Ohio battles to care for mentally ill

Medicaid expansion could close treatment gap in Lucas County

Edward Poelstra, formerly of Tucson, Ariz., and Rebecca Mallin of Toledo talk about their experience with Unison Behavioral Health Group on East Woodruff Avenue. Poelstra said Unison has helped him to recover and function better on a daily basis.

First of two parts

As the nation has embarked on a debate over mental health care, massive budget cuts in Ohio have shattered what once was one of the top mental health systems in the country, state and local experts say.

Only 23 years ago, Ohio ranked fourth in the country for the quality of its mental health system, according to a report compiled by the National Alliance on Mental Illness. The report attributed Ohio’s success to the 1988 Ohio Mental Health Act, watershed legislation that transferred funds from expensive state hospitals to more cost-effective community-based agencies, marking the beginning of a deinstitutionalization process that became a model for the nation.

But between 2009 and 2012, Ohio cut more than $93 million in general funds for mental health services across the state.

Today, thousands of individuals are not covered by Medicaid or private insurance and, unable to access treatment, end up on the streets or in more expensive settings such as nursing homes and jails, said Terry Russell, executive director of NAMI Ohio. Meanwhile, he said, untreated mental illness has caused the suicide rate in Ohio to reach a 10-year high, with more than 1,420 Ohioans taking their own lives in 2010, the latest year statistics are available.

But recent changes in Ohio, pushed by Republican Gov. John Kasich, could change all that.

The court battle being waged over expanding eligibility for Medicaid coverage in Ohio under the federal health-care law could have a profound effect on the level of mental health treatment available to people in Lucas County.

The local community-based mental health system currently provides treatment to about 7,000 people each year, said Scott Sylak, executive director of the Mental Health and Recovery Services Board of Lucas County.

If the Medicaid expansion is upheld by the courts, he said, “We think that 90 percent of all the people that we serve will become eligible in one way, shape, or form for coverage.”

This is significant because currently non-Medicaid funded people with a mental illness or substance abuse issue receive two-thirds less treatment than Medicaid recipients, Mr. Sylak said.

Mr. Kasich’s decision to expand Medicaid was immediately opposed by six conservative Republican state representatives and the Cleveland and Cincinnati chapters of Right to Life. The groups asked the Ohio Supreme Court to overturn the Ohio Controlling Board’s 5-2 decision to accept $2.56 billion in federal funds to pay for the expansion. The high court has placed the lawsuit on the fast track and is expected to issue a ruling before Jan. 1, when the expansion is set to take place.

A Quinnipiac University Poll released recently found a majority of Ohioans, 51 percent, liked Mr. Kasich’s move to partner with the federal government to expand Medicaid coverage to about 275,000 Ohioans, mostly adults without dependent children. But 40 percent did not.

The additional Medicaid funds would help the Lucas County mental health board close the treatment gap, particularly for low-income men, with no children, who don’t qualify under current Medicaid guidelines. The increased cost of men with mental illness cycling through the criminal justice system could be eased with the Medicaid expansion, Mr. Sylak said.

Downward spiral

Edward Poelstra, 43, of West Toledo has personally experienced how untreated mental illness can cause a person’s life to spiral out of control and can land those battling mental illness in jail.

Thirteen years ago, Poelstra was living in Tucson, Ariz., and was at the peak of his political career. A Republican, he was elected to the Arizona House of Representatives at the age of 30, becoming one of the youngest politicians in the statehouse.

At the end of two years in office, though, Poelstra’s life took a sour turn. He started experiencing severe depression and anxiety, to the point that he attempted suicide by drinking a dose of antifreeze. Diagnosed with bipolar disorder, he was prescribed daily cocktails of medications to keep his condition under control.

“As a former state legislator, I know Arizona has very limited funding for mental health. They just give you medications, and they hope you will get better,” Poelstra said. “I used to take 14 pills a day, but I wasn’t getting better.”

The suicidal voices in his head proved hard to quell: Poelstra was living in semi-isolation, consuming drugs to numb his thoughts, and unable to perform even the simplest tasks — from sitting in a waiting room to using public transportation. Soon, the former state representative said he turned to small crimes, including possession of drug paraphernalia and theft, and was eventually sentenced to eight months in an Arizona prison in 2011.

A new start

After serving his sentence, Poelstra moved to Toledo and in October, 2012, he entered Unison Behavioral Health Group, one of the local mental-health providers.

When he first arrived at the clinic he was overmedicated and could hardly walk. He was immediately admitted into the Genesis program, a partial hospitalization program that provides intensive therapy and daily support groups to help individuals in crisis stabilize. He was also told to cut back on his medications, to be replaced with individual counseling sessions.

Today, Poelstra says he’s a new man. He rides the bus to Unison for his therapy sessions, the voices in his head are not as loud, and his vocabulary has improved significantly. More importantly, he wants to live.

Poelstra attributed his recovery to the “consistent support and commitment” that he has received through Lucas County’s community-based mental health system.

“I can’t fail this time. Even if I screw up, there’s always a safety net,” he said. “If I don’t show up, a social worker will come to my house and check up on me.”

A growing need

Just like Poelstra, thousands of Lucas County residents receive publicly funded mental health and substance addiction services every year.

The number of individuals served in community-based mental health agencies has grown consistently over the years. Local providers such as Unison Behavioral Health Group, Harbor, Rescue Mental Health Services, and the Zepf Center — the four major providers in the area — have seen their client numbers rise steadily over the years.

Between July, 2011, and June, 2012, about 25,000 people received treatment for either mental illnesses or substance addiction, more than a 14 percent increase since 2009.

As the number of clients increased, funding to mental health agencies steadily decreased. Between 2009 and 2012, Ohio cut more than $93 million for mental health services, Mr. Russell said. Lucas County lost about $4.1 million in state and federal funds. “As a society we should look at that and be ashamed,” Mr. Russell said.

Encouraging signs

After years of holding the Lucas County mental health system together on a shoe-string budget, the tide began to turn last year when voters approved a new 1-mill,10-year levy for mental health and substance abuse services. It is expected to generate about $5 million annually.

“It basically moved us back to 2008 funding levels. What’s different though is that we are serving a dramatic increase in population. So while we are at 2008 funding levels, we’re not at 2008 population levels for need of our services,” Mr. Sylak said.

Mental health providers across the state of Ohio were also bolstered by an unexpected surprise in the state budget this year. As part of the 2014-15 budget, Mr. Kasich allocated an additional $50 million per year for mental health services. Lucas County received a $2 million increase.

This year has been a transition year for local mental health agencies. With the additional funding from the levy, the state budget, and possibly from the Medicaid expansion, there are more discussions about, and examination of, bringing in innovative treatments that have been proven to work in other communities.

The mental health board is reviewing proposals from the local providers that will increase outreach and try to identify people at the early point before their situation spirals out of control, Mr. Sylak said.

“You know one of the big knocks on our system is that it takes forever to get in — 30 days in some cases, even longer maybe to see a psychiatrist. We have a goal of everybody getting access to services within seven days,” he said.

“For the first time, in a very long time, our system can say we are really close to being able to focus on everything, within reason, that can put people in the best position for stability and recovery,” Mr. Sylak said.

On Monday: The mental health community moves toward a more holistic approach to treatment.

Contact Marlene Harris-Taylor at: mtaylor@theblade.com or 419-724-6091.