June 15, 2008
Mental health care threatened
Leslie Boyd
The state could lose more mental health service providers on July 1 if a new rule goes into effect as planned.
The regulation would disallow practice by many provisionally licensed therapists, counselors, social workers and psychologists who now provide critical mental health services.
Marissa Kent-White works with families and children in Haywood County. She said many of the children are in Department of Social Services custody and need the stability offered by a single counselor.“In two weeks, I’ll have to walk away from them,” she said.
A provisional license in mental health fields is akin to a medical internship. Professional status requires one-two years of supervised experience after earning an advanced degree.
Provisionally licensed workers in the mental health field are usually supervised by professionals in their own specialty — other therapists, counselors and psychologists. The new state rule would allow them to be supervised only by a physician, such as a psychiatrist, if they are to receive Medicaid reimbursement.
Tara Larsen, of the N.C. Division of Mental Health, Developmental Disabilities and Substance Abuse Services, said the new rule will draw more family-practice physicians into the mental health system, but service providers and advocates say the new rule would severely limit where and how people with provisional licenses could work.
“In general, I don’t know what the department’s motivation is on this,” said Tom McDevitt, CEO of Smoky Mountain Center, the local management agency for 12 counties in Western North Carolina. “In the seven westernmost counties, there is only one practice with one part-time psychiatrist who could supervise these people. This is going to be very problematic for us.”
Currently, those with provisional licenses can perform Medicaid services, including outpatient counseling. After July 1, they will perform mostly services such as community support and crisis services as part of a team. Medicaid will not reimburse for the more basic services that state boards insist be part of their training.
“What is the logic in graduating people we need to do the work and then not letting them do it?” McDevitt said. “We will have a system that won’t pay people for the work they need to do to become fully licensed.”
Raymond Turpin, a licensed psychologist with a Ph.D., employs four provisionally licensed professionals in Haywood and Jackson counties, where providers are in short supply. One of those he supervises is Kent-White.“At a time when there aren’t enough providers to go around, this is unconscionable,” Turpin said. “Doctors here are busy, and they don’t want to take on patients with severe mental illness. They hardly have time to see the patients they have already.”
Larsen said Turpin and other psychologists could form a contractual relationship with a physician and retain their employees.But the employees still would not be able to perform the duties they do now, and Turpin and McDevitt believe most doctors would be reluctant to assume responsibility for workers employed by someone else.“We’re asking them to put their medical malpractice insurance on the line,” Turpin said.
Before adopting the new rule, the state consulted an advisory team of professionals in social work, psychology, marriage and family therapy and counseling, but the rule adopted was much narrower than the team recommended.
“There’s a desperate need in the system for trained professionals,” said Sally Cameron, executive director of the N.C. Psychological Association.McDevitt said the need is most desperate in rural areas, and he is certain the new rule will cut access to services, not enhance it as state officials believe.“It’s still a mystery to me how they reach some of their decisions,” he said. “We have squandered the money, alienated the workforce and betrayed the people we’re supposed to be serving. Whatever reform was supposed to be, it has failed miserably.”
http://www.citizen-times.com/apps/pbcs.dll/article?AID=200880614049
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