Fitzsimon File

Easter surprise for the mentally ill

Just when you thought things couldn’t get much worse for families in North Carolina relying on the state’s mental health system for support, state officials gave them an unwelcome Easter surprise Thursday afternoon.  

It came in the form of a memo announcing that the state was slashing by a third the amount it will pay for community support services provided to children and adults with mental illness.   That is likely to mean some of the most vulnerable people in the state will no longer get the help they need.

The services are designed to help people with basic behavior and life skills and for many patients, especially children, it is the only form of focused care they get from a mental health system teetering on the edge of collapse in many parts of the state.

The state says that the $60 an hour paid to providers was too high and that $40 an hour is closer to the actual cost. State officials say the services are being provided by “paraprofessionals,” staffers without college degrees, instead of more highly trained personnel.

The reduction comes after a state audit found that some providers improperly billed the state for the services and many weren’t filing claims correctly. The response apparently is to make it more difficult for all providers to offer the services, not just the ones having problems.

Advocates for the mentally ill are up in arms about the decision and it is easy to understand why. Parents have seen other key services for their children disappear as mental health reform efforts have steamed ahead, dismantling a statewide system and sending families back to their communities for care, where few services are available because the promised funding has never materialized.

The parents now fear the state’s latest decision will mean an end to the one service that their children still get.

Part of the mental health reform passed in 2001 took local governments out of actually providing services, instead setting up Local Management Entities (LMEs) to coordinate services with private providers.

Even though it may have been well intentioned, the privatization scheme suffers from inherent flaws. Many services provided to mentally ill are not exactly profit centers. And the system completely breaks down if the state isn’t paying the companies and nonprofits enough for the services.

Community support was one service that providers were adequately compensated for and some used the money to help defray the costs of providing other services they provided at a loss.  That raises the question about why the profit motive is part of the equation at all, but that is a philosophical discussion that policymakers seem unwilling to have.

This announcement also reinforces the view among advocates and families caught in the dysfunctional system that state officials believe one of the problems is that some people are getting too many services. That prompted one parent of a child with mental illness to ask “why in the world would we choose to be part of the system if we didn’t need help because the system is so horrible?”

Others were taken aback by the timing of the announcement, just hours before the end of the last workday before the Easter Holiday, all but guaranteeing slim media coverage. The reduction was retroactive to April 1, meaning that people who provided services a few days earlier believing they would be paid $60 an hour by the state will now only receive $40 an hour for that care.

Even if state officials believed cutting the reimbursement rate for the services was the right thing to do, why not announce it 60 days in advance and allow public comment?  

The timing and substance of this announcement could be a metaphor for mental health reform efforts overall. The dispute is about provider rates and how to save money and how to crack down on providers that aren’t following the rules.

The problem is that just like with the overall reform efforts, the losers are adults and children with mental illness and their families who need help taking care of their sons and daughters. For them, this was not a very happy Easter.  

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