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SOCIAL SERVICESMental HealthCounties, as Regional Support Networks (RSNs), are responsible for administering inpatient and outpatient community mental health services according to the provisions of 71.24 RCW, the Community Mental Health Services Act. In addition, they are responsible for administering the provisions of the adult and children’s involuntary treatment act (ITA), sometimes known as civil commitment, under 71.05 and 71.34 RCW respectively. In coordination with the criminal justice system and its duties to care for the mentally ill offender, the RSN also is involved in the criminal insanity statutes, 10.77 RCW, as it utilizes the county-designated mental health professional and overlaps the civil commitment process. As RSNs, counties are responsible for collaborating and coordinating with all other health and social services systems, the tribes through Memorandum 7.01, local and state criminal justice systems, the courts, the schools, and other agencies and organizations to ensure the most appropriate care for the mentally ill.The public, the federal government, and the legislature are asking that outcome measures be used to determine the success of the services that are being provided. However, increasing administrative responsibilities from both the federal and state level continue to cause concern as already limited funds are diverted from direct care to pay for the costs of burdensome process requirements. State hospital and local community hospital psychiatric beds continuie to be reduced with limited resources for community services, especially residential, to replace them. WSAC Policy: Counties support full state funding of all mental health services the state requires counties to provide whether in state statute, WAC, waiver, or contract, as well as for any additional state mandates and shifts in priority populations to more difficult and treatment resistant groups. Counties support state funding for additional administrative responsibilities mandated by the state and the federal government. Counties call for a concerted effort from the state to only reduce process requirements in favor of research-based outcome measures. Counties support the increase of residential resources statewide. Counties only support the continued reduction of inpatient resources at the state level only the necessary resources are provided up front to increase local residential capacity and provide programs to appropriately serve those persons discharged from the state hospitals. Counties support additional state funding for non-medicaid adults and children and/or non-medicaid services provided to medicaid eligible persons. Counties strongly support additional Short-term invluntary committment resources both at the state hospitals and the community. Developmental DisabilitiesCounties administer a range of specific programs for persons with developmental disabilities. The counties provide day and employment programs that promote the goal of maximizing everyone’s ability to work and earn a decent wage, and enhance their integration into the many activities of community life. Some counties administer programs for children with developmental delays, who are age birth to three, in coordination with local school districts and other public entities. Some counties also administer residential programs, but most such programs are administered by the state including the state institutional. The state institutions are called Residential Habilitation Centers (RHCs).Counties are responsible for information, education and coordination of overall planning activities regarding services for persons with developmental disabilities. Counties follow the county guidelines, which in combination with the residential guidelines and the state strategic plan are the philosophical foundations of all programs for persons with developmental disabilities. WSAC Policy: Counties support adequate state funding for the continuation of community programs. Without it, institutionalization will continue and/or increase at a great cost to the state, putting individuals and their families at risk. Counties do not support any reductions to day and employment programs or the funding that supports their administrative expenses. Counties support both new funds dedicated to increasing these community resources as well as the redirection of institutional resources into the community to begin reducing the numbers of those either un-served or underserved. Counties support the codification of funding for transition services through inclusion of the program in statute. Counties also support additional state funding for those who require special services, such as the community protection program, or for those who are also diagnosed with substance abuse or mental illness. Chemical DependencyCounties plan and manage chemical dependency prevention and treatment services for a broad spectrum of the community: youth and adults who are at risk of or addicted to drugs and alcohol; pregnant women; children and families in the child welfare system; those leaving welfare for work; injection drug users; persons with HIV/AIDS; and those disabled by drug or alcohol dependence. Increasingly, counties serve adult and juvenile offenders being released from state institutions and either diverted from or incarcerated in local facilities. Treatment related to these populations, such as drug courts, has had a significant impact in reducing recidivism at both the state and local level. It also provides for community safety while potentially saving limited funds currently required for building and operating additional correctional facilities.A recent economic impact study, commissioned by DSHS, estimated the total costs of drug and alcohol abuse to be $2.54 billion to Washington State in 1996. Criminal justice costs alone equaled $541 million, plus an additional $254 million in property damage and $211 million in health care costs. However, recent research has found that for every $1 paid for drug and alcohol treatment in FY 95, $3.71 was saved over the next four years in Medicaid health care cost, law enforcement, and court, jail, and prison costs. Other cost-benefit studies have shown equal or greater returns from investment in treatment. Despite the clear evidence of such cost-effectiveness, state, federal, and local funding has remained inadequate to serve even one-quarter of the estimated need, or as put in the reverse, 75.3% of those eligible for and in need of treatment went without. Several concerns continue to draw attention. The increase in the manufacture and use of methamphetamine has dramatically increased costs for law enforcement, public health, and the treatment community. The legislature is also demanding that the state and counties pay additional attention to the growing number of those with challenging and complex multiple diagnoses, including those with co-occurring drug and alcohol dependency and acute or chronic mental illness, frequently compounded by developmental disabilities or severe medical conditions. WSAC Policy: Counties seek a partnership with the state to implement effective prevention strategies. Counties support adequate funding for drug and alcohol services for low-income persons, which will reduce the cost to local communities from untreated drug and alcohol abuse and dependence. Added resources are needed to provide for inpatient and outpatient treatment in the areas of detoxification, opiate and methamphetamine addiction, and involuntary care. Specialized and integrated services for the chronic public inebriate and the dually diagnosed are needed. Youth should be given a high priority in prevention, intervention and treatment programs. Counties also support adequate funding for any additional state and/or federal mandates to increase services to new priority populations. |
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