Idaho courts see uptick in mental commitment cases

BOISE, Idaho (AP) - The courts have seen an exploding number of involuntary commitment cases in recent years, according to an annual report from the Idaho Supreme Court, and that has some judges wondering if budget cuts to the Idaho Department of Health and Welfare and the poor economy are partly to blame.

Last year more than 4,500 mental commitment cases were filed in state courts - an 82 percent increase compared to five years ago, according to the report. Idaho Supreme Court administrator Patti Tobias said there wasn't any research examining the cause of the increase, but an informal poll of magistrate judges throughout the state had some speculating that cuts to Idaho Department of Health and Welfare staff and offices across the state, a lack of affordable mental health care, drug abuse, limited health care access and the faltering economy could all be contributing factors.

"It's a tough question with a complex set of factors," said Ada County Deputy Prosecutor Michael Anderson, who handles many mental commitment cases. "There's been, with the economy, some people who have lost their jobs and that are depressed, so we've seen a few of those. But overall, the pie just seems to be bigger - the numbers of people just seem to have increased."

Usually, involuntary commitment proceedings begin when an emergency room physician, police officer or official of another facility initiate a "mental hold" on someone out of concern that the patient is a threat to themselves or others, Anderson said. A judge has to be notified of such holds within 24 hours, triggering the case filing.

Sixth District Judge Paul Laggis said he suspects that cuts to Idaho Department of Health and Welfare are a big factor in the increase in case filings. Laggis said he frequently discusses the "plight of adult mental health care" with the mental health professionals who work with his court.

"They tell me the state used to have clinicians who would actually make contact with people at their homes to see how they were doing, if they are taking their meds," Laggis said. "They'd check their pulse, so to speak, to see if they're deteriorating to the point where they might need intervention."

But many of those services have been cut in recent years.

"We're losing a layer of support," Laggis said. "So when our mentally ill people start acting mentally ill - they don't take their medication because they forget or they can't afford it or don't like it - sooner or later they deteriorate to a place where they're in front of us for an involuntary commitment."

The Idaho Department of Health and Welfare, like all state agencies, faced significant budget cuts with the recession. In 2009 and 2010, 35 workers, including 28 clinicians, were laid off from the Department's Adult Mental Health Program. Several of the department's regional offices were also closed in rural communities through the state. In 2011, Idaho Department of Health and Welfare officials advised lawmakers that mental health services had taken a 19 percent budget cut since 2008, forcing the agency to prioritize by first funding intervention services for people in imminent danger to themselves and others, pushing to the bottom of the heap services for those who don't have insurance.

But IDHW spokesman Tom Shanahan said his department's numbers don't show an increase in commitments as dramatic as the court statistics show. The department's data show a 35 percent increase in mental health holds since fiscal year 2009, and a 16 percent increase in court commitments during the same time span.

"As you can see, these are significant increases, especially for mental health holds, but they don't explain the huge increase by the courts," Shanahan wrote in an email to The Associated Press.

The disparity could be partly because of the emphasis placed on training law enforcement officers to deal with mentally ill suspects in recent years, Shanahan said, making police officers more likely to identify someone experiencing a mental health crisis and to place that person on a mental hold, rather than just taking them to jail.

Shanahan also said many Idaho residents are still struggling because of the economic downturn, and that added stress contributes to mental health issues.

Department layoffs and budget cuts likely also played a role, Shanahan said, leaving fewer employees to help a growing population with a reduced level of services.

In fiscal year 2009, the department served 8,209 people, he said, but that increased to 10,921 in fiscal year 2013 - about a 33 percent caseload increase.

"It's sad, because next to juveniles, it's the most needy population we have in this state," said Laggis. "They're horribly unrepresented. I think we have a responsibility to people in our communities who are in need, and mentally ill people, along with juveniles, ought to be two of the top populations we worry about."

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