An Expert Interview About the Thunderbird Treatment Center
By Caitlin Rothermel
Last month, we ran part 1 of our interview with Dr. Marli Parobek, a Vashon resident and doctorally prepared nurse practitioner who is board-certified in family practice and psychiatry. Dr. Parobek previously developed and managed a voluntary inpatient medical rehab/detox center at the Astria Toppenish Hospital in Yakima, and is currently the only prescribing psychiatric professional on the Island.
This month, Dr. Parobek summarizes some changes the Island is likely to experience with the establishment of the Seattle Indian Health Board’s (SIHB) Thunderbird Treatment Center, discusses some pressures and incentives that may affect patient screening and care, and reiterates her concerns that neither King County or SIHB has involved any local medical or mental health clinics or professionals in collaborative conversation about on-Island needs.
Patient Screening
Dr. Parobek is concerned that, as a low-intensity facility located on an Island that is, at minimum, one hour away from emergency care, the Center will not have the medical staffing or flexibility needed to ensure patient safety.
The SIHB has emphasized that they plan to screen for lower-risk patients, a level of caution that is essential because the Center will house pregnant and parenting patients. SIHB has also stated they will not admit individuals who have been convicted for felonies, and plan to screen to avoid medical complications due to undertreated mental illness.
Dr. Parobek believes that, due to the nature of the system and the incentives that drive it, these screening procedures will be inadequate. When people detox, the first step is usually a 3-7-day stay at a high-resource treatment center. According to Dr. Parobek, this is expensive and closely managed, “… Getting insurance to pay [for extra days] is difficult – there is absolute pressure to move patients out of beds. This leads to less-than-ideal screening systems.”
SIHB has indicated they plan to sell “pre-paid” beds to certain tribes; this is also common practice. Dr. Parobek explains: “At Astria Toppenish, we had 12 beds, and the Yakima tribe bought two. If the tribe didn’t have two people who needed those two beds, they remained empty because the tribe paid for those beds.”
On the other hand, with pressure to transition patients out of detox treatment, this pre-paid arrangement can serve as an incentive to use beds that may not be ideally located for the patient.
Thunderbird is also a voluntary facility and, lacking adequate ground transportation and a well-functioning ferry system, if patients choose to leave early there is not always an easy way to get them home.
A Community Resource?
Dr. Parobek believes it is incorrect to view the Treatment Center as a community resource. “If King County truly wanted to invest in Vashon substance treatment and prevention, they would provide funding directly to Islanders via a pre-existing, successful program that simply needs more funding to expand its services. I would start by asking ‘Why now? Why here?’ It’s not the people of Vashon asking for it, it’s not Vashon having the infrastructure and the medical professionals to manage it – what really is the incentive here? Because it’s not community health.”
In line with this, there’s no guarantee that someone from Vashon needing addiction treatment would be transferred to this Center. Why? The priority for rehab is not location, but the first open bed. Also, according to Dr. Parobek, “Statistically, people don’t like treatment in their hometown. Part of the reason they use is the people and environment they’re surrounded by … Drug and alcohol rehab should be the opportunity to seek respite away from the people and places that trigger substance use.”
This leads to another overlooked consideration in siting this facility on Vashon – clinical recommendations for addiction treatment emphasize the importance of involving family in the recovery process. According to Neal Cotter – a licensed mental health consultant who previously worked at the Astria Toppenish Hospital inpatient psychiatric unit: “I always like to think about best practice. What makes sense? Having people near their family.”
It is important for patients to be in a location that is close (enough) for family to visit, with accessible places to stay. This infrastructure doesn’t exist on Vashon, and because of this, the Center’s location could have the unintended effect of isolating patients.
Conclusion
Having this discussion isn’t about privilege; it’s about accountability and realistic considerations. SIHB has indicated that they have provided multiple program updates and opportunities for community input. Speaking as an Island mental health professional who interacts with other Island health professionals, Dr. Parobek disagrees:
“SIHB has only engaged with Vashon on a limited basis, and mostly with special events for invited guests and supporters. We have only heard from SIHB administrators and KC politicians – none of our businesses, schools, medical or mental health clinics have been engaged in a meaningful conversation about daily operations and the impact of adding the largest residential and the largest medical facility to the Island. If King County truly wanted to invest in Vashon substance treatment and prevention, they would provide funding directly to Islanders via a pre-existing, successful program that simply needs more funding to expand its services.”
