The news so far in 2008 indicates that North Carolina’s mental health system steadily continues to crumble around us. In January, Wilson Medical Center announced it was closing its psychiatric beds. Last week, the Board of Trustees of Beaufort Community Hospital in Washington voted to close its 18 bed psychiatric unit, further depriving North Carolinians of psychiatric hospital beds in the community and putting more stress on our already overcrowded state hospitals. Two days ago, Partnership for a Drug-Free NC announced it was closing its mental health clinics in Mount Airy, Yadkinville, Statesville, and Mooresville, leaving the psychiatric care of 265,000 people in limbo.
In my own backyard, Caring Family Networks is closing its clinics at the end of the month in Orange-Person-Chatam Counties, leaving 1,500 patients without care.
The recent closing of mental health clinics and of psychiatric hospital beds in the community is the latest in a long list of private companies and community hospitals psychiatric units failing to survive in the “reformed” mental health care system of North Carolina. More closures are brewing on the horizon. The message cannot be more clear - the reform of North Carolina’s public mental health system has failed.
But I think we all that by now. I personally believe that we need to establish publicly run Safety Net Clinics or Clinical Homes that will provide a stable and consistent setting for mental health care. These Clinical Homes will be run by the county or the LME and funded with county and state money. They will not close down because they can’t make money. Most of the people that the system serves are indigent. North Carolina ranks 43rd in the country in per capita spending on mental illness. It is no longer reasonable to think that private companies can break even or turn a profit while offering decent, quality care in a system with very little money.
We are all seeing the consequences of the failure of North Carolina’s Mental Health system. I’m asking people in Orange–Person-Chatam Counties to tell us what is happening - how is this closure is affecting you? If this has happened to you in other parts of the state, let us hear from you as well. Whether you are a patient, a provider, or anyone else we need to hear from you. Post a comment on this blog. Write a letter to the editor of your local paper. Call your elected official. Let our current and future leaders in state government really understand how this broken system is hurting people.
3 comments:
Marsha V. Hammond, PhD: Clinical Licensed Psychologist
NC Mental Health Reform blogspot:
http://madame-defarge.blogspot.com/
Here in western NC, things are no better. Authorizations are terribly slow coming from Western Highlands Network LME which services Asheville (Buncombe County) as associated with state funded clients. Only 8 sessions are doled out in terms of psychotherapy. There are no psychiatrists to be had in any reasonable amount of time and so I send my client 40 miles west to the Balsam Center, which is the only good thing that Smoky Mountain Center LME has perfected as associated with mental health reform.
In terms of Medicare, 50 cents on the dollar is what I get for CPT codes: 90804; 90806; 90808 (for this last category, if you utilize it to the point that you are in the top 10% of providers in NC---this code being associated with 70-90 minutes of psychotherapy, an efficient way to do therapy if you go to the client's homes, which I commonly do)---you will get audited.
Behavioral Health Codes are a good way to see clients CPT 96152, advantaged to psychologists by the American Psychological Association, which pay at the usual medical rate of 80 cents on the dollar, if they have chronic medical illnesses which impact their mental health functioning.
So, in a nutshell: the agenda of NC mental health reform, which was to provide mental health services to ALL citizens, has been trumped by the LME's in terms of:
difficulties with authorizations;
post payment reviews which are time-consuming and pay nothing;
Person Centered Plans which are time-consuming, serve no good purpose, are repetitive, and pay nothing to the provider.
I'd say that Carmen Hooker Odom had pretty much trashed any mental health reform possibilities and Dempsey Benton continues this by disallowing mental health providers from any real input as associated with any of his 'committees.'
Marsha V. Hammond, PhD
This was e-mailed to me asking me to post it anonymously. I really appreciate this person speaking up. Only this way will we know what is going on.
As was reported earlier this month, mental health
provider Caring Family Network (CFN) is closing it's
doors in Orange, Person and Chatham counties as of
2/29/08, with the last day for doctors being 3/10/08.
http://media.www.dailytarheel.com/media/storage/paper885/news/2008/02/15/City/N.c-Mental.Health.Care.Suffers.Funding.Cut-3212549.shtml
This is being written so that the real picture of
CFN's closure is understood by those in the mental
health field and by the North Carolina community at
large.
CFN staff were told yesterday that OPC’s plan for a
smooth transition for transferring CFN clients to a
new provider had broken down. This breakdown boiled
down to the unwillingness of an outside provider to
take on the bulk of CFN’s clients and, equally
important, to provide the critical and poorly state
reimbursed services of Psychiatry and Outpatient
Therapy. With a mere eight days until CFN’s closing,
everything is up in the air.
OPC apparently is in talks with other local mental
health providers to expand their services so they
could absorb CFN’s clients (forget about the dedicated
CFN staff members, few are thinking about them).
These agencies are currently at capacity and the smart
ones are leery about taking on too much lest they
become financially unviable like CFN. One agency
appears to be taking things on willy-nilly which
raises issues about the quality of care they will be
able to provide and how they will avoid falling in to
the same financial difficulties that caused CFN to
close. Those remaining CFN staff are trying
desperately to connect their clients to other
providers. But to where?
There has been no direction at all from the LME/OPC
except that the press reports there is a “plan.”
http://www.carrborocitizen.com/main/2008/02/14/mental-health-provider-shutting-down/
There is no plan. There has not been any concrete
instructions on what to tell clients given the current
situation. CFN has mailed out a letter notifying
clients of the looming closure that included a list of
other providers who accept Medicaid and other insurers
so that they can try to find a new provider. The only
option for clients without insurance is to call the
OPC STAR referral line and hope that another provider
will accept them.
CFN staff are struggling to develop their own plans to
deal with other issues such as ensuring clients
continue to recieve Patient Assistance medications and
how to get as many clients as possible prescriptions
before CFN closes completely. After March 10th CFN's
clients are on their own.
It is critical that anyone looking in to CFN closing
not stop digging when they are told by some
functionary that there is a well thought out plan for
the transition. There is no plan if no one is sharing
it with the people that need it most: CFN's clients
and those still working with them. CFN is closing in
eight working days and people are scrambling to try to
connect clients to other providers to ensure
continuity of care. It is inevitable that some
clients will fall through the cracks.
If anyone doubts that this fallout from North
Carolina's mental health "reform" is serious all they
need to do is to think: Northern Illinois University.
I saw an article in the Charlotte Observer about North Carolinas mental health system. It was from February 24, 2008. It was talking about child and adult community support programs. I am the guardian of a disabled adult who lives in the home. I have a 4 year degree and am out of work. It stated that 98% of the service was being provided by high school graduates. The initial rate of 61.00 an hour but was dropped to 51.00 an hour. I am very angry I would of never of used the service if I knew the people are high school graduates. The disabled adult in my home has a new case manager starting soon. Is this person a high school graduate telling me what I need to do with the disabled adult in my home and I have a 4 year degree. Many of these case managers have made trouble for me in the past and now I know why.
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