NC Mental Health Channels - a swamp of uncertainty
Since the recent reorganization of health care and mental health care in 2001-3, articles in the media have shown weaknesses in the system. LME's (Local Management Entities), formerly the Departments of Health and Human Services, have been granted autonomous powers of budget and care management. Each one is a power center unto itself.
They receive medicaid/medicare allotments and distribute benefits based on their individual programs. Further, they have censure not only over private practice, hospitals, hospital services, and reimbursement for those services for patients handled through their system, they have censure over private practices and hospitals for patients outside their system in the Certificate of Need(CON) and licensure pathway.
A new service or hospital must gain approval of the LME to proceed down the path of state approval for a CON or licensure for the new facility.
In the event that the new service is focused on local need, that may be appropriate. However,if the need is statewide or regional, it has no logical place in this pathway for approval. Example: a psychiatric residential treatment facility (PRTF), which services have been in the news recently for mismanagement and gouging, has a local market or service area. While a private hospital or a new wing on an existing private hospital for psychiatric inpatient care has a market larger than the LME and larger than the state. ("Private hospital" is a facility not managed by the state.) How is this form of patronage, equal to that of Richard Daley's in Chicago last century, anything other than another local government empire?
Further, some LME's pay chosen hospitals for reservation of beds for psychiatric inpatient care in large sums of monies received from federal sources. Then, the per diem reimbursement alloted for such care is reduced to less than the cost of a motel room in rural North Carolina. It should be a straight pass through of per diem to licensed psychiatric hospitals, rather than financial support for state facilities. These last have not been performing well, according to articles on deaths and mistreatment in the media.
A measure was introduced by UNC School of Nursing today in teh N&O. In the article, RN's will be trained in diagnosis and treatment to supply LME's and local services with personnel. This measure must be considered stop gap, not long term. However, it will become part of our health delivery system and, probably, exist forever within it.
An extremely intelligent and dedicated department head left state service some years ago during the reorganization. Now, the trail of communications regarding potential downfalls in the system and reogorganization from her is disappearing.
Maybe it is time to break the vessel into pieces again and start over without protection of agencies unqualified to manage the problem. Maybe it is time to open the door to solutions provided by professionals in mental health, MD's in psychoanalsis or psychiatry, professionals in business management, or PhD's in pyschology, rather than people with master's degrees in social work or with state training exclusively from within the system.
This comment is NOT a criticism of social work programs, social workers, RN's or the dedication of state employees. It is a comment about appropriate training and management for the solving problem at hand and the review of systems managed by the state. It does not ask questions about outpatient vs. inpatient treatment, psychotropic drugs vs. professional long term counseling, drug and outp-atient care management vs. more frequent inpatient care.
What are your thoughts?
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A good question Bunt
It may be hard to get attention today with all the debate buzz ... maybe you can get this onto the debate agenda tonight ... or at least remind us tomorrow that there's more to be thinking about than campaign noise.
My son is an MSW working in Florida. He would probably say it's not either/or.
I hope we are able to get mental health on the agenda tonight.
It's important.
And James, I agree, it's not an either/or solution. At this point in our history with mental health, NC has to be open to all viable solutions, and whoever becomes Governor better be ready to lead on this one from day one.
Be the change you wish to see in the world. --Gandhi
Pointing at Naked Emperors
None of the solutions are
None of the solutions are either-or, but they do need to be based on common sense and reality, and local officials need the flexiblity to pursue solutions best for their area. In Nash County, the former mental health center was far more effective in providing serious outpatient services to patients than dispersing those patients to the few private providers willing to see them. In other areas, private providers may be the best way to go. But the one-size-fits all mandate in the recent "reform" has been a disaster. Let authorities rebuild their centers if they've been working.
Besides the nurses, another group that has potential for extending quality services from psychiatrists are a relatively new group of pharmacists — clinical pharmacist practitioners, licensed by both the pharmacy board and medical bard. They are similar to PA's and nurse practitioners in their function and must meet the same high standards for licensure. Unlike PA's, the CPP is not involved with diagnosing illnesses but works under a physician's protocols to manage a patient's treatment, including writing prescriptions and orders as appropriate. My wife is a CPP who is board-certified in psychiatric pharmacy and works in a community psychiatric hospital. Her practice enabled one psychiatrist to handle more hospital patients than he otherwise could, and at less cost than physician reimbursement. A CPP, naturally, is more effective than other midlevel providers in drug management, critical to a modern psychiatric practice. The big problem facing CPPs is that they are having difficulty getting their work recognized by Medicare/Medicaid so they can bill for their services.Without that recognition and ability to bill, hospitals are reluctant to use them as fully as they could. Getting recognized requires an act of Congress, and while our delegation is supportive, they haven't been successful. Burr was an early supporter who hasn't been able to "get it done," and Dole hasn't been helpful at all. Not one bit. Many of our Representatives say they are supportive. I hope those who care about health care in general, as well as mental illness, will ask their representatives to support this request.
Our failure to care properly for our mentally ill is a disgrace and urgent human need. The more treatment options we can provide, and the more flexiblity we can allow within a reasonable framework of state standards and strong oversight, the better.
Ken Ripley