wednes-daynight.
A little boy poked his headout the window and yelled:“Hey,what are you guysdoing?”
A small army was working
feverishly under bright lampsnext to 15-footcastlewalls— thefront of Count Dracula’s castle.They added tombstones to agraveyard, put up decorativefencing and assessed the laststeps to awaken the fire-breath-ing dragon,Zhran’El.
“We’rebuilding adragon,” re-sponded son John Myers, 46,who grew up in a house wheredreamswerebrought to lifeby afatherwhocouldbuildanything.
“No you’re not,” the boy shotback. “For real?”
For real.The mechanical dragon that
71-year-oldUlmenmadeaboutadecadeago—after retiring from33 years with the phone compa-ny—has a head that tips up anddown, eyes that glow andchange colors, wings that openand fold, and a mouth thatopens, closes andbreathes fire.
He’s constantly tinkering tomake it better. One fix
PhilUlmen Jr. looks forwardto seeing his traditionaldisplay, dragon included,delight trick-or-treaters.
SeeREHAB,A6
SeeDRAGON,A7
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INCRISISA SPECIAL REPORT ONIDAHO’S FRAGMENTED
MENTAL HEALTH SYSTEM
LASTOFAFIVE-PARTSERIES
Monday:Manyget leftbehind.Tuesday:Police,crisisunits respond.Wednesday:Needingtreatment,many justwindup in thehospital.Thursday: Courtsandhospitalsserveasmen-tal healthproviders.
Forayearandahalf,KendraandBeason have spent about fourhourseachweekdeveloping socialand personal skills for Kendra,who has had a tumultuous start tolife.
By the time she was 3, Kendrawas in a foster home, removedfrom her biological parents be-cause of severe abuse andneglect.
“No child should go throughwhat she went through,” saidKendra’s adoptive mother,GingerKreiter. “Becauseofwhat shewentthrough, it put her in severe trau-ma. She had no coping skills withyourordinary life.”
That’s whyKendra has been re-ceiving community-based rehabil-itation, individual counseling andoccupational therapy. She’s beenreceiving similar services, off andon, since she was 3. They have allbeen paid for through Medicaid,the shared federal-state health in-surance program for poor and dis-abled people.
But sincebehavioral health serv-ices offered through Idaho’sMedi-caid program were privatizedthroughamanagedcarecontractorinSeptember2013, some recipientsof services have seen their ap-proved hours cut back or eliminat-ed.
Kendra has attention deficit hy-peractive disorder, and reactive at-tachment disorder. Her mothersays she also has post-traumaticstressdisorder, although thatdiag-nosis isn’t part of her filewithOp-tum Idaho, a division of United-HealthGroup, the state’smanagedcare contractor.
Community-based rehabilita-tion, formerly known aspsychoso-cial rehabilitation, ismeant tohelpsomeone with a mental illnessfunctionwithin the community. Itteaches people coping skills andreal-life skills, from hygiene andhome management to financialmanagement and social skills.
Optum is deliberately curbingthose services, saying community-based rehabilitation isn’t alwaysthe best treatment or medicallynecessary.
“It’s important to re-emphasizethe transformation the state is do-ing to focus care on the use ofmore evidence-based practices,”Optum Idaho Executive DirectorBeckyDiVittorio said.
NEWMANAGER FORBEHAVIORALHEALTH
That’s been a familiar line fromOptum Idaho as the company hasfaced criticism from serviceproviders and lawmakers duringthe bumpy first year of its three-year contract.
During the first 12 months, thestate—with amixof stateand fed-eral dollars—haspaid the compa-ny $126million. That’s well belowthe $148 million the state paid forbehavioral health underMedicaidin fiscal year 2013.
Idaho’smental healthMedicaidcosts have increased each fiscalyear since 2006, while the state’sfunding of its behavioral health di-vision has fluctuated.
Overall, the state’s support ofmental health programs has be-come a smaller share of the$2.5 billion Department of Healthand Welfare budget, from a 2006peak of 11.2 percent to 7.6 percentin fiscal year 2014.
Service providers— themostlysmall businesses and nonprofitswhose claims for payment forMedicaidpatientsOptummustap-prove — have submitted formalcomplaints with the company andthe federal government. They re-port longwait times for serviceau-
thorizations and claims reim-bursementsmeasured in cents in-stead of dollars. Some providershave even closed their doors per-manently, blaming the instabilityofOptum’soperation.
