US/NC/health/mental/government services/2001 reform

Sources

Most of this information comes from the N&O articles linked below. Overall, the article sounds like it could easily be cherry-picking a relatively simple, clear-cut story from what must in reality be much more complicated; information is needed from other sources – but the situation appears to be every bit as bad as the series portrays it.

Story

In 2001, the North Carolina mental health care system underwent sweeping changes designed to decrease costs overall, but with the opposite actual effect; as of 2008-02-24 the cost had more than doubled, to $1.5 billion per year. The N&O theorizes that this is because standards are being applied with extreme unevenness: some people are receiving services they don't really need, while others who desperately need service are receiving nothing, or the wrong services. (The example they cite, however, may make sense in context; the article doesn't give enough details to tell for sure – but the pay rate of $61/hour was clearly much too high for the type of service.) Too much money went to "community support", it says, and not enough to critical services.

The 2001 reform apparently planned to shift care responsibility away from centralized institutions and out to community facilities; unfortunately, the counties were told to unload their responsibilities before the funding for the local groups was approved by the federal government. Federal approval finally arrived in late December 2005, and the new services were launched 2006-03-20.

In February 2007, the Health and Human Services (DHHS) accountability team started an audit; in November, DHHS declared a moratorium on new services. On 2007-04-04, the "community support" rate was slashed to $40/hour and then raised back to $51 on 2007-04-26.

Many new service providers were formed to take advantage of the restructured funding; Dominion Health Services, a Raleigh-based company with about 1000 employees which went door to door looking for customers for the new "community support" services, was among those – and has now been asked to return $1.5 million (of a total of $59 million from companies which DHHS says broke the rules).

In 2008-9, the US (and global) economy went into a recession, making a further mess of the already-broken system. CAP-MR/DD funds were frozen in early 2009 (no slots were released all year), and many services were cut.

Links

News

• 2010.11.24 Feds launch probe of N.C. mental health system "The U.S. Justice Department has opened a formal investigation into North Carolina's struggling mental health system, the first step in a process that could trigger a federal edict for sweeping reform. .. The probe is the result of a complaint filed in July by the advocacy group Disability Rights North Carolina, which contends that the state is violating the Americans With Disabilities Act for failing to provide proper housing for people with mental illness.
• 2010.01.27 Mom camps out to get spot in mental ward for son
• 2008.04.06 State keeps mentally ill teen at jail
• 2008.02.26 - 03.03 Mental Disorder: The Failure of Reform:
  • Part 1: Reform wastes millions, fails mentally ill "Mental-health changes in North Carolina were intended to improve community treatment and give taxpayers good value, but they have done neither. Providers took clients shopping, swimming and to movies for $61 an hour. And the cost of the community support program was more than 10 times what the state expected."
  • Part 2: Companies cash in on new service "Community support is lucrative for providers, but reviews say many clients don't need the mental-health service. Now the state wants its money back."
  • Part 3: Serious mental therapy fades "North Carolina's 2001 mental-health reforms aimed to make its mental hospitals places of last resort and to have as many people as possible seek treatment near their homes. But now people with severe needs are left without care."
  • Part 4: Caregivers abuse patients, and usually get away with it "Charges are filed in just 13 percent of cases. The lowest-paid, least-trained workers spend the most time with patients."
  • Part 5: Patients die from poor care; families don't hear full story "Since December 2000, at least 82 patients in the state's mental institutions have died in ways that raise questions, including homicides and suicides."
  • Q: How can N.C. fix a broken mental health system? "In 2001, state legislators and Gov. Mike Easley's administration set out to reform the public mental health system with a sledgehammer." This was apparently intended to lead into a reader-driven discussion, but it's not clear where any reader comments might have ended up.