Pubdate: Tue, 28 Dec 2004
Source: Courier-Journal, The (KY)
Copyright: 2004 The Courier-Journal
Contact:  http://www.courier-journal.com/
Details: http://www.mapinc.org/media/97
Note: does not publish LTEs from outside their circulation area
Author: Deborah Yetter

Series: A RIsing Blight - Day 3: The Solution - Part 3E

Money Crunch

STATES' TREATMENT RESOURCES STRAINED

Waits For Aid Long; Some Get No Help

Meth is further straining Kentucky and Indiana's underfunded systems for 
treating drug addicts and alcoholics, according to state officials, 
treatment advocates and others.

Kentucky addicts face months-long waits to get into public and private 
treatment centers, including Park Place, a residential center in Bowling 
Green with a 60-day wait for one of 28 beds.

"It's ridiculous," said Martin Wesley, its executive director.

Nearly 270,000 Kentuckians have a problem with alcohol, illegal drugs or 
prescription medicine such as the painkiller OxyContin, a recent state 
survey found.

But the state's publicly funded regional treatment programs served about 
10percent of that number last year - 26,315 people, according to the 
Association of Regional Mental Health Boards.

What Kentucky spends on treatment Substance abuse treatment per year, 
mostly through the 14 regional community mental health services. $25 
million ($15 million, federal and $10 million, state money)

$9 million on prevention ($7 million federal and $2 million state money)

26,315 People served last year

266,000 Estimated number of people who need treatment

Needed

Advocates are seeking at least $50 million to expand mental health and 
substance abuse services.

Also, the state Corrections Department spends about $3.9 million a year in 
federal and state money on substance abuse treatment for inmates. Capacity 
- - about 1,600 a year.

Sources: The University of Kentucky Center on Drug and Alcohol Research; 
the Association of Regional Mental Health Boards; the state Corrections 
Department; the Statewide Drug Control Assessment Summit 2004; the House 
Bill 843 Commission on Mental Health and Substance Abuse

The centers have received no new state funding for the past 10 years and 
only slight increases in federal funds, said Dan Howard, executive director 
of the state Association of Regional Mental Health Boards.

"We are never able to catch up to the demand," Howard said. "The harder you 
run, the behinder you get."

Kentucky spends about $25million a year - mostly federal money - on public 
programs to treat substance abuse, said Robert Walker of the University of 
Kentucky Center on Drug and Alcohol Research.

A few private nonprofit agencies, mostly in Lexington and Louisville, offer 
extra help.

The state is planning a major expansion of "recovery" centers throughout 
Kentucky, using federal tax incentives aimed at creating affordable housing 
for the poor and homeless. The state wants to create 10 to 12 centers to 
help up to 1,000 people with substance problems.

But it could take several years to build and open the centers. Meanwhile, 
the need is acute, advocates said.

Howard said the state generally pays for treatment, or the lack of it - one 
way or the other.

Arresting someone on a drug trafficking and possession charge costs an 
average of $3,358 - and that does not include jail time or other costs, 
according to a study released in October by the University of Kentucky 
Center on Drug and Alcohol Research. By comparison, it costs an average of 
$2,395 per client to treat someone for substance abuse in Kentucky, the 
study said.

Saving Money

Programs Praised, But State Funds Are Short

The UK study found that for every dollar Kentucky spends on treatment, it 
gains about $4 in savings from the cost of jailing and prosecuting 
offenders and tax revenue from those who are working.

Advocates said Kentucky must funnel at least $50million more into 
mental-health and substance-abuse treatment to move from 44th in the nation 
in state spending to about 25th.

That would be about a 30percent increase in the about $165million the state 
spends each year on mental-health and substance-abuse programs.

The state should take advantage of a Medicaid provision that would allow 
Kentucky to provide more treatment through 70percent in federal matching 
funds for the 30percent in state money, advocates said.

But to do that, Medicaid must provide additional money for the state's 
share and, with a projected shortfall of $500million by the middle of next 
year, officials do not see any way to offer new services, said Gil Lawson, 
a spokesman for the Cabinet for Health and Family Services.

