If you want to hear horror stories, just call me; I have plenty to share and have begun chronicling them on Stone Soup Video Station, but the truly sad part is that there are so many I simply cannot get to them all...
I don't think it's much of a secret that one of the biggest problems with the deregulation and privatization of mental health care - from an administrative perspective anyway - is the lack of available money for agencies, who must then compete against each other for the few pennies that are available.
It doesn't take a brain surgeon to recognize what happens when a group of privately owned agencies must compete with each other for the same tiny pot of funds. While there continues to be some moral and ethical decorum in the "collaborative, inter-agency effort" to ensure proper care for those who need it, most folks aren't going out of their way to assist other agencies, since to do so could lead to a better outcome for a competitor than for ones' own agency, thus giving that other agency an edge when it comes time to request additional or continual funding for continuity of care.
I believe this is a well-known problem but one that isn't much discussed, since to speak publicly about it would formally acknowledge that it does exist and that it is indeed a matter of concern.
Instead, I believe the majority of providers ignore it and I think that for the most part, we all try to provide the best care possible, regardless of who ultimately ends up with the client. Unfortunately, doesn't seem possible to do so without at least some bias, even if it is a subconscious bias that doesn't manifest itself overtly.
This of course could be easily remedied with sufficient funding, but apparently it's more important to spend our public monies fighting unnecessary wars in foreign lands than to worry about taking care of our own here at home....
State and local officials didn't do enough to help the neediest of patients when they reorganized the mental health system, according to an expert's report. Sweeping changes in the last six years have converted the mental health system by making private companies largely responsible for community mental health treatment, taking that role from local government agencies. Instead of treating patients, local government offices were to monitor companies and ensure that patients were getting what they needed from private providers.
According to a consultant's report, local mental health offices are not able to guide patients to needed treatment or adequately monitor private companies.
"There has been insufficient joint effort at resolving consumer access problems," says the report by Alice Lin, a consultant to the state mental health division.
Eighty-five percent of patients, those whose care is paid by Medicaid, can find companies to treat them, Lin said in an interview Wednesday. But the 15 percent who are poor but don't qualify for the federal money or have hard-to-treat disabilities continue to slip through the cracks of the new system, just as they did the old.
Lin, who helped write the 2001 bill that changed the mental health system, said the changes were meant to help the tough patients, homeless people who use illegal drugs, for example. The state and local offices have not cooperated well enough to resolve the problems of patients unable to find care. Most states have a hard time with the same problems, Lin said, but "I wanted to feel proud of our system. I feel we can do better."
Lin said some good things have happened since 2001. North Carolina legislators pay more attention to mental health than do their counterparts in other states; the state has a special fund for mental health services; and consumers and their families are asked for advice on what counties need.
"I think it was a very balanced report," said Mike Moseley, director of the state office that oversees mental health services.
Lin focused on seven local mental health offices, including the Durham County office and one that oversees Orange, Person and Chatham counties. She also talked to state government officials and private companies.
Local mental health directors said remaking the system took effort, but they did not ignore patients' needs. "That's what we keep in the forefront of our mind," said Judy Truitt, head of the Orange/Person/C
One man's odyssey
Deby Dihoff, executive director of the state chapter of the National Alliance on Mental Illness, said state and local offices are failing to help the neediest people, those discharged from state mental hospitals after short-term stays, for example. This week, she worked to find a shelter that would take a man who was discharged from the state psychiatric hospital in Goldsboro to the home of a casual friend. The friend said the man could stay a few days, but there were no long-term housing arrangements, Dihoff said.
NAMI, a nonprofit agency that runs a hotline, got the call for help after the man had been carried from his friend's home while still lying on a bed sheet. He had an appointment to see a psychiatrist 25 days after leaving the hospital, when he should have seen a doctor within five days, Dihoff said.
The hospital social worker and the local mental health office jumped to help when told about the problem, Dihoff said, but this case is one of the "horror stories" involving people getting out of hospitals with no place to go.
"We need to admit there is a problem with discharged and admissions. It's a complicated problem. If there aren't enough psychiatrists to go around, what are we going to do about that?"
The connection between the state hospitals and the community system has weakened since 2001, the report says.
"Efforts must directed at resolving this problem, so the consumers will not continue to fall through the cracks at both ends," the report said. The current situation creates "burdens on the limited resources in law enforcement ... and state hospitals."
Over the last six years, the state also has lost psychiatrists and substance abuse counselors. In the past year, private companies offering basic mental health services have flooded the state, with no way for local mental health offices to determine whether they are qualified to treat people.
Patients, their families and local mental health offices have become more and more unhappy with the new system.
Fixing the system
Lin recommended that Gov. Mike Easley's policy office get involved to help improve communications among state and local officials. Debbie Crane, a state Department of Health and Human Services spokeswoman, said Easley's office has already started meetings.
Local mental health offices say it is harder now to find treatment for poor people without Medicaid because companies don't want patients whose bills are paid with limited state money.
In the last year, a private company, ValueOptions, has taken control of approving treatment for people on Medicaid. Local offices say they want that job back so they can better manage services in their counties and have leverage over companies that refuse to take state-paid patients.
Ellen Holliman, head of the Durham Center, the county's mental health office, said it is essential that local offices get back the job of screening patients and monitoring services.
"We need to restore the public safety net" she said. "Especially for people found to be going in and out of state hospitals, there needs to be a way that [local offices] can provide care coordination for those people."
State Rep. Verla Insko, a Chapel Hill Democrat who sponsored the 2001 law, said a legislative committee that oversees mental health will discuss Lin's report and how the state can implement her recommendations
