High-quality, ethical care has become mission impossible

Before relocating to the Spokane area recently, I was a data analyst at Mentor Health Northwest, one of the larger community mental health centers in King County.

I have watched wonderful, dedicated professionals leave that agency because the workload required to remain competitive in public- sector, managed-care environment has made ethics an impossibility. Caseloads have become outrageous and paperwork is nearly impossible to complete, resulting in less than adequate care for many of the people who need it. Salaries and morale are low and it is very difficult to hire and retain qualified and dedicated staff.

I was continually frustrated by the hoops that mental health providers must jump through. One of them is to make sure the clients are treated as consumers, which means the provider must ensure that they have a pleasant environment while on site. Therefore, I was amazed to read that the Spokane County auditor is quibbling over the $3,000 spent on a smoking gazebo for the clients of Spokane Mental Health.

A smoking gazebo makes perfect sense to me. It can be quite intimidating to enter a building where smokers congregate just outside the door, especially at a center that treats the chronically mentally ill. The gazebo gives these folks a place to get out of the weather, making them feel that their needs are being addressed. It also eliminates the clump at the door.

I would love to return to the behavioral health field someday, but for now it seems that the system needs to break down completely before it gets repaired.

The average payment that King County paid for a client needing case management, medication maintenance and day treatment was $7 to $8 per day. It doesn't take a financial wizard to determine that quality care isn't possible with this kind of revenue. I wonder if people who complain about the smoking gazebo expenditure are the same ones who will object the loudest when one of these unfortunate folks falls through the cracks and commits a violent act.

Perhaps there are accounting and business operation issues that need improvement, but I can tell you that Spokane Mental Health has a nearly impossible obligation, which is to provide efficient, caring, competent, competitive and financially responsible mental health care in a rapidly changing environment where funds are shrinking just as rapidly.

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