08/21/07 — Mental Health Reform - Linking patients to treatment

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Mental Health Reform - Linking patients to treatment

By Matthew Whittle
Published in News on August 21, 2007 1:46 PM

Despite all the changes in North Carolina's mental health system, one fact has remained constant -- most patients in Wayne County still go to Eastpointe's James Street doorway in search of help.

Only it's not quite the same.

No longer is it the Wayne County Mental Health Center where people went for all their psychiatric and case management services. And no longer do most people simply walk in.

Today, the majority of people accessing the mental health care system through Eastpointe do so over the telephone and are directed to another agency for their actual care.

Eastpointe, which serves Wayne, Duplin, Sampson and Lenoir counties, is the local management entity for mental health services.

That means that while its role still revolves around providing access to mental health professionals, it no longer employs them.

Instead, Eastpointe's focus is on getting the patient to the private providers, and that rather simple process begins with a brief screening that access director Suzanne Lewis describes as a "clinical snapshot."

"It's not like an in-depth evaluation," she said.

But it is enough to determine the severity of each person's case and how they would be best served.

From there, Eastpointe's access team then finds the patient a private provider -- either a case manager or a psychotherapist depending on the need. If more than one is available, then the patient is able to pick whichever provider best fits his needs in terms of available times and location.

"Individuals have input into their treatment and it starts with who's going to be their provider," Lewis said. "We just tell them what their choices are."

From there, while still on the phone with the patient, an access team member schedules the appointment -- often within two hours for emergent patients, two days for urgent patients and seven days for routine patients.

"Our goal is to make the appointment while the caller is still on the phone so that connection doesn't close," Lewis said. "We don't hang up and leave that person with just a name and number. We want to make sure that appointment is made and that they know when it is, where it is and how to get there."

However, once that appointment is made, even though Eastpointe does have a customer service center, the patient is more or less on his own.

And with the exception of those patients who are indigent and for whom the state pays, Eastpointe has little control over future care. Those paying with Medicaid have their care plans authorized by Value Option, a state-contracted company, while anyone using private insurance receives little to no oversight.

To further complicate matters, though, once the patient reaches that first provider for a more in-depth analysis, if any specialized care is needed, it is that provider's responsibility to find the right alternative.

"To put it in medical terms, we send these folks to general practitioners or a family physician," Lewis said. "But we're going to send them there so that person can do their own exam, and based on their findings, refer them to a specialist.

"It puts a very large responsibility on the providers. Once a referral leaves access, we're done with it."

And that is one of the areas where the system can falter.

Currently, there are more than 200 endorsed providers in Eastpointe's four-county region.

Most offer community support, psychotherapy and developmentally delayed services. Fewer companies, though, offer either substance abuse or the other types of in-depth care needed by many patients.

For many providers, the lack of in-depth services is a matter of economics.

"We've gone from a system of a community mental health center providing services to people regardless of their ability to pay, to a system of where you're paid for the services you provide," said Eastpointe Clinical Director Jonathan Barnes.

"There were some services that we provided when we were the mental health center, in which the budgets were always in the red," Jones added. "Private providers aren't going to do that, especially when they can't provide enough of the services that are making money to cover those that are not."

But that's not the only potential roadblock in the provider network.

Even when providers are able to afford to offer those specialized services, others might not be aware of them because the expertise that once was centered in the mental health centers has been scattered across an unfamiliar and rapidly growing community.

"We're at a place today where, one, there's not as many services, and two, there's not a true network of services," Jones said. "There are good things in having competition and choice, but the things I think are not so good include having so many providers providing so many different services and having them working individually and not making referrals to each other.

"We've got to do a better job of working with our providers to create a more comprehensive provider network. I think the providers are going to have to begin to work with one another better."

Still, Ms. Lewis continued, most of the clients entering the mental health system are receiving high quality care. The biggest obstacle is simply making sure people know where and how to get services.

"To me, the quality of service is not so much the issue as is the need for education," she said. "We took appointments (at the mental health centers), but people also could walk in without one, Monday through Friday, 8 a.m. to 5 p.m.

"Now the whole divestiture and privatization of services has required all that to go away. There are no more one-stop shops or places they can go regardless of their payer source. Now it's a fragmented system, and that presents a challenge to clients who may not be as adept at maneuvering through a complex system.

"But if people get to us, their odds are very high. If we can get to them, I think they get the services they need from the private sector."