"We are interested and we are looking at it," Lawson said. "But we can't 
fund it right now."

Indiana's treatment picture is not much different. The need for treatment 
is rising and resources for providing it are not keeping up, advocates said.

A state-sponsored survey shows that 295,000 Hoosiers sought treatment for 
addictions last year. That's more than 11 times the number the state was 
able to serve through its 109 publicly funded treatment providers.

The result, said Scott Cleveland, director of the Indiana Addictions Issues 
Coalition, "is that people go untreated ...(and) usually end up dead or in 
jail after they've passed through the homeless phase."

The state treated 1,785 people in the 2003 fiscal year who said 
methamphetamine was their primary or secondary choice of drug, according to 
Diana Williams, bureau chief of Addiction Services in the Division of 
Mental Health and Addiction.

That figure jumped 40percent in the 2004 fiscal year to 2,972, Williams said.

Indiana spent $34.8million of mostly federal money treating 28,386 people 
for all addictions in the year that ended June30. Williams said the state 
contribution to that has remained constant at $10.3million for at least the 
past three years while there were small increases in the federal contribution.

Service Gap

Many Need Help, But Resources Can Be Scarce

Ajay Ross of Louisville says she is grateful for the treatment she received 
last year at a women's residence in Louisville run by Wellspring, a private 
nonprofit mental-health agency.

Ross, 54, took her first drink at age 8.

By her early 50s, she was a lifelong alcohol and drug abuser. She had been 
homeless, in hospitals and recovery programs, and she repeatedly had 
attempted suicide, she said.

Ross said she is sober now. She said she knows there are many like her who 
need help.

"There are hundreds of women still out there," she said. "It would be good 
if we had facilities for others to go into."

One of the biggest problems is a lack of money and services to help people 
such as Ross who abuse drugs or alcohol and have mental illnesses diagnosed.

Sixty to 70percent of mentally ill people in Kentucky also have a drug or 
alcohol problem, according to mental-health professionals.

Dr. Thomas Brown, a psychiatrist and vice president for medical services 
for Seven Counties Services Inc., the regional mental-health agency for 
Jefferson and surrounding counties, said the failure to address both 
problems worsens the crisis.

"You get more hospitalizations, more relapses, higher rates of arrest, 
homelessness," he said.

Kentucky's Medicaid program, which covers mental-health treatment, does not 
cover substance abuse, except for pregnant women.

As a result, the state's 14 publicly funded regional mental-health programs 
and private agencies can bill Medicaid only for mental-health treatment, 
not for substance-abuse services.

"That's very frustrating," said Wesley, whose center is run by Lifeskills 
Inc., the regional mental-health agency. "Until people see there's really 
no difference between mental illness and substance abuse, we're going to 
have these problems."

A Kentucky mental-health commission supports an increase in the state's 
3-cents-a-pack cigarette tax, which is the nation's lowest.

State Rep. Mary Lou Marzian, sponsor of House Bill 843, which created the 
mental-health group known as the 843 Commission, initially offered 
legislation proposing an increase of 44cents a pack - tied to Kentucky's 
ranking of 44th in state spending on mental-health and substance-abuse 
treatment.

This past legislative session, Marzian and other lawmakers sponsored an 
unsuccessful bill seeking to raise the tax by 75 cents a pack - in part to 
provide funding for mental-health and substance-abuse treatment.

Marzian, co-chairwoman of the commission, has filed the same proposal for 
next year's session and she said she believes a significant tax increase is 
needed for revenue and to discourage youth smoking.

But lawmakers have rejected all past cigarette tax increases, including a 
26-cents-a-pack increase that Gov. Ernie Fletcher proposed in his 2004 
budget that legislators failed to pass.

"You're dealing with a chronically under-funded system to begin with and 
you're seeing more and more people coming into the system," said Sheila 
Schuster, executive director of the Kentucky Mental Health Coalition.
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MAP posted-by: Beth