05/06/08 — Officials discuss mental health concerns

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Officials discuss mental health concerns

By Matthew Whittle
Published in News on May 6, 2008 1:46 PM

After spending much of their winter break examining the state's mental health system and the consequences of the reforms that have been implemented since 2001, Rep. Van Braxton, D-Lenoir, said legislators are beginning to feel like they have figured out what needs to be done to stabilize the network of caregivers.

"They're tough problems to get our hands around, but I think we have a pretty good handle on it," said Braxton, an advisory member of the joint mental health oversight committee that's been meeting to formulate a set of recommendations.

Participating in the Wayne County Mental Health Association's legislative briefing Monday morning, he explained to the group of industry professionals that with the system making news in the past year for its problems with the community support network and the state's psychiatric hospitals, interest in making some much-needed adjustments seems to be running high, and that he expects some steps to be taken during the short session.

"I think there will be a lot of interest," he said. "I'm hopeful and feel like they will listen to the recommendations the committee has."

The problems boil down to several issues.

The community support network is still facing scrutiny after the state found last year that more than $400 million in improper Medicaid services had been authorized, with the federal government looking to recoup between $130 million and $170 million.

The state's psychiatric hospitals also are still under close examination after problems caused their federal Medicaid dollars to be called into question, and the opening of the new facility in Butner was delayed.

But, Braxton said, even though legislators don't plan to tear the whole system down and start over, they do think they have some good ideas about how to fix those problems.

"We're not going to make wholesale changes because that's not what we need at this point. I think we're going to have to move slowly," he said. "We'll make small changes and monitor them and make sure we're on the right track. Then we'll make more small changes. We didn't get into this mess overnight, and we're not going to get out overnight."

Those small changes are likely to begin with a proposed bill, drafted by the joint committee and mostly agreed to by Eastpointe Director Ken Jones and Cherry Hospital Director Dr. Jack St. Claire, that will be presented to the legislature when it reconvenes a week from today.

Included in it are proposals for single-stream funding for the local management entities -- allowing them to direct funds where they are needed the most -- regional substance abuse programs, more outpatient housing for the mentally ill, tiered rates for community support based on professional or para-professional services, requirements for national accreditation within two years for community support providers, and the streamlining of the appeals process for providers who are being required to make repayments or whose endorsements have been pulled.

Also included in the draft bill are requests to keep Dorthea Dix open for overflow mental health patients from Cherry and the new Butner hospitals, as well as funds to provide incentives for community hospitals to accept more acute psychiatric patients and to increase mobile crisis units.

"Cherry Hospital is busy. Business is too good," St. Claire said, explaining that since Jan. 1 the hospital has been at capacity for about 50 percent of the time. "It's putting a real crunch on us. Space is a huge issue for us."

But that's not his only problem.

Both he and O'Berry Center Director Dr. Frank Farrell also told the legislators -- Rep. Louis Pate, R-Wayne, also was in attendance -- that they need more money to pay their employees, especially those nurses and others who are making little more than when they started.

"One of the things we're struggling with is trying to find good people," St. Claire said.

Finding the funding to meet those needs, however, is likely to be a challenge, Pate noted.

Currently, there is only a projected surplus of $50 million -- down from the $350 million projected several months ago.

"With this kind of money available, there's going to be very little we can do," he said.

But that's not the end of the system's needs.

Other proposals included in the bill are ones to take the Medicaid payment authorization authority away from the private vendor Value Option, and put it back in the hands of the LMEs by June 30, 2009, and to delay any action toward regionalization until at least that same time.

"(Medicaid authorization) needs to come back to us because we're local and we know the consumers," Jones said. "And the LMEs are really concerned about any regionalization at this point because this system is fragile. Right now, the LMEs are really the only link between the consumers and the providers. We don't need sweeping changes at this point."

But they do need some, and Braxton believes they will start in the coming months.

"I think there's good chance of some of these changes happening," he said.