How A Broken System Fails Mental Health Consumers

HICKORY, NC – Eight years ago, the mental health system in North Carolina began to change. This change was prompted by new legislation that has come to be known as mental health reform. Then, decision makers in Raleigh thought it would be better to stop local governments from providing mental health services and allow private providers to begin to provide this service.

The mental health reform law explicitly required that all public services be made private through what it called divestiture. No longer would local governments be the provider of mental health services. This decision was meant to spur additional options for the mentally ill and help the overall system. It was also believed that divesting from a “public model” would enable additional private providers to open their doors, spurring additional revenues on the state and local level. More so, it enabled mental health consumers to have a choice in who they selected to attain treatment services.

Along with the changes that mental health reform brought, additional training was required by the state. Providers of mental health services were required to undergo extensive reviews, audits and training requirements. As the state continued to monitor the progress of mental health reform, it required certain providers to go through accreditation processes as well.

For the mental health consumer, they were promised less restrictive environments and services that met their individual needs, rather than settling for a “cookie cutter” solution for their mental illness.

The management of local mental health services would be accomplished through an area authority or local management entity (LME). The LME would be a government authority that would ensure local mental health services were handled in accordance with the law.

Back then, it all sounded promising. To hear proponents tell it, no longer would patients be shut out and shut up when it came time to decide on treatments. Now they would get to pick from a virtual smorgasbord of choices, all conveniently located in their own county/hometown.

Taxpayers were told, that these changes would save them money and lots of it. Millions, in fact, because more people would be treated in their own communities instead of being admitted to one of the state’s four psychiatric hospitals.

Who could argue with empowerment and saving money? Some did, but none of their voices were heard by leadership in Raleigh. The result?

A mental health system that has wasted, not saved, millions of tax dollars. And worse, many of the state’s most vulnerable residents are unable to obtain adequate treatments. For those people and their families, the price has been incalculable.

Culture Shock
For thousands of mental health consumers, their lives involved living in a state hospital with trained staff and easy access to medications and support structures. Facilities like Broughton State Hospital in Morganton, was home to these individuals, who could not live safely alone in the community.

After mental health reform, thousands of consumers were evicted from Broughton and the State’s other three hospitals, and required to rely on residential and assisted living facilities. These facilities are traditionally designed for the elderly and frequently are understaffed. These staff have little or no medical experience or knowledge, and especially in dealing with special populations like the severe and persistently mentally ill (SPMI).

This change has resulted in a firestorm of controversy and issues. To many on the outside, including families of those who once relied on State hospitals to provide a higher quality of life to their loved ones, the state has just moved the mentally ill out of their hospitals and forgotten about them. Other families have seen a different side of the crisis, mental health reform has created.

For the family of 70 year old Roland Simmons, they are devastated. Mr. Simmons had suffered a stroke several years ago. He didn’t require the full assistance of nursing staff, but couldn’t quiet live on his own. He and his family opted for him to move into an assisted living facility in Hickory, specifically the Walden House Assisted Living Residence.

During the early morning hours of July 9th, Mr. Simmons was on the facilities back patio smoking a cigarette when 43 year old Dennis Scherzer joined him. The details of exactly what happened are unclear but Mr. Scherzer, an individual housed at the facility because of mental illness, attacked Mr. Simmons. Mr. Simmons deceased from head trauma, as a result of the attack.

This tragic story embodies the results of mental health reform. Facilities like Walden House, who are designed for the elderly, are finding themselves inundated with the mentally ill who have been rejected from the state. Blending the mentally ill with other at-risk populations, as this instance illustrates, can be tragic.

One Crisis Leads To Another
When mental health reform evicted the mentally ill from our state’s hospitals, it created several “enhanced services” that alleged to provide the same or better level or service than was provided in State hospitals. These services were designed to be nonrestrictive. They included services such as community support, community support team and the assertive community treatment team (ACTT Team).

These services, according to law, are managed under close eye of the local management entity (LME) and it’s networked private providers. In the Catawba Valley, our LME is Mental Health Partners. MHP serves both Burke and Catawba counties. MHP has contracted with The Mental Health Fund, Inc (who does business as Catawba Valley Behavioral Healthcare) to provide these services to the community.

