Fitzsimon File

The latest news from the mental health reform front is both maddening and mystifying, though at least someone on the inside is finally calling attention to the perils of privatization, long the ignored elephant in the mental health policy room.

Lieutenant Governor and Democratic Gubernatorial candidate Beverly Perdue kicks off the maddening list with her assertion in the Raleigh News & Observer that she would have vetoed the 2001 mental health reform legislation if she had been governor.

Perdue says “the reforms went too far too fast,” and that frustrating hindsight comes on the heels of her comments to the editorial board of the Greensboro News and Record that she never believed the reforms would work.

There have been some improvements in some parts of the mental health system in the last year, but there is a general consensus among advocates and policymakers that the 2001 reforms were a disaster for people with a mental illness, developmental disability or an addiction.

There’s plenty of blame to go around. The reforms were poorly designed, dramatically underfunded, and atrociously managed.  Perdue claims she knew all that in 2001 and decided to not mention any of it.

Governor Mike Easley still claims his administration opposed the reforms, though Easley signed the legislation that created them, and there’s no record of Easley or anyone who works for him registering that opposition.

And now Perdue says she knew it wouldn’t work and didn’t tell us. 

Meanwhile, investigators are urging the federal government to cut off federal funding for Cherry Hospital in Goldsboro after a patient died after sitting in a chair for 22 hours and staff members allegedly beat another patient.

The hospitals were a mess in 2001 and they are a mess now, seven years into the reforms that promised fewer patients in hospitals and more services in local communities. But the services have been spotty and inconsistent and the hospitals have been forced to pick up the slack, despite an overworked and underpaid staff working under management that has been questionable at best.

The state recently announced that it will reduce payments to companies and nonprofits that provide assertive community treatment to people with severe mental illness. One nonprofit provider called the rate cut devastating, another described it as ludicrous.

Officials with the Department of Health and Human Services say the lower rates came after a review of rates paid across the country and input from people providing the services. The Department is still operating under a cloud created by the News & Observer series that said the state wasted $400 million by  mismanaging  community support services, an amount that continues to define the debate, though department officials believe the actual waste in the program was much less.

Last month, John Turcotte, the head of the General Assembly’s new Program Evaluation Division told an oversight committee that the problems should have been easy to predict when the state turned over services to private companies and nonprofits that the government used to provide.

Turcotte said that the private market will always respond quickly when “you turn loose what had formerly been a government-run, institutionally based program…because when there is money to be made, people are going to find ways to make that money.” 

All sorts of ways. An account from inside that new privatized system makes it clear that in many cases profit drives decisions about care, not the best interests of the patients. Cheryl Johnson, a former clinical supervisor for outpatient therapists for a private provider in Wake County, recently explained how it worked in a letter to the editor of the News & Observer.

Johnson says the company always requested the maximum number of hours for treatment whether appropriate or not, and preferred to treat children with ADHD because it was easier to work with them than seriously mentally ill adults.

Johnson says that “private companies have made a fortune because they are in control—justifying the need for treatment and determining what services are actually provided.”

She makes a compelling case that the state itself should be providing services, not turning patients over to the vagaries of the profit-driven market.

Not many people want to hear that and even fewer want to talk about it.

There are clearly some nonprofit providers doing a good job, spending public money wisely, and taking care of some of the most vulnerable people in the state.

But it’s hard to ignore Johnson’s analysis when you consider the multi-million dollar industry that has sprouted up to find ways to make money off the mentally ill and developmentally disabled, from billing and management to training and services.

Wonder if Lieutenant Governor Perdue knew that was going to happen too?

 

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This entry was posted on Tuesday, September 2nd, 2008 at 4:47 pm and is filed under Fitzsimon File. You can follow any responses to this entry through the RSS 2.0 feed.