The state and Optum contendthat overhauling the behavioralhealthportionof Idaho’sMedicaidprogram won’t be smooth andseamless, but it will be worth it.The company and some lawmak-ers anticipate better care throughevidence-based treatment.
That answer isn’t acceptable toKreiter. Her adoptive daughter“lacks huge social skills, evennow,” she said.Community-basedrehab “has helped her a lot withthe social skills. They’re gettingher out there. They tackle everylife event you think of to prepareher for when she gets older. If wedon’t take care of the kids now,then it’s going to cost a lotmore torehabilitate them as adults.”
Optum has cut community-based rehabilitation services by10 percent, while adding alterna-tive services.Optum says ithas ap-proved a 25 percent increase in thenumber of children getting indi-vidual therapy, a 34 percent in-crease in adults accessing individ-ual therapy, and a tripling in chil-dren receiving family therapy.
Optum Chief Medical DirectorDr. Jeffrey Berlant says communi-ty-based rehabilitation could actu-allyhurtKendra’sdevelopment.
“The treatment for reactive at-tachment disorder, according tothe American Academy of Childand Adolescent Psychiatry, is toavoid service people getting in theway of a bond being formed be-tween the new caregiver and thechild,”Berlant said. “Having some-thing like CBRS get in the middleis actually contraindicated bythose guidelines.”
Instead, Optum has recom-mended that Kreiter and her hus-band enroll in family therapy andextendedparenting-skills training.
Kreiterdisagrees.“Kendra needs to address the
trauma that she’s been through,and that makes her feel embar-rassed and ashamed, even thoughwe’re constantly telling her itwasn’ther fault,”Kreiter said. “Sheneeds thatprivacy.”
LOCAL PROVIDERSTOLDTOADAPT
For Idaho Medicaid’s mentalhealth service providers, theswitch toOptum hasmeant reim-
bursement rates have changed,client services have changed, andproviders are being asked to adapttoa system thatdoesn’thaveall thetoolsneeded to run smoothly.
One of the state’s largestproviders, Boise-based Idaho Be-havioralHealth, has seen a 28 per-centdecline in thenumberofcom-munity-based rehabilitation hoursapproved for its clients.The com-pany says its services are morecost-effective than individual ther-apyorhospitalizations.
“You’re getting more bang foryour buck, you’re getting a moreefficient way of spending yourbudget,” said Idaho BehavioralHealth President and CEO TamiJones, “and it should always be a
part of an effective community-based mental health treatmentprogram.”
AsKendra’scasehighlights,Op-tum — and the state — believethere are Idahoans who’ve beengetting thewrong treatment basedon theirdiagnosis.
Even the businesses who pro-vide them acknowledge that com-munity-based rehabilitation serv-ices have been used as a sort ofone-size-fits-all solution to a rangeofproblems.Abig reason, theysay,is that Medicaid in Idaho hasn’tbeenwilling topay foralternatives,forcing them to do what they canfor patients within the authorizedlistof reimbursable services.
That’sacriticism stateRep.Fred
Wood understands. Wood, a doc-tor, is a Republican from Burleywho chairs the Idaho HouseHealth andWelfareCommittee.
“A lot of the treatment pro-grams, the up-to-date programsjustweren’tbrought in (to Idaho),”Wood said. “So that is a valid criti-cism, I think.But that was the past.And just because that was thewaywe used to do it — and it waswrong — doesn’t mean that’s theway we ought to do it in the fu-ture.”
FIGURING FINANCESINAPARK
Community-based rehabilita-tion is the appropriate treatmentfor people who’ve been found tohave various forms of schizophre-nia, according to the AmericanPsychological Association. So itwas a shock toTeresa Koscierzyn-ski and her providers when shewas toldearlier this year thatMed-icaid would no longer pay for hersixweeklyhours.
Koscierzynski, 28, has schizoaf-fective disorder, a mix of bipolardisorder and schizophrenia.
Since she was 15 years old, Ko-scierzynski has been in and out ofIdaho’s statemental hospitals.Hermost recent stay at StateHospitalSouth in Blackfoot was in 2012.Shewas there for sixmonths.
