By Taylor Sisk
Staff Writer
As planned cutbacks came down this week, the local provider for mental health services defended the move as the only course possible in the wake of lower state funding.
On Monday, the Caring Family Network (CFN) put into effect changes to mental health services it offers in its Hillsborough offices. While those offices will continue to be open five days a week, walk-in services will only be available on Tuesdays and Thursdays.
Along with the changes, CFN also said seven full-time employees would be let go, including those providing community support services, which are designed to help those in need of clinical services better integrate into their local communities — assisting them, for example, in securing physical health services and applying for jobs. The network also said it had terminated the contracts of a psychiatrist and a therapist.
State Rep. Verla Insko, a longtime proponent of mental health reform, said the cuts will hurt.
“They certainly are not in the best interests of the consumers … and the system should put them first.â€
But CFN representatives say that the state mental health care system, as administered by the North Carolina Department of Health and Human Services, has forced them to make the changes.
At a recent public forum in Chapel Hill, CFN regulatory systems director Marcia Lewis said that while the agency had already been finding it difficult to stay afloat, recent reductions to it’s funding from the state meant CFN “just couldn’t get by†without reducing the services it provided.
A greater challenge than ever before
CFN is a private agency that contracts to provide mental health and substance abuse services through the OPC Area Program. OPC is a local government agency tasked with providing oversight and management of mental health, developmental disability and substance abuse services in Orange, Person and Chatham counties. CFN announced in May that due in large measure to the recent rate cut by the state for community support services, it would be restructuring its services. The Medicaid rate reimbursed to organizations providing community support previously had been $60.96 an hour and was reduced to $51.28.
At an OPC-sponsored mental health public forum†held May 22 at Sunrise Church, CFN’s local program director Jim Martin provided an overview of services that would be reduced – including both child and adult psychiatric services – and acknowledged that the changes would have a real impact on a number of current and potential clients. “I don’t mean to say this is not a big deal,†he said. “This is a big deal.â€
CFN has been serving approximately 1,000 clients in Orange County.
At the forum, Truitt said the system is strained.
“Public mental health is facing a greater challenge than we’ve ever faced in the life of the system,†she said.
Truitt outlined the major issues facing mental health services in North Carolina today, including the amount of funding mental health services receive from the state legislature and a general shortage of crisis services. She also expressed concern with changes taking place at the state level with the departure last month of Department of Health and Human Services Secretary Carmen Hooker Odom.
“The system may seem chaotic,†said Truitt. “It is chaotic.â€
Concern with how decisions are made
When Hooker Odom announced the state’s rate reduction for community support services, she said that, based on an audit of 167 mental health service providers in the state, it had been determined the rate was too high.
“The original rate was set up with the idea that a quarter of the services would be provided by professional staff with master’s degrees,†Hooker Odom said at the time. “Certainly, with those 167 providers, who represented 16 percent of the [community support] providers, that wasn’t happening.†She said that those 167 providers “were billing for services that were almost totally provided by people with high school degrees or less.â€
“I think there’s concern with how decisions are being made in Raleigh,†Truitt said at the OPC public forum when explaining the rate change. She said she believed the change was carried out without allowing for adequate participation from all stakeholders.
Rep. Insko echoes CFN’s assertion that the reduction in the agency’s services in Orange County are largely due to the rate change – a change she says she opposed because it was made without having conducted proper monitoring of every provider offering services on behalf of the state.
“The state wasn’t monitoring [providers] closely enough to see they had a problem,†Insko said.
Short of such comprehensive oversight, Insko feels the rate reduction was premature – and she believes its consequences will be profound.
“There will be people who will lose services,†she said, “and who will end up in emergency rooms or in creating dysfunctional situations for their families…. We’re not serving those we need to serve.â€
Sate Sen. Ellie Kinnaird said she believes mismanagement at the top of the Department of Health and Human Services contributed to legislators’ reluctance to send more money into the programs.
Kinnaird said much of the blame rests with Hooker Odom.
“I really lay this at her feet,†Kinnaird said.
As for funding in the state budget currently being hashed out, while acknowledging that there’s not enough money allocated for mental health services, Insko added: “But we’re not going to spend money properly till we make some structural changes†– meaning, she said, putting more control into local hands.
She pointed out that such community-based initiatives are being proposed in the budget, including House Bill 691 to build community infrastructure for mental health, developmental disability and substance abuse services, of which she is primary sponsor.
Marsha V. Hammond, PhD: Licensed Psychologist
NC Mental Health Reform blogsite:
http://madame-defarge.blogspot.com/
1. Hooker Odom’s DHHS created ‘Service Definitions’ which are engraved-in-stone guides to Mental Health Services . The Service Definition associated with Community Support (CS) stated NOTHING about CS providers being master’s degree practitioners. There were no non-high school graduates acting in such roles.
2. Emergency Services have been cut (& bear in mind that CS services are emergency services also re: contact w/ clients being available 24/7). At the same time that psychiatric beds have significantly been cut and hospitals have been closed or are about to be closed (Dix), there is also a cut in these emergency services.
THIS IS A WITCHES BREW OF A DISASTER.
Marsha V. Hammond, PhD