By Mike NelsonÂ
Mental health reform in North Carolina has come off the tracks and it’s time to take a good hard look at what went wrong and take corrective action. May was Mental Health Month in North Carolina, which is a good time to admit that the State of North Carolina’s experimental reform of our mental health system, which essentially privatized mental health services, has been an embarrassing failure. It’s time to reform the reform.
In Hillsborough, over 100 clients of a mental health clinic are looking for new providers after the outfit that now operates the clinic decided to cut services. In other parts of Orange County, professionals who provide care for mentally ill children are finding it difficult to get Medicaid reimbursements because of licensing and definition changes. Failure to be reimbursed for services means that professionals will no longer be able to treat patients who desperately need help.
These are just two consequences of the well-intentioned, but failed, reform of North Carolina’s mental health system. The state’s reform program has resulted in confusion, reduced services in some areas, and a sense that some individuals and population groups are falling through the cracks. Basically, the state managed to make a bad system worse.
It’s hard to overstate the consequences of the failures in our state’s mental health system right now. I’ve heard several normally reserved observers describe our system as in near total collapse. Across the state, real people are no longer being provided quality care.
Here in Orange County, for example, the Caring Family Network (CFN), which runs the Hillsborough clinic mentioned above, is consolidating operations. As a private entity, responsible to their out-of-state headquarters, they found they couldn’t make money providing mental health services at the same quality level that had been provided for decades. Therefore this facility, which has been in operation for 38 years, has reduced operations and laid off staff. Additionally, over 100 patients have had to find new caregivers — all because CFN is putting the goals of their headquarters management above the needs of those who are sick and need treatment.
The bottom line is that the needs of the patients should come first, not the needs of management teams at far-away, out-of-state headquarters. There are just some programs that should not be privatized. Mental Health is a good example of a need that is best met by a well-managed public program, one that values successful treatment over profit margin. Let’s be real here: Providing mental health services isn’t likely to ever be a profitable business.
The Hillsborough situation is a perfect example of why the state’s reform effort has failed. After CFN took over the Hillsborough clinic a year ago, they found they couldn’t make money unless they reduced services. The reduction in availability in central and northern Orange means that some residents will not have access to treatment they need. Our residents will fall through the cracks, something that wasn’t supposed to happen because of this reform movement.
What can be done to address this reform? First, Dempsey Benton, the new Secretary of Health and Human Services, has an opportunity to take a fresh look at mental health reform in our state and to recognize that all has not gone well. Because he’s new, Benton is in a unique position to take reform in a new direction.
Second, the state needs to place more power back in the hands of the local agencies that used to oversee mental health services, the LMEs (local management entities).
The state should begin by making the LMEs the single portal of entry for the mental health and substance abuse system. In short, this means they would do the assessment, refer patients out to a public or private provider and then manage the case. The case management role means that one entity would have the oversight to ensure that patients get the services they need and that they step down to less intensive services when their conditions improve.
The LMEs should also provide the safety net for those in crisis and should be able to bill Medicaid for services or patients for whom no outside provider exists.
These simple reforms would help get our distressed mental health system back on track.