When Jai Nelson looked into Kootenai County's biggest issues after she became commissioner, one quickly topped the list.

The dollars and manpower committed to involuntary holds.

The county, law enforcement and Kootenai Medical Center are investing a great deal, Nelson said, in putting up individuals who are at risk because of intoxication, substance abuse and mental issues.

"The cost is exorbitant. That term has been raised by every entity I talk to," she said.

From 2007 to 2010, Nelson learned from KMC stats, Kootenai County spent $1,597,500 in funding hospital stays for individuals placed in protective holds at KMC.

City police and the Sheriff's Department also report a burden on officers, who can wait hours for hospital staff to become available for such holds.

Nelson is pursuing an answer that agencies have long discussed.

She would like to see a facility created for involuntary holds only, where folks can be placed to sober up over one or a few days, and receive exams determining their release or higher-level treatment.

That would be less draining on resources than placing folks at KMC, she said.

Some like Mike Baker with Dirne Community Health Center say the project could help address substance abuse in the county.

Maybe even pave the way for a future detox center, he said.

"In general in our community, we do have a problem with substance abuse issues," Baker said. "And we don't have a lot of services for people who have substance abuse and don't have money."

But first, Nelson said, let's improve involuntary holds.

"We are dealing with this problem on the back end," she said. "I want to deal with it on the front end, with an appropriate facility and at vastly reduced cost."

Pressure on Police

Local law enforcement has envisioned a holding facility for years, officials say.

Conducting involuntary holds currently consumes significant time and manpower, said Chief Wayne Longo with the Coeur d'Alene Police Department.

Officers can take individuals into protective custody if they pose a danger to themselves or others, he said, whether from substance abuse or mental issues.

Not being under arrest, these folks must be taken to a mental health facility - KMC - and not jail.

But beds and staff aren't always available.

So officers must stay with the individual and wait, sometimes for hours.

"It ties up police personnel, and justifiably so," Longo said. "We don't want to leave, especially if a person is hell-bent on hurting themselves or will lash out and hurt someone else."

If KMC just doesn't have room, he added, officers transport the individual to a hospital in Lewiston, or in some occasions, Boise.

"You can see the time factor. It's at least a two-hour drive down to Lewiston," Longo said, adding that state law requires the individual go to an Idaho facility. "By the time we get into St. Joseph's and we turn around and drive back, it's chewed up half a shift."

That situation arises twice a month on average, according to KMC staff.

Coeur d'Alene Police provides an average of 200 involuntary holds a year, Longo said.

The Sheriff's Department has faced the same problems, said Undersheriff Travis Chaney.

"We all have this issue," Chaney said. "This facility and this issue needs to be resolved, and sooner rather than later, because it's not going to go away."

Hospital Stresses

The holds stretch hospital resources, too, said Carmen Brochu, chief nursing officer.

Individuals brought in under police custody must first undergo medical evaluation, she said, which can take from one hour to an entire night, depending on staff availability.

"They (involuntary holds) are not typically emergencies, so other patients will come first," Brochu said.

Those individuals can be volatile or out of control during the wait, she added, so hospital security sometimes has to help law enforcement keep watch.

The holds are placed in KMC's adult behavioral health unit, she said, a locked-down area under observation.

These individuals require specialized treatment, she said, which requires significant resources.

"If they're taking up a bed, we can't admit a patient who really needs to be there," she said.

KMC provided 541 involuntary holds in 2010, she said.

Folks in protective holds receive an independent designated exam within 24 hours to determine if they are fit for release, at which point about 50 percent are.

More are released following a second exam after 72 hours. A small portion stay for a court hearing to determine if they should be committed.

The days prior to the hearing are funded by the county, Brochu said.

The average day costs $700, she said, though that varies per situation.

KMC always allows the county to pay at the discounted Medicaid rate, Brochu added.

"We believe those first 24 hours and until the first DE is done, could be done more cost efficiently to the county," she said.

Involuntary holds have been an issue since the early '90s, she said. It's only getting worse, she added, as local population rises and the economy remains mired in recession.

"The environment has posed lots of situations with job loss, financial burden, which has triggered mental health issues or coping with drug and alcohol abuse," she said. "It's a huge burden, and not one agency's responsibility."

Solution Uncertain

The solution is in a regional, multi-partner effort, Nelson said.

Planning is in its earliest stages.

Nelson has recently held meetings about creating a new facility with a bevy of stakeholders, including law enforcement, KMC, Panhandle Health District and other officials.

PHD has agreed to be a leader in the effort, said Director Lora Whalen.

"Certainly we all care about these individuals and we want them to be safe, and by statute, law enforcement is obligated to protect them from themselves or others," she said. "We want to be able to most efficiently and effectively provide them these services, at the lowest cost."

A subcommittee is determining the scope of need across all the northern counties for an involuntary holding facility, Whalen said.

"What would it take? What kind of facility would we need, what is the problem?" Whalin said.

Once that information is in, she added, another subcommittee will conduct a financial feasibility study to gauge if the project is viable.

How much it will cost, she couldn't guess, nor how many stakeholders would help fund it.

But she only sees this going forward if it's cost efficient, she said.

"Will it come to fruition? I don't know, I don't have a crystal ball," Whalen said. "We've certainly got the right players at the table. Everybody is energetic, and we're looking to go forward, but in a fiscally conservative manner."

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