Her CBRS worker, KristinCordero, helps manage hermonthly finances. They sat at apicnic table at a Boise park one re-cent day, working through Ko-scierzynski’s Social Security dis-ability income checks forOctober.
“I just got a raise, right?” Ko-scierzynski asked.
Cordero’s employer,AccessBe-havioralHealth, isKoscierzynski’spayee. The Boise companycollects hermonthly disability in-come and cuts her weekly checksso she canbettermanage themon-ey.
“You’re going to get five checksinOctober,OK?”Cordero said.
Koscierzynski can’t work. Shehas a hard time being aroundother people because of the near-constant noise of voices in herhead.
“My purpose is to help herfunction in the community withher mental illness,” Cordero ex-plained. “If she didn’t see me,she’d never leave her apartment.She would isolate to her apart-ment, and that would make itworse.”
Koscierzynski doesn’t havefamily in Idaho, so Cordero andfour other service providers havebecome her support system. Shelives with a new cat in her smallapartment in West Boise. Sheknows she has certain strugglesthat most people don’t, but she isin denial about her diagnosis.
“I’m trying to get her to acceptit so that I can help hermorewithit,”Cordero said. “She can’t live ingroup homes, because she’s beenkicked out of them, because (of)what happens when she hears thevoices. She thinks it’s me, or you,or them or anyone else, so thenshe gets really aggressive.”
Cordero’s goal is to show Ko-scierzynski she cango to the store,orbeoutsideof herhome,withoutgetting angry at thepeople aroundher.
Access Behavioral Health wasable to stopKoscierzynski’sCBRScuts from taking effect, preventinga gap in services. But every threemonths, her file is sent to Optumfor reauthorization. Every threemonths, she andCorderoworry achange in services could have abig effect on her fragile situation.
“On paper, maybe it doesn’tlook bad,” Cordero said. “But Ihave no idea what they’rethinking. They don’t know thekind of clients that we’reworking
REHABCONTINUED FROMA1
$807570656055504540
CBRS PAYMENTS (FISCAL YEAR)
INTH
OUSA
NDS
CBRS PATIENTS (FISCAL YEAR)
CBRS ALLOWED PER PATIENT, PERWEEK
2006 2007 20122011201020092008 2013
20151050
2006 2007 20122011201020092008 2013
2006 2007 20122011201020092008 2013
INMILLIONS
20
4-5
COMMUNITY-BASED REHABUSAGE GROWSDESPITE COSTSIdaho’s Medicaid program slashed the number of hours it wouldcover for psychosocial rehabilitation, a popular service offeredby mental health providers. But providers gave CBRS to morepatients, which led to growth overall in CBRS payments.
Source: Idaho Department of Health andWelfare
16141210864
KATHERINEJONES/ [email protected]“Everything is intentional,” said JenniferBeason,whoprovidedcommunity-based rehabilitation to9-year-oldKendraKreiter.KendrawasdeniedmoreappointmentswithBeason thisyear.Although their last session togetherwasmostlyabout fun—includingbowlingatBoiseStateUniversity— therewere teachingmoments, suchasmakinggoodeyecontact, followingdirections,manners,communicatingwithothersandverbalizingemotions.Beason’swork isamental health serviceoffered throughMedicaid.
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with every day that need thishelp.”
Asked why she needs to seeCordero three times a week, Ko-scierzynski answered: “My sanity.I thinkmy sense of securitywouldgo down, because if somethingbad happened,whowould I go to?And it would go downhillprobably pretty fast.”
Her goal is to stay out of thestate hospital and continue learn-ing how to live on her own.
“There’s times when I think Ican do it, and times when I think Ishould check myself in, I’m notdoing too great,” she said. “Butthen I say, ‘No, I gotta pull through— I gotta.”
Koscierzynski’s case is atypical.Cordero saidwhen they first start-ed working together two yearsago, she felt there should havebeen a better option for someonelike Koscierzynskiwith a chronicmental illness that prevents herfrom fully participating in the lifemostpeople know.Fornow, a cob-bled-together plan of community-based rehabilitation, individualtherapy, medication managementand in-home personal care work-ers are the best option they cancome upwith.
It’s a life wholly reliant on astate system in flux.
