By Eric Reeves
What did Butch Cassidy and the Sundance Kid yell as they jumped off the cliff?
That is where we are with mental health reform in North Carolina: We are off the cliff.
As the director of the N.C. Division of Mental Health services, Rich Visingardi, has repeatedly said all year: “We are moving forward with a comprehensive mental health, developmental disabilities and substance abuse reform effort. Everything is changing.”
The state is in full divestiture mode and our intent is to use the savings to finance support services at the local level.
In addition, there is hope that the new system will create competition at the local level and thus make more services available to those in need and that the services will be delivered more efficiently.
As we move from here to there, there is a lot of risk.
No one argues for the present system. The goal of the reform is to create an integrated system with an emphasis on local program options.
To achieve this goal, the state is shutting down existing services in order to finance the “bridge funding” for the new comprehensive community services.
The safety net of hospital beds and existing public clinical staff will cease to exist and will place a great amount of stress and responsibility on the nonprofit community.
All of this comes at a time when community hospital beds are being lost across the state and many doctors are refusing to see Medicaid patients due to financial constraints.
Additionally, the existing shortages for children mental health services borders on obscene.
These trends fly in the face of privatization proponents.
How can we have meaningful competition when we are witnessing an erosion of services at the local level?
As area programs shift clinical staff to nonprofit agencies, will the new non-profits make it financially?
Wake County, a wealthy county, is experiencing this same erosion trend. I can only imagine what it is like in the more rural counties that have been hard hit by our current economy. If other states are a guide, then we should expect increased community capacity to be slow in coming.
Listening to the members from the Hospital Association, it is clear they expect the results of the reform effort to show up in the emergency room. Essentially, there is great fear that “community capacity” will not materialize to meet the needs.
While there is broad support for the current plan, concerns about community capacity and money are growing. It is hard to tell if we will successfully negotiate this transition.
I do know that a lot of the burden will rest on two key areas.
First, the state needs to fully fund the cost of transition and should be ready to step in if treatment gaps appear.
The state should also consider funding alternatives for private institutions. For instance, Medicaid funding should be made available where there is substantial collaboration between local officials and a private institution.
Second, the nonprofit community will bear the brunt of the transition. The search for stable funding from both private and public sources will be at a premium. Further, I would encourage the non-profit community to coalesce and join forces to make sure that the rules developed by the state and local governing entities are workable and helpful to their service delivery mission.
Eric Reeves, a Raleigh lawyer, is a member of the North Carolina Senate.