David Wertheimer Lecture

David Wertheimer, Service and Systems Integration Administrator for King County DCHS, spoke to a large audience at NAMI Whatcom's educational meeting at the St. Luke's Community Health Education Center on March 9, 2000. He spoke about integrating the criminal justice, mental health and chemical dependency service systems into one system that more effectively treats the vulnerable, high-risk population of people with mental illnesses.

The integration of these three systems is King County's response to the problem of seriously mentally ill people cycling through the hospitals and jails for years without getting better.

Wertheimer explained that the problem is not a lack of services, but is instead a lack of integration of the services we have. The three systems traditionally have not worked together.

The integration of the three human services systems has resulted in a system that makes sense from a consumer's perspective. Information is shared; planning is done together; responsibility for clients' welfare is shared and resources to serve the clients are divided among the three systems.

With this collaboration fewer people slip through the cracks to cycle through the most expensive resources in the community (e.g. hospitals and jails) without lasting improvement. The resounding success of this pilot program, which began in June of 1999, begs the question: why wasn't this done before?

Wertheimer explained the difficulty of integrating systems that are, historically separated by bureaucratic, economic and political forces. To promote the integration, extensive gathering of data and data analysis were used to reveal the connections between hospitalization, incarceration, increased jail and hospital stays, homelessness and substance abuse.

Armed with this data, it was easy for Wertheimer to make the economic argument that treating substance abuse and homelessness would lead to a reduction in hospitalization and incarceration. But even with the statistical proofs, it took an order from county executive Ron Sims before the pilot program was developed.

For the first time in King County, there are now no “wrong doors” into the system. Instead, there are multiple portals of entry into both mental health and substance abuse/chemical dependency treatment systems from the jails.

Wertheimer noted that the success of the integration depended on a number of factors, but one of the most important was the requirement that every system provide funding for the new, integrated system making everyone a stakeholder. In this way, everyone can claim the credit for the success of the new system.

The integration of these systems is an evolutionary process. But with local government playing an active role and administrators who can learn from mistakes, Wertheimer expects the expansion of the program and the quality of life for people with mental illnesses in King County to significantly improve.