Optum’s Dr. Berlant says thatcommunity rehabilitation, like
other kinds, doesn’t go on forever.It stopswhen skills are learned, al-thoughBerlant acknowledges that
somepeoplemightneverhave thecapacity to learn the skills theyneed to survive.
“With (CBRS) training, theydon’t have fewer symptoms, theydon’t have fewer relapses, theydon’t have fewer hospitalizations,they don’t necessarily functionbetter,” he said. “But they mayfunction inways thatmay improve
The amount of money spent onmental health care for Idahoans onMedicaid has changed little. It makes up a smaller share of the IdahoDepartment of Health andWelfare’s total budget than in the past.
MENTALHEALTHASMALLERPRIORITY
Source: Idaho Department of Health andWelfare
11.2%11.1%
11%9.7%
9.7%
8.7% 8.6%
8.7%7.5%
FISCAL YEAR
Ifsomeoneyouknow is inemo-tionalcrisis:
Call the IdahoSuicidePreven-tionHotlineat 1-800-273-8255.
prevented the fire from ig-niting the dragon’s teeth.
Did he ever get a visitfrom the fire marshal? “No,but I got a visit from my in-surance agent,” Ulmen saidwith a laugh. “I getdrive-bysfrom the EMTs, and I waveat them.”
‘DADLIVES FORTHIS’Like most everything in
his Halloween display, thedragon is made of recycledparts: PVC pipe (neck), fur-nace duct (jaw), paintedmilk jugs (scales) and foam(horns and claws). At onepoint, thedragon’sbodywasa water bed bag filled withair from a leaf blower, saidanother son, BenUlmen, 31.That doesn’t mean it wascheap tomake— thedragonstill cost an estimated$5,000.
“My dad lives for this.This is his thing,”Myerssaid. “His entire year is builtaround this.”
Doctors diagnosedprostate cancer in Ulmenabout three years ago. He’sbeen plagued by secondaryinfections in recent weeks,and told his kids he wasn’tstrong enough to do hisHal-loweendisplay this year.
So thosewho loveUlmencame together to make ithappen— includingGriffenGettman, a 13-year-oldneighbor who has assistedfor eight years.
“I’m excited that we’verallied thismuch,” saidGrif-fen, an eighth-grader at SageInternational School. “It’s alotofwork—it’s 100hours.”
BACK TO THE FUTUREUlmen’s grown children
— six kids from two mar-
riages — liken their fathertoDoc Brown, the time-ma-chine inventor in the “Backto the Future” movies. Theelaborate spaceship he builtthem40yearsago sitson thefrontporch,nowa toy forhisfive grandchildren.
“He is the oldest little kidyou will ever meet in yourlife,” saidOtto Kitsinger, 42,one of many friends awed atthe model train landscapesthat fill Ulmen’s basement.“If it’s not October, it’strains.”
Ulmen has been Boise
Little Theater’s unofficialspecial effects guy, buildingsome unusual things overthe years, including a deathray and a replica of the
Zoltar fortune-telling ma-chine from the movie “Big.”Little Theater set designersJimAndersonand JimKoep-pl were among those at theUlmenhouse helping returnthe favor.
Ulmen is a Caldwell na-tive and graduated fromCaldwell High School in1961.Hewonacongressionalappointment to the NavalAcademy, but lasted lessthan ahalf-year.
“I am not a military per-sonality, and it didn’t takeme long to figure that out,”
he said. “So I resigned.”Buthe still owed theNavy
six years of service. He didfour years in the Navy Re-serve, he said,and twoonac-tive duty in theVietnamera.
When he finished hisservice, he pursued a liberalarts degree at theUniversityof Portland. He worked atthe campus radio station inhopes of being a “shock ra-dio jock.”
“I loved to perform,” hesaid.
Henever finished college,but did do a stint at a Cald-
well radio station.He held acouple of other jobs, includ-ing one building oscillo-scopes, before he began hislong career with the phonecompany.He retired in 2005.
The Ulmen tradition ofgoing all-out on Halloweenwas a legacy of the previousresidents of the 17th Streethouse, a family that ownedthe Idaho Candy Company.Their candy set ahighbar.
Ulmen first createdCount Dracula’s castle. Hedressed up like a vampire.Then he built a “mad scien-tist lab” with fancy-lookingequipment.
