Don't neglect your mental health

If you live in Idaho, chances are good you have to work a little harder than you would in most other states to get the mental-health services you need.

A national advocacy group gives Idaho a grade of "F" for the quality of its care, especially the care it gives its most fragile residents — people with schizophrenia or other serious illnesses who rely on the public-health system to keep it together. Roseanne Hardin, vice president of the National Alliance on Mental Illness Boise, has tips to help you navigate the state’s mental-health system:

Educate yourself

That may mean figuring out the difference between the blues and depression, learning more about post-traumatic stress syndrome or talking to the counselor at your neighborhood school about an out-of-control child.

"What I would say for persons with mental illnesses or persons and their families who think they might have a mental illness is what I would say to anyone who has an illness — educate yourself as best you can," Hardin said.

NAMI Web sites for Boise, Nampa and Fruitland (start at nami.org) offer detailed information and links to other sites about illnesses, along with treatment, online communities, symptoms and other information.

Waiting is the hardest part

If you make an appointment with a psychiatrist, you may wait six to eight weeks for your first appointment, if you can get an appointment at all in a busy practice. One alternative is to see mid-level health providers such as psychiatric nurse practitioners.

They are not doctors, but they get special training and can prescribe drugs. You may be able to get care quicker and cheaper. Some are good, and some aren’t. The same is true of all health providers.

Don’t let stigma stop you

Swallow your pride and visit your family doctor first. You won’t be the first patient your doctor has seen complaining of symptoms of mental illness. Such illnesses are common. An estimated 26.2 percent of Americans age 18 and older — about one in four adults — suffer from a diagnosable mental disorder in a given year, according to the National Institute of Mental Health.

Primary-care providers might be able to help you with medication while you wait for an appointment and can rule out other causes of your symptoms, Hardin said. For most illnesses, patients don’t hesitate to see their primary-health doctor first, but mental illness packs such a negative punch that many people will stall endlessly.

"In a way, we find it easier to talk about cancer," Hardin said. Clinical depression, unlike cancer, raises "the whole idea of, ‘Oh, you are just a weak person who just can’t get a grip,’ " Hardin said.

Stigma may be loosening its grip a little in Idaho. Much of the credit for that goes to former first lady Patricia Kempthorne, who has publicly discussed her bouts of depression.

"I think that it is incredibly meaningful for people to know that people who are important in our communities have depression, got counseling, got medication, and it helped," Hardin said.

On the 2006 NAMI report card, Idaho ranks 49th among the states in per-capita spending on mental health. The report also takes into account Idaho’s suicide rate, among the highest in the nation.

"I think the high suicide rate is a function of how underfunded this state is in terms of per-capita expenditures for mental health and treatment," said Dr. Robert Negron, a psychiatrist with several titles, including chairman of the Department of Psychiatry at Saint Alphonsus Regional Medical Center in Boise.

No state did all that well on the report cards. The national average was a "D." Five states received "B’s." None scored an "A."

The Idaho problems are most severe at the bottom of the economic and social ladders, but they snake all the way up to middle-class Idaho, with its garden-variety mental-health issues and its decent health insurance.

Those people may find their mental-health coverage is full of holes that force them to pay more out of their own pockets. Their mental-health coverage may have extra deductibles, pay for fewer doctor visits or have lower lifetime benefits than the rest of their coverage.

Idaho does not so far make employers, or the health-insurance companies they use, cover mental illnesses the same as other illnesses. "Even with private insurance, you still have discrimination and disparity in funding," Negron said. "They ... have limitations in how often they can be seen and those kinds of things. And they have to pay 50 percent out of pocket," he said. "Some of them just can’t do that."

Despite Idaho’s problems, hope is justified on several fronts:

More beds are coming: For years, families of people with serious mental illnesses who need long-term help have been sent to State Hospital North in Orofino, a five-hour drive from the Boise area. In August 2007, Intermountain Hospital, a private psychiatric hospital in Boise, began contracting with the state of Idaho to treat some of those patients.

That lets patients stay near their families and lets doctors who started their treatment in Boise finish it here.

