Ounce of Prevention
Wednesday, September 20, 2017
OUNCE OF PREVENTION: Behavioral health factor large in discussions among Whatcom County Council members this week.
With the capital budget held up in Olympia in a quarrel over residential wells, County Council created a fund to begin expansion of a Crisis Triage Center to decrease the use of the jail and hospital emergency services for people experiencing a behavioral or mental health crisis. The county has set aside about $3 million for the project, and North Sound Behavioral Health Organization is providing $2.5 million in matching grants in support of expanding the number of beds in the current severely restricted center. The state had likewise approved funds to assist with the expansion, but the capacity constriction cannot wait for legislative intransigence in Olympia.
Council’s action moves the expansion forward.
A second agreement approved this week with North Sound Behavioral Health Organization provides funding for housing case management and shelter operations services to homeless individuals living with mental illness. North Sound BHO administers state and federal funds for mental health and substance use disorders services for the five-county region including Island, San Juan, Skagit, Snohomish, and Whatcom. A six-member advisory group serves as liaison between the organization and county administration.
Council also approved $111,700 to establish a contract with the same organization, North Sound BHO, to provide funding for access to treatment and recovery for opioid and intravenous drug use dependency.
Whatcom County is not alone among counties across the United States that are struggling to deal with the financial costs and social toll of a drug addiction epidemic that killed 53,000 people in 2015 alone, according to the U.S. Justice Department. More than half of those deaths involved the use of heroin, fentanyl and other opioid drugs.
Opioids are drugs formulated to replicate the pain- reducing properties of opium. They include both legal painkillers like morphine, oxycodone, or hydrocodone prescribed by doctors for acute or chronic pain, as well as illegal drugs like heroin or illicitly made fentanyl.
The problem is not merely one of the black market. The number of opioid prescriptions dispensed by doctors steadily increased from 112 million prescriptions in 1992 to a peak of 282 million in 2012, according to the market research firm IMS Health. The number of prescriptions dispensed has since declined, falling to 236 million in 2016.
Reports suggest the medical insurance industry itself may have played a factor in the crisis, providing lower-cost opioids to manage pain in preference to more expensive pharmaceuticals and treatments to actually address the cause of pain.
In June, the state Attorney General convened a summit on the opioid epidemic at the University of Washington, as part of Gov. Jay Inslee’s executive order to address the public health crisis.
Whatcom County deaths from opioids increased by almost 23 percent from 2002-2013, according to data from the County Health Department, while opioid-related emergency room visits have doubled in ten years.
Whatcom may rank as the third-highest county in the state in opioid addiction and related problems, based on police evidence, yet the county does not have a dedicated opioid treatment center.
Lummi Nation’s Healing Spirit Center built an Opiate Treatment Program (OTP) that can provide treatment and counseling for up to 450 patients; however program resources are directed toward tribal members. The program, however, provides a model for what might be achieved if Whatcom County applied resources to the problem. A community response plan was presented this week to the behavioral health subcommittee of the Incarceration Reduction Task Force established by County Council in 2015.
“Abuse of opioids continues to contribute to emergency room visits, jail incarcerations, and other costly community resources,” staff reported to the subcommittee this week. “Local concerns repeatedly focus on easy accessibility of pharmaceutical medications, as well as a lack of perceived harm from their use or their potential for abuse.” They term their project HOPE, Heroin and Opiate Prevention & Education.
The Triage Center, homeless outreach and opioid response plan are funded through a 0.1 percent sales tax to address mental health and substance abuse issues approved through the Legislature and passed by County Council in 2009. The sales tax generates about $3.5 million per year in revenue applied to nearly 90 programs and organizations, according to county records. Programs include therapeutic court services, jail behavioral health programs and mental health services for youths in all seven school districts.
Council this week also approved an overdue request from the administration to enter into an agreement with Yakima County to provide capacity when bookings at the county jail in downtown Bellingham are restricted. The City of Bellingham entered into a similar agreement with Yakima when booking restrictions at the jail were imposed in 2016. The city’s experience has been satisfactory if not ideal.
The agreement with Yakima covers an important gamble as a tax initiative to fund a new county jail heads to the ballot in November. A nearly identical proposal failed at the polls in 2015, and Whatcom County may very well face a situation where it must move inmates out of the current facility to initiate infrastructure renovation, maintenance or repairs.
With well over half of the average daily jail population suffering from some kind of behaviorlal health or substance abuse issue, Council is doing its best work on incarceration rates by focusing on the root causes that send people to jail.