Each year became moreelaborate and lovingly de-tailed. For example, the can-dy the dragon gives out isgold coins.
“Thedragon is sharinghistreasurewith everyonewhocomes to see him,” Ben Ul-men said.
HALLOWEEN JOYUlmen said his cancer
was Stage 5 by the time itwas found. It metastasized;once it entered his bones, hestarted suffering greatpain.
He was treated at the VAHospital this week for an in-fection.He shifted frequent-ly in the hospital bed, tryingto find comfort.
Ulmen was happy to talkabout his life, his family andhis Halloween helpers. “Itstill makes me tear up,”Ul-men said. “It makes me feelwonderful that they careabout this project and theirsillyold father.”
More than anything, hewanted to be home for theannual festivities.
He got his wish. OnThursday, he was backhome, making sure the finalpreparations on his dragongotdone properly.
KatyMoeller: 377-6413
DRAGONCONTINUED FROMA1
KATHERINEJONES/ kjones@idahostatesman.comTeenagerGriffinGettmanhasbeenhelpingwith the fire-breathingdragon,Zhran’El, sincehewas5.Heglueson the teeth.“Otherwise,”he said, “they’llcatchon firewhen they fall off.”
Balukoffargued thatOtterwas too removed from thesettlement process, and healso criticized Otter’s stafffor agreeing on a settlementwith CCA before the com-pletionofanongoing federalinvestigation.
“Hewas absent,”Balukoffsaid. “Even if your friendsare cheating the state, you’restill the governor.”
Otter responded that heremoved himself from thenegotiations because CCAdonated tohis campaign.Heargued that the settlementwould be up for renegotia-tion depending on the FBI’sreview.
“Shame on you, A.J., youknow better. If the FBI findssomething, then all bets areoff,”Otter said.
However, in February,The Associated Press re-ported that the settlementreleased CCA from all civilliabilityconnected to theun-derstaffing, as well as any li-ability stemming fromundiscovered staffing issues.
Otter is running fora thirdterm, a rare feat for an Idaho
governor.Balukoff—aBoisebusinessman and presidentof the second-largest schoolboard in Idaho — has re-mained a competitive candi-date. He has spent millionsof dollars on campaign ad-vertisements focusing onwhathe says isOtter’s lackofaccomplishments during hiseight-year tenure.
Balukoff’smain campaignfocushasbeenon improvingIdaho’s public schools, say-ing that Otter has failed to
provide enough funding andsupport to prepare studentsfor theworkforce and retaingood teachers.
Bujak, a former CanyonCounty prosecutor, has la-beled himself as the state’sonlyconservativecandidate,but he struggled to raiseenoughmoney and generatename recognition runningasa third-party candidate.
LikeBalukoff,Bujak spentmost of his time criticizingOtter’s two terms.
He called theCCA settle-ment premature andOtter’spromise to keep fighting thelegalization of same-sexmarriage “a losingbattle.”
“That ship has sailed, youmight as well be arguingabout interracialmarriage atthispoint,”Bujak said.
Otterdefended his recordby saying that under hisleadership, Idaho’s unem-ployment rate and economyhave rebounded from theGreatRecession.
Idaho’s economic rank-ings remain low in anumberof areas, including its highnumber of minimum wagejobs.
“Today, Amy’s Kitchenwas going to build a facilityand bring potentially 1,000jobs inPocatello,”Otter said.“All of those are prettygood-paying jobs. Whenbusinesses recognize this isa good, safe place toput cap-ital in, more will want tocome to Idaho with morehigh-paying jobs.”
Although he voiced some
reservations, Otter said hewould sign legislation thatwould add the words“sexual orientation” and“gender identity” to Idaho’sHumanRightsAct.Current-ly, same-sex couples maymarry in Idaho, but there isno legal protection if theyare fired or kicked out oftheirhomes.
Otter said therewould bea hearing during the 2015legislative session.However,it’s ultimately up to the Re-publican-dominated Legis-lature topass a bill.
After theTwinFallsTimes-Newsreported thatDemocratA.J.Balukoffdonated toRepublicanMittRomney’spresi-dentialcampaigns in2007and in2012,Spokesman-ReviewreporterBetsyRussell searchedFEC records forBalukoff’sotherdonations in federal races.