When people are looking for help with addiction or mental disorders, they’re more likely to recover if they get it right away. An effort in philanthropy and county government is aimed at making that the standard in outpatient treatment.
When someone is shooting up heroin several times a day, there are a few points when they might say to themselves, “I’ve really got to stop this,” according to Molly Carney, executive director of Evergreen Treatment Services in Seattle.
Those are tiny windows of opportunity.
Yet right now in King County, if that person walks into a clinic asking for help with an addiction or with mental health, it’s common to wait a week or two — sometimes as much as a month — for an appointment.
King County is seeking to change that with $1.4 million in incentive payments to help treatment agencies provide on-demand outpatient treatment for addiction and mental health. Billionaire Steve and Connie Ballmer’s philanthropy is also providing $600,000 to design the pilot system and evaluate the providers.
The agencies will have to reach targets to get the incentives.
“At the point when someone says, ‘I really want to get into treatment,’ ” said Carney, “you need to connect them with someone when their stamina and courage is kind of up.”
The incentives, which are designed by the Third Sector Partners advisory group in San Francisco, are part of a push to get the county to treat mental health and addiction like any other health condition, said Jim Vollendroff, director of the Behavioral Health and Recovery Division.
It’s like, “if you had a broken leg, and you went to a doctor, and they said ‘Yeah, you’ve got a broken leg, but we can’t see you for a week,’ ” Vollendroff said.
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Currently, only five out of 29 local treatment agencies are able to consistently provide on-demand outpatient treatment for low-income clients.
This could affect homeless people the most. King County, which declared a state of emergency on homelessness two years ago, points out that half the respondents to a January count of homeless people said they had at least one “disabling condition,” which was usually mental or drug-related. Many have both mental and drug-related conditions.
People often come in for treatment because of a crisis, Vollendroff said, but after a week, that crisis passes. Treatment can feel less urgent.
Studies going back 20 years have found that the longer the wait, the less likely a person is to enter treatment.
But Vollendroff acknowledged that behavioral health agencies don’t get enough funding to provide treatment on demand. That’s where the incentives come in.
A lot of the money probably will go toward pay for staff; Vollendroff says keeping people on staff at treatment agencies is a problem across King County. Nationally, the substance-use treatment field has a high turnover rate — studies in the last 15 years have found between 19 and 50 percent.
“Nobody gets rich in this business,” Carney said. “We spend so much time trying to keep our doors open that it’s exhausting.”
Thea Oliphant-Wells, a social worker with King County Public Health, said some of its patients have died waiting for an appointment. Oliphant-Wells is well-known in the county for being outspoken about opioid treatment, often telling of her own experience being homeless and using heroin.
Oliphant-Wells said she can’t remember how many appointments she missed. She would lose the slip of paper with the address and time, or she’d get lost on the way, or something else would go wrong.
“When you’re dealing with a brain that’s already altered with drugs,” Oliphant-Wells said, “and then add a layer of trauma, then add to that malnutrition or any of the other poverty effects that are happening, so often I just couldn’t get to that next thing.”
Eventually her life changed when she was hospitalized for an abscess related to drug use, and her mother took her in, making sure she made it to every appointment.
Oliphant-Wells thinks her recovery would have happened sooner if she had been able to get same-day treatment on demand.
In the last year and a half, treatment on demand has become more of an emphasis at King County Public Health, and Oliphant-Wells said it makes a big difference.
“There’s no greater gift for me as a social worker and also someone in recovery from opiate-use disorder to be able to tell someone who’s suffering, who’s in withdrawal … that they’re going to be feeling better within the next few days,” Oliphant-Wells said. “And even, ‘A nurse can see you in a few hours.’ ”