The effects of mental health reform, combined with the gross mismanagement of services, have caused tremendous issues for mental health consumers that rely on these programs.

According to two recent reports by the North Carolina Department of Health and Human Services (NCDHHS), our local management entity rated 24, out of the state’s 25 authorities, making it the second worst for emergency room mental health admissions.

This data indicates that Catawba County’s emergency room admission rate was 59% higher than the state average. Burke County came in at over 68% higher. Collectively, this data indicates that the services established by mental health reform have either not worked or been extremely mismanaged.

In addition, this data indicates mismanagement of our area authority’s emergency mental health crisis services. This service was designed by the state to prevent unnecessary hospitalizations & emergency room visits. Additionally, its designed to help connect individuals with local providers that can provide community-based outpatient treatment over a more restrictive in-patient program, when possible.

Sources close to our investigation, have described the failure of this program, as is evident in the NCDHHS report, as being the provider and not the individual professionals working on these teams. The private provider and the area authority, have an obligation to the state to review and correct issues that prevent these programs from being successful – including changing policies and procedures to ensure that the programs are in full compliance with state law.

The failure of these programs not only affect the consumers, who are forced to rely on more restrictive forms to treatment, but they also affect local hospitals who are inundated with an overwhelming number of mental health consumers desiring help.

One local doctor, on condition of anonymity, told us that he has seen as many as eight or nine mental health consumers in the emergency department at one time. This places a strain on our local emergency rooms, especially when some only have 15 treatment rooms, more than half of their available space.

For mental health consumers, who have gone into crisis because of no supports or failed programs, they often find themselves stuck in the emergency department under an involuntary commitment order. These orders require law enforcement personnel to remain with the consumer until he/she is placed in a 24-hour inpatient facility or is found to no longer be a threat to themselves or others.

The doctor who we spoke with, said these consumers do not receive any mental health treatment while in the emergency department. “Emergency rooms were not initially created for the mentally ill, so our staff often finds difficulty relating to their needs,” he said. “We are required by law to hold the patient until they are approved for placement in a mental health facility. Many of these patients do not have health insurance and therefore it’s very difficult to find placement outside of a State hospital. Often times, we find ourselves having to wait for placement at Broughton. If Broughton does not have a bed available, we have to wait until one becomes available. This ties up the treatment rooms in the emergency department and law enforcement that must remain with these individuals.”

The doctor said that it is often times, members of the “mobile crisis” unit, that are able to secure placement for these individuals. He commended their professionalism and their ability to work within the rigid guidelines that are provided by both the local authority and the state.

Just When You Thought Things Couldn’t Get Any Worse
With the state of the economy today, many people are “trimming the fat” from their budgets. The State of North Carolina is no exception. Recent budget negotiations have called for tremendous cuts in funding for the state’s mental health community, among other areas, to make up for an estimated $4 billion shortfall.

Many local providers such as Catawba Valley Behavioral Healthcare, we’ve learned, are calling on the community and their consumers to get involved. CVBH staff have written columns in local newspapers and addressed the Catawba County Board of Commissioners – looking for support and funding.

In a letter we obtained from a CVBH consumer (below), we see how worried the agency is about not receiving the same level of funding from the state this year, as last year. In fact, the agency has said any cuts in the state budget will result in changes to the services it provides. Other providers expect the same changes, and some have already implemented them.

It should be the priority of the State, our local government and the local management entity to prioritize and make every penny go as far as possible. Providing quality mental health services to individuals suffering from mental illness is paramount.

Likewise, it’s more important than ever to encourage fair competition among providers and ensure that everyone is dealt a fair hand. As the state tightens it’s belt, one should expect that local government, the local management entity and private providers would do the same.

More Information:

NCDHHS Reports: 1st Quarter / 2nd Quarter

CVBH Consumer Letter: Click here to view

Catawba Valley Behavioral Healthcare: Website

Mental Health Partners: Website