Saint Alphonsus’ behavioral health services likely will grow, too. Two nurse practitioners with special training in psychiatry joined the staff, making it easier, and less expensive, for new patients to get timely appointments.

Inpatients and outpatients alike get help in a cramped building along Allumbaugh Street. "The facility is inadequate to support a quality program," said Sherry Parks, director of behavioral health services at Saint Al’s. The recently renovated main hospital has mainly private rooms, but the psychiatric facility, located blocks away, has none.

Experimenting with insurance equality: A pilot project to provide equal health insurance to state employees is under way. The goal is to see if health-care costs rise for everyone if the mentally ill get coverage that is as good as everyone else’s. In other states that have passed such laws, the answer has been no, Hardin said.

Training our own psychiatrists: A residency training program for psychiatrists is brand new in Idaho, and Boise saw its first students in June 2008, Parks said. If trends in other states hold true here, some of those doctors will remain in Idaho to practice. That will help relieve a severe, statewide shortage.

Psychologist, psychiatrist or social worker?

What’s the difference and why should I care? You want to get your money’s worth, and you want to see the right person, or people, for the job.

Licensed psychologists have doctorate degrees and extensive training for diagnosing and treating mental disorders. They go to school for six years after they get their bachelor’s degrees and must get at least 1,000 hours of supervised time helping patients before they are allowed to work on their own. They administer and interpret psychological tests, but can’t prescribe medication.

Only psychiatrists are medical doctors who can order medical tests and prescribe medication. After earning bachelor’s degrees, students must graduate from medical school and go on to complete four years of residency training in the field of psychiatry. Many receive extra training beyond that.

Mid-level practitioners. In parts of the U.S. short of psychiatrists, including most of Idaho, a lot of mid-level health workers, such as nurses with extra training, perform many of the same duties as psychiatrists, seeing patients and prescribing medications. Those providers are called nurse practitioners.

Licensed clinical social workers (L.C.S.W.) are trained in psychotherapy and help individuals deal effectively with a variety of mental health and daily living problems to improve overall functioning. A social worker usually has a master’s degree in social work (M.S.W.) and has studied, among other things, sociology, growth and development and mental-health theory and practice.

Sources: Idaho Psychological Association, The American Psychiatric Association

Finding a psychologist

At the Idaho Psychological Association, you can generate a list of psychologists who work in your city. You can tailor your list to include psychologists who treat the age group you need and who have expertise in the areas you need help. It also tells you the insurance they accept.

The American Medical Association's Idaho doctor finder lists 47 psychiatrists from Mountain Home to Ontario. Remember, the Idaho Medical Association says you may have to waits six weeks or more for an initial visit with a psychiatrist because of high demand.

The Idaho Mental Health Counselors Association has a "Select a Counselor" link that lists some of the counselors across the Valley. It also has a list by specialty, so you can find a counselor who deals with whatever is bugging you.

Also, try IdaCare, at the Idaho Board of Medicine Web site. Health-care providers of all stripes, including psychiatrists, nurse-practitioners, psychologists and others are supposed to provide information for the public, including training, board certifications and other information. Note that accuracy of the information is not verified.

Check individual boards through the Idaho Board of Occupational Licenses for the mental-health professionals you may want to see: The boards oversee the qualifications of health professionals and deal with complaints. A few boards to check for names and qualifications are:

The Idaho State Licensing Board of Professional Counselors and Marriage and Family Therapists.
The Idaho State Board of Psychologist Examiners.
The Idaho State Board of Social Work Examiners.
Idaho State Board of Naturopathic Medical Examiners.

Don't forget to ask people you know for recommendations. They can be the best resources.

See a list of providers compiled by Colleen LaMay.

Short of health insurance and cash?

You can still get help. The ISU-Boise Counseling Clinic offers low-cost counseling: $10 for individuals and $15 for couples and families. Students pursuing master of counseling degrees do the counseling, under the supervision of faculty members. Counseling interns videotape counseling sessions for training purposes. To ensure your privacy, the videos are kept briefly for supervision, and then are erased.

For more information, contact Dr. Judith Crews, clinic director. Call 373-1719 to leave a confidential voice mail. Your call should be returned within one business day. Hours are noon to 8 p.m. Monday through Thursday.