Jan. 31--Following national tragedies like those in Newton, Conn. or Aurora, Colo., many citizens across the state question policies regarding gun control, but they also question the effectiveness of their local mental health agencies.
Nearly a decade ago, the state made a decision to move away from local mental health authorities and move toward local management entities that service a number of counties. Rockingham County Social Services Director Larry Johnson said before the state directed administrative funds from local agencies to LME's, the county's mental health center was in pretty good shape.
"Once all the administrative funds started to go to Burlington, Rockingham County entered an arrangement with Alamance and Caswell counties called ACR," he said. "Rockingham came into this agreement rather reluctantly, but there really wasn't a choice -- the state forced them into it."
Johnson said this forced Rockingham County's mental health center to become a fee-for-service agency, which unraveled when the state started to cut mental health funding. He said he became part of the mental health services debate in 2007 when the county manager asked him to evaluate the mental health center.
Sponsored by the Reidsville Area Foundation, then Annie Penn Trust, a mental health focus group formed in 2005 to talk about issues across the board.
"It was a perfect storm in Rockingham County," he said. "Funding was getting cut and we were all complaining...about the state forcing people into doing things they didn't necessarily want to do."
Rockingham County then gave the mental health center three years of what was average funding at the time, around $2.8 million. Johnson said the center received funding with an understanding that the local agency would be a self-sustaining fee-for-service operation.
"That might've worked under the 2004-05 dollars, but they just kept on shrinking," Johnson said. "They were trying to run it like a clinic where you really didn't get any real subsidized operating funds -- where you just got paid dollar for dollar for whatever you did. It wasn't working. So we made a decision that I'm sure some people didn't agree with."
Rockingham County was still part of ACR with Alamance and Caswell Counties, but after Daymark Recovery Services started administering services through CenterPoint Human Services, commissioners decided to break ties with ACR.
"Daymark had a great track record of working in the same system that wasn't working for us," Johnson said. "They seemed to have a handle on how to do a franchise-type setup with a centralized administration system...It was sort of like we outsourced the administrative side since we weren't getting money for it anyhow. Initially, it worked great for the first couple of years. And then the state started cutting again."
Daymark serves a large population of the adult indigent population in Rockingham County for adult mental health services. Executive Director Billy West said it's been challenging with all the budget cuts over the past couple of years. But he thinks they've helped Rockingham County provide a higher level of mental health services.
"When Rockingham County ran the services, before merging with CenterPoint, they were struggling," West said. "I think the county was losing close to $1 million a year. The waitlist to see a physician was four to six months, the waitlist for outpatient therapy was about a month or two, and the waitlist just to be seen was about a month out."
He said now, waiting time for patients to be seen by a general therapist can be within one day to two weeks, depending on when they come in, and walk-ins can be seen within the hour if it's an emergent case.
"We turned things around really quickly and took those major funding losses off the county," West said. "I would say the needs for adult mental health patients and substance abuse patients were being met in Rockingham County when we took over," he said. "Now, the state has levied some pretty heavy cuts on these LME's, including CenterPoint, so we've lost a good bit of funding over the years. It's really taken a toll on what we can offer."
One of these cuts is in substance abuse services. West said they no longer have the intensive substance abuse services they used to offer, only outpatient services.
"Is it better than it was? Absolutely," he said. "Is it where it was when we first took things over? No, not at all. The budget cuts have been tough, and so is the inability to get more paying customers. When you only see people who have no money, it makes it very, very hard to keep your services robust."
For fiscal year 2012, Daymark saw a total of 3,616 patients. Out of this total, 1,930 were indigent, 978 were on Medicaid, 119 on Medicare, 328 had Medicare and Medicaid and 261 were on private insurance. Over the last 12 months in Rockingham County, Daymark had more than 27,000 appointments kept, which includes duplicated patients.
West said they've even had calls about people worried following national tragedies.
"I've had a lot of calls about the Sandy Hook thing -- can people get help and all that stuff -- and even though service can be better, there's always help available," he said. "We can take any walk-in or people brought in by their families or the police and they will be seen. It doesn't mean we will have the perfect treatment for them down the road, but we can certainly intervene and stop a crisis situation if given the opportunity."
Rockingham County is also dealing with the availability of beds after a person is determined to need involuntary commitment. Johnson said people can sit up to a week in emergency room beds at Morehead Memorial Hospital or Annie Penn Hospital before they can find a state bed.
"It felt like we had turned a corner on it...and we got to the point where we offered Crisis Intervention Training to our law enforcement officers to teach them a gentler way of diffusing situations when someone is acting out," Johnson said. "I don't know if our problems will get better or stay the same, but my hope is when these Medicaid dollars start flowing into Winston-Salem, it will take some pressure off the system. Because you can't do a $100 service for $50, and that's what's being asked right now."
Future of mental health
Moving forward, West said he doesn't see much room for improvement in services unless the funding improves.
"I think the Medicaid waiver is our only hope," he said. "I don't think there's going to be any new money at all...Our saving grace is this waiver and having CenterPoint be able to adjust rates locally..."
West said they are even holding off on billing because Medicaid has yet to adjust rates back to rates before they were decreased in wake of the fiscal cliff talks. West said Medicaid assumed Congress would not reach a deal and rates were adjusted 20 to 30 percent lower, effective Jan. 1.
"So everyone is holding their billing because Medicaid is saying they're going to readjust the rates back to where they were since the fiscal cliff was avoided," he said. "I just don't have any confidence that we will not see more rate reductions. They're averaging two per year for the past couple of years, and it would be a shock to me to hear we're getting an increase. I would say, 'What's the catch?'"
West said there only a few things that could help Daymark improve its services.
"North Carolina has to stop reducing funding, and we don't need anymore regulations," he said. "There's a lot of non-value added paperwork that we're keying into an IT system, and it would be a tremendous overhead expense lifted off of us. The Affordable Care Act would also afford a large number of indigent patients the opportunity to get on Medicaid, which would be a big boost for everyone."
West said on average, it would increase federal funding $17 for every $1 the state sends.
"The problem with that is it's not a done deal -- our state can still opt out of it," he said.
CenterPoint will become a managed care organization effective Feb. 1 and receive a direct allocation of Medicaid dollars based on people in its service area. The LME currently serves Forsyth, Stokes, Davie and Rockingham counties.
Rockingham County gives roughly $700,000 to CenterPoint to manage mental health services in Rockingham County. The county also approved a five-year loan of $228,579 after more cuts from the state last year. Daymark's offices are located beside the county's governmental center in Wentworth.
"It's a tough time for mental health services Rockingham County is trying really hard to stay one step ahead, but it's not easy," Johnson said. "Everyday is a challenge."
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