Anchorage Daily News

The biggest community mental health center in Alaska has stopped accepting adult clients and is closing a downtown branch that served many homeless people, the latest signs of a strained health system and looming public crisis.

But help may be coming.

Anchorage Community Mental Health Services has long been the main place in town for outpatient treatment of seriously mentally ill adults, those with schizophrenia, bipolar disorder and depression -- people who back in the 1950s would have been locked away in an institution.

Many are sent there for treatment by probation officers, judges and hospitals.

More than 1,700 adults are on its active caseload, as well as more than 400 children diagnosed as severely emotionally disturbed. Most of the kids are covered by Denali KidCare. But large numbers of adults don't have any type of insurance and few places to get help.

In March, the agency started turning away new adult patients -- a policy it says is only temporary. Its budget shortfalls began in the 2005 budget year and have gotten worse since, said executive director Jerry Jenkins, pointing to audited figures.

Last budget year, the shortfall topped $1 million and this year is even worse. So far, from July 1 to Dec. 31, 2007, the agency was nearly $750,000 in the hole. The more adults it serves, the bigger the gap.

The agency also will close what it called the Annex effective April 30 to save money. The branch in rented space on Fifth Avenue downtown served about 230 clients, many with basics like housing. They will be transferred to Midtown offices.

"As far as I'm concerned, this is a barometer of the health of our behavioral health system," said Anchorage Judge Stephanie Rhoades, who presides over Mental Health Court. "Because when you have oil at a hundred bucks a barrel, and you can't get access to basic services for people with serious mental illness, I consider that to be a big problem."

People end up in her court charged with low level nuisance crimes like disorderly conduct after, say, running around in traffic. Their bizarre behaviors often stem from their illness, she said.

"I had a guy in court the other day who comes up to me and says in a court hearing 'I'm hearing voices. I'm trying to get in and see somebody. I'm trying to see a doctor. I need help,' " the judge said. "Where do we send that person?"

The same pressures bearing down on Anchorage Community Mental Health Services also hurt other private agencies that rely on public funding.

"I'm a symptom. That's it. This is about public health," Jenkins said.

SYSTEM, PEOPLE STRESSED

Reimbursement rates by Medicaid -- the state-federal insurance program for the poor -- for many mental health services haven't gone up since 1992. Medicare rates, for elderly and disabled patients, are even lower, and if someone is covered by both, the Medicare rate applies. Many adults seeking treatment have no coverage at all. Agencies around the state are struggling to hire nurses, doctors and other staff.

Last year, the Salvation Army's Clitheroe Center abruptly shut down its drug and alcohol detoxification unit for financial and staffing reasons. Anchorage Neighborhood Health Center is closing its Mountain View clinic. And mental health agencies in Juneau, Fairbanks and elsewhere also have had financial struggles, according to state advisory boards and news reports.

"A growing statewide public health crisis is looming, created by the loss of crucial services," warned a press release last September put out by Kathryn Craft, then the executive director of the Alaska Mental Health Board and the Advisory Board on Alcoholism and Drug Abuse.

At the Clitheroe drug and alcohol treatment center, "the detox is shut down and the remainder of the services are open but they are extremely financially stressed," said Maj. Sherry McWhorter, who oversees social services across the state for the Salvation Army. By the budget year's end, Clitheroe could be $1 million in the hole, she said.

Nearly half the adults who first came to Anchorage Community Mental Health Services for help during a recent 18-month period had no health coverage of any type. While the agency expects to resume accepting new adult patients later this month, it will severely limit the number who don't have some kind of insurance, including Medicaid or Medicare, Jenkins said. Its main state grant has shrunk from $6.8 million in the 2004 budget year to just over $4 million this year.

That means some patients will continue to be turned away.

A BOOST FROM JUNEAU

State officials pushed for more money from the Legislature this year and say they don't believe the system overall is in trouble.

"I would not characterize our system by any means as being in crisis," said Melissa Stone, director of the state Division of Behavioral Health, which includes mental health and substance abuse treatment.

Other nonprofit agencies are taking some of the turned-away patients. Private psychiatrists are, too. Alaska Psychiatric Institute has offered to follow up with medication management until patients find treatment in the community, said Ron Adler, API chief executive officer.

For the budget year that begins July 1, Gov. Sarah Palin sought an additional $23 million for behavioral health, including grant money as well as $6.8 million to raise rates paid by Medicaid to outpatient providers. Legislators didn't approve every item but added a total of $25 million, according to Laura Baker, acting deputy director of finance and accountability for the state Department of Health and Social Services.

SKIMPY DONATIONS

One reason community mental health centers struggle financially is the long lag time between when a patient is seen and when Medicare or Medicaid provide payment, said Dennis McMillian, president of The Foraker Group, which advises and trains Alaska nonprofits.

Also, Alaska nonprofits overall are shortchanged. Just 9 percent of their revenue comes from private donations to charity, compared to 25 percent of the revenue for nonprofits Outside, he said. And mental health centers probably get less than that average.

"When one of our largest providers of community mental health services -- in our largest community -- is unable to meet those needs, we consider that a serious gap in services," Kate Burkhart, the current executive director of the Alaska Mental Health Board and Advisory Board on Alcoholism and Drug Abuse, wrote in an e-mail responding to questions.

More people likely will end up in the emergency room -- the psychiatric emergency department at Providence Alaska Medical Center, said Kimberly Grossman, the department's clinical supervisor. Providence, which already treats about 350 patients a month in that department, is readying itself for more, she said.

"Some people are going to fall between the cracks and more than previously. There aren't going to be enough resources for folks," Grossman said.

Overall, Anchorage Community Mental Health Services is solvent and not in danger of going under, Jenkins said. It keeps a budget reserve for tough times.

Find Lisa Demer online at adn.com/contact/ldemer or call 257-4390. FAA whistle-blowers bringing out charges

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