Wednesday, February 27, 2008

Mentally ill suffer under faulty system

Letter to the Editor of the Charlotte Observer

http://www.charlotte.com/239/story/507148.html

GUEST COLUMN | SELBERT WOOD JR.

Mentally ill suffer under faulty system
More taxpayer dollars are spent every year, but fewer are helped

I live in the state of North Carolina, but since 2001, I have also lived in the state of mangled care, as our state attempts to manage public-funded mental health care. What began seven years ago as an effort to increase access, choice and effectiveness of services has developed into a quagmire of haste and collapse.

Private providers have started, changed and stopped. Local management entities have merged, changing systems and functions. Service definitions alter frequently, just as reimbursements are reduced and availability of care diminishes. Clinical services that require heavily regulated credentials and expertise are difficult to find, while community support and hospitalizations increased.

Existing and new providers throughout the state, including HopeRidge, Telecare, Mountain Laurel, and New Vista, have closed. Caring Family Network, the largest provider in Chapel Hill, announced recently that it will close in April. Many providers have ceased some services or closed entire service centers.

It is impossible to fly a plane while building it in mid-air.

Services are eroding in our communities while psychiatric hospitalizations have increase 21 percent. In the past three years
49,137 fewer consumers (34 percent) have received clinical therapy.
They have dropped out of services, moved to an inappropriate form of care or faced expensive, disruptive care in institutions.

During the same three years, persons receiving services through state funding and federal block grant dollars have dropped 61 percent (or
32,474 people).

Medicaid expenditures have skyrocketed, with more than $76 million a month getting doled out for community support. A little over half of those cases are deemed medically necessary and only one in ten received the appropriate intensity and duration of services.

Readers would be hard pressed to find any fans of our current system.
Every gubernatorial candidate has a policy statement or platform plank to change it.

We must do better for the families who need our help instead of placing them in expensive hospital or prison beds and outside their own communities.
There is enough money to provide clinical services, but the existing funding and infrastructure should be better utilized.

Reduce the inefficient and overly managed system, which some estimate may spend around 65 percent in administrative oversight instead of care delivery for consumers in our communities.

We have redundancy in our system, with 25 LMEs, Value Options and several divisions in the Department of Health and Human Services performing similar functions in our communities when it comes to authorizing and managing care.

They are often in conflict with each other, to the detriment of care delivery and stability.

We know there are limited resources and finite funding for the care of the populations we serve. Appropriate care should be maximized to the best of our ability. If there is a problem, however, with an overused or inappropriate service, then the answer is not making all care harder to access.

Issues of accountability for this care cannot be addressed merely by increasing bureaucracy.

I am constantly reminded that the process may be complicated, but the impact is simple: enhancing lives.

It is time to focus on service delivery and not turf protection. It is time to invest our existing resources in families instead of sending them to hospitals and building 800 new prison beds each year.

It is the time for politicians, bureaucrats and citizens to step up and untangle this mangled care.

Guest Column | Selbert Wood Jr.

Selbert Wood Jr. is president/CEO of Partnership for a Drug-Free NC Inc., a not-for-profit organization that provides services to reduce the impact of substance abuse and mental illness. The group announced this week that it was closing mental health clinics.

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