When it comes to caring for people with mental illness, Idaho is at the bottom of national rankings. Psychiatrists are few and far between. Vast stretches of rural emptiness separate people who are struggling mentally from the resources that can help them. In this installment of our series on rural health care, correspondent Elizabeth Wynne Johnson looks inside Idaho’s ‘psychiatry gap.’
Dusty Davis: "My name’s Dusty Davis. And I’m 42."
All throughout her modest Coeur d’Alene apartment, Dusty’s got stacks of forms for Section 8 housing.
Dusty Davis: "They each have [chuckling] different applications, so…"
Dusty’s a single mom with a 16-year old living at home. Plus two adult kids and a bunch of grandkids. Her life isn’t easy. Mostly because for as long as she can remember, she’s only known one way to be.
Dusty Davis: "I was always on the go and ten feet tall and bullet proof. And my mind racing. I’ve got, you know, 5-6 things going on in my head at the same time."
Imagine a rollercoaster of peaks and valleys that have no relationship to the world around them. Dusty is bipolar. It’s hard for to explain what that’s like. But she says this song by the band Matchbox-20 comes pretty close.
Dusty Davis: "It says, ‘I’m not crazy, I’m just a little unwell…’"
[sound of CD being inserted]
AMB music up: "Hold on. Feeling like I’m headed for a breakdown…"
For a while she had it as her cell phone ring tone.
Dusty Davis: "Like the song says, You may know me, but just wait a little and then you’ll see a different side of me. …[music up] So many times Ijust wish so much that I didn’t have this challenge, this struggle."
Dusty was a young adult when she began to suspect there was something wrong. She went to a mental health agency in Coeur d’Alene and asked for an evaluation.
Dusty Davis: "And I didn’t have insurance. So I couldn’t get any help. It’s a catch-22. If you’re ill and you need help, you can’t get help without insurance. And you can’t get insurance without a diagnosis… A lot of people I think get caught in that crack.
Dusty slipped through that crack and hit rock bottom about seven years ago.
Dusty Davis: "I slashed my arm to the bone… I got caught before I was able to cut my other arm… So now I have this horrible ugly scar on my arm for the rest of my life to remind me how fragile and special and important life is. But it’s too bad that, you know, it had to come to a near-accomplishing suicide in order for me to be able to get a
Joe Stegner: "We don’t do a very good job in trying to intervene in people’s lives."
That’s Idaho State Senator Joe Stegner.
Joe Stegner: "We make a conscious social decision not to do so because we’re Americans. And because we’re westerners to some degree. And we don’t quite know where to draw that line."
Stegner co-chairs the state joint subcommittee on mental health. The Lewiston Republican’s been championing legislative reform for nearly a decade. His passion for the issue is rooted in practicality.
Joe Stegner: "We wind up paying a much, much higher bill financially and socially because we react to those problems after they become major, major events."
Currently in Idaho the only way for someone like Dusty to get an official diagnosis is to show up at an emergency room and declare that she’s a danger to herself or to others. In Dusty’s case the suicide attempt got her out of the gap.
She was diagnosed with Bipolar-1 disorder. That in turn allowed her to get on Medicaid and see a psychiatrist. One of only a half-dozen or so psychiatrists in the northern half of the state. With medication, she got her first glimpse
of what it was like to be on an even keel.
Dusty Davis: "And it was like, wow. So this is how normal people feel, you know?"
To keep this feeling she relies on the little orange bottles in the medicine cabinet.
[opening cabinet, pulling out bottles]
Dusty Davis: "This is the mood stabilizer. This one and this one for the ulcers. And this one to…allow me to sleep. Knock out an elephant if you took enough."
Dusty’s life has changed dramatically. Changes in Idaho’s mental health system are coming more slowly. But they’re coming.
This year the legislature approved $12 million in new spending. Stegner and his fellow lawmakers also gave quick approval to the state’s first psychiatry residency program. That one’s aimed squarely at Idaho’s
critical shortage of psychiatrists.
A similar program in Spokane has been successful at increasing the number of psychiatrists in Eastern Washington.
Joe Stegner: "We just need more people. More of those kinds of services. But we have to be realistic and recognize, we’re not going to have them in every small county.
In the meantime, Idaho’s mental health system is bolstered by federal dollars. Private non-profits use the money to provide a service called PSR -– psycho-social rehabilitation. A similar program exists in Oregon.
In essence, it’s life coaching for people with mental illness. The PSR goal is to ward off crises before they happen. That can mean teaching clients how to stay on meds or how to shop for groceries.
Ian Bradshaw runs PSR programs in Sandpoint and Bonners Ferry.
Ian Bradshaw: "Medicine in and of itself is an aid, but it’s not the answer. A person has to learn how to cope with what they’re dealing with."
One PSR provider gave her client a broken cell phone, so she could walk around town and talk back to the voices in her head without attracting attention. Advocates say this approach does reduce hospitalizations.
Still, PSR is strictly limited and has to compete with other state programs for Medicaid dollars. Bradshaw still worries
about whether lawmakers have the will to support preventive mental health care.
Ian Bradshaw: "It depends on a choice of whether those who make the decisions with what we do with our tax dollars want to sustain it or not. Can I ignore the problem and have it go away? This problem will not go away."
For his part, Idaho state senator Joe Stegner believes as attitudes shift, resources will follow.
Joe Stegner: "How much better off would we be? That individual citizen would be far, far better off. Our society would be better off, and financially the state taxpayer would be better off."
It’s only now, he adds, that the legislature is recognizing that these options are desirable. Perhaps even achievable.