Built-in disparities in Utah's health-care system — from the thousands of poor and minorities who are continually underserved to a teenager who committed suicide last month because he couldn't get the help he needed — dominated Wednesday's discussion of the Legislature's Health and Human Services Interim Committee.

Experts, state agency administrators and a distraught aunt of the boy who killed himself urged lawmakers to do something to address gaps in the system that have reached a crisis stage, particularly in mental health services.

Department of Human Services executives told lawmakers that centralizing care or hospitalization of those most in need runs counter to a more community-based approach that would allow families with mentally ill children to have continuing involvement in care. That countered a previous proposal from the department to remodel the state hospital for about 100 mentally ill children.

Mark Payne, who directs the department's capital facilities, said the agency isn't asking for more beds but just replacement capacity to handle children whose emotional problems require constant oversight available only in a closed setting.

The model for treatment to those who have varying degrees of substance-abuse problems, ranging from intensive, resident care to more outpatient to community-based daytime treatment options "has dealt with that pretty well."

Sherri Wittwer, executive director of the Utah chapter of the National Alliance for the Mentally Ill, said discussions have been under way for years to address an inpatient versus outpatient approach. But even if a new program is proposed, "the funding never materializes," which makes everyone hesitant, even those who support new programs and want to suggest cuts to current funding.

"People are reluctant to even have the conversation because they don't want to lose what we have," she said.

Treatment options in recent years have focused on doing whatever is possible to provide services that would keep people with mental illnesses near families and in their home communities.

"If we have centralized locations and you have a family in St. George, how do you stay involved in your child's care?" Wittwer said. "If you put them away, often there is increased depression and other problems that aren't in the best interest of the well-being of the child."

Committee member Rep. David Litvak, D-Salt Lake, said the notion of hospitalization is "scary" to any family and suggested that fellow lawmakers at least begin a dialogue that would address both the realities and scope of mental illness treatment.

The system hardly served the best interest of a boy "gave up" on living by shooting himself, the boy's aunt told lawmakers during emotional testimony. In telling the story, she also read his final journal entry.

She said her nephew fell through the gaps in the system that are created by policies that won't allow treatment providers to share information, treatment protocols or current medications.

"If the other facilities could have shared what had been going on, maybe he would still be here," she said. "Not even a family member was contacted when he was released the last time. And now a loss as difficult as any caused by a physical problem is rippling through his family — siblings, aunts, uncles, grandparents, even great-grandparents — for who knows how long."

The disparity built into the system isn't just letting down single individuals, lawmakers were told. Inconsistencies over who gets what health care isn't only harming Utah minorities and poor, the entire system is suffering from overpriced services and less than desirable outcomes for every dollar spent.

Minorities in particular and thousands of low-income residents don't receive proper screenings, allowing cancers not to be detected until they have grown large enough or have metastasized to different parts of the body where symptoms can be detected — usually too late to do any good.

That same group is likely to receive recommended immunizations for influenza and pneumococcal pneumonia, the most common type of pneumonia. They tend to be hospitalized at a higher rate and have below normal rates of positive treatment outcomes when they are, lawmakers were told.

Judi Hillman, executive director of the Utah Health Policy Project, said Utah has had a health care system designed for one of the most homogeneous states in the country. Utah is now one of the most rapidly diversifying populations in the country. The focus of whatever is done must take that into account.

Lawmakers took no action, other than to advise the audience not to expect much if any additional funding to help solve the problems.


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