By CHARLES R. BENJAMIN
Voices of the Valley

Mental illness impacts 25 percent of Washington adults and families. A few people with mental illness are so profoundly debilitated by the disease that they require involuntary commitment to a hospital or treatment facility to protect the patient and the community.

Over the last month, media attention has focused on the role of the North Sound Mental Health Administration (NSMHA) in mental health civil commitments. Some question whether NSMHA should pay the prosecuting attorney and the public defender the legal costs of handling the court proceedings required to hold people involuntarily for mental health and safety reasons. This column will provide details about this important agency and its limited budget, the mental health civil commitment process and collaborative solutions to this issue that impacts the most fragile members of our community.

NSMHA, headquartered in Mount Vernon, is one of Washington’s 13 Regional Support Networks created by the Legislature to administer mental health and crisis services. NSMHA was formed by an interlocal agreement between Island, San Juan, Skagit, Snohomish and Whatcom counties to provide all federal- and state-funded mental health services in all five counties. NSMHA’s Board of Directors is composed of elected county officials from all five counties, tribal representatives and two nonvoting NSMHA Advisory Board representatives.

NSMHA has no taxing authority and no independent means to raise money. The state of Washington contracts with NSMHA to provide an array of mental health services to eligible individuals, including evaluation and treatment. The funding comes from two different sources: the federal government, including Medicaid and block grants, and the state.

The federal funds are strictly limited to pay for specific treatment services, and it is a violation of federal law to divert funds to other uses, such as paying the prosecutor or public defender. Other funds totaling $17,267,316 come from the state in a contract with the Department of Social and Health Services to be spent first on crisis services and hospital inpatient services, according to priorities set by that agency. Secondary priorities include outpatient services and residential programs. As federal funds are insufficient to meet the need, a portion of our state funds go toward under-funded Medicaid services.

In turn, NSMHA contracts with private nonprofit and for-profit mental health providers to serve patients with outpatient counseling, case management, support groups and other essential services. By law, NSMHA is allowed to use up to 10 percent of total revenues for administrative activities, including creation of an exhaustive federal and state-mandated performance review and quality assurance documentation. Yes, paperwork — which is an inevitable part of state and federal funding. However, the agency runs a very lean administrative ship, using just 4.6 percent of total funding, so the agency can stretch the woefully inadequate state funds to benefit treatment services.

What are mental health commitments? People who are in a mental health crisis and unable to care for their basic needs and those who are dangerous to themselves or to others may be held against their will for 72 hours. After 72 hours, a court hearing is held to determine if more treatment is required for the safety of the individual and community.

This Superior Court hearing is the mental health civil commitment hearing that is currently at issue. Under state laws enacted in 1983, the prosecuting attorney is required to represent the petitioning agency, and the public defender is required to represent the patient in the hearing.

This legal work, mandated by the state for 25 years, has recently become the focus of objection by the Skagit County prosecutor as an unfunded mandate. The state does not provide or designate funds to the counties or to NSMHA for the prosecutor or the public defender to handle these cases. The offices of the prosecuting attorney and public defender are county-funded agencies. The prosecutor has asked NSMHA to fund the legal costs that would limit the agency’s treatment budget by an estimated $210,000, crippling its already underfunded efforts to help people with mental illness in our community. This is only the beginning. If NSMHA funds Skagit County’s legal costs, then NSMHA would also have to pay for the same costs in Snohomish and Whatcom counties, totaling an estimated $482,000 annually. This is not the solution to this dire problem.

NSMHA is offering three solutions. First, the NSMHA board will ask all five counties to look at how legal services are funded and to investigate a potential cost-sharing mechanism that will fairly compensate counties handling more than a fair share of commitments. Second, NSHMA board members are committed to organizing the five counties (and hopefully counties statewide) to seek funding for civil commitment legal services during the next legislative session. Finally, NSMHA already has a committee that is reviewing involuntary detentions in our region and how they are handled by the mental health and court systems.

While NSMHA is committed to providing appropriate treatment for all who qualify, we also are vigilant about tracking the number of civil commitments in Skagit County to make sure it is appropriate to ensure individual and public safety as well as easing the burden on both the legal and treatment systems.

NSMHA is inviting the Skagit County prosecutor and public defender to participate in each of these tasks and to work with the mental health community. This will include all five counties working on cooperative solutions that do not deplete already inadequate funds for community mental health services, while funding legal services as fairly and completely as possible with available resources.

The agency looks forward to working with the county officials in the region to seek solutions in the best interest of all concerned. We seek to carry out our mission as mandated by the Legislature while maintaining the safety of the individual and public by providing much-needed services for people with mental illness who are at risk of harm to themselves or others.

Let’s approach this unfunded mandate in a collaborative manner and not place people and our communities at risk.

• Charles R. Benjamin is executive director of the North Sound Mental Health Administration in Mount Vernon.