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Many Thanks for the series of articles on Mental Health reform ( and previos articles by lynn Bonner and Ruth Shehan). Maybe someone will now sit up and listen. That's been a major problem throughout Reform. No one was willing to listen to the County agencies that previously ran the programs.It difficul for me to hear a Division employee say "in hindsight" since they were told repeatedly that combining case management and para professional services was a bad idea. For a future article go to the Division and poll staff as to when they last provided services to a client. If they had invited a couple of experienced techs from Dix to tour the new facility every quarter they would not have the design problems they have know.

My first recommendation:Include people who actually do the work ( and are not making a profit doing so) in the decision making.

Second: Cutting rates, changine authorization etc for Community Support will not fix it. The definition has to go. We have to go back to having case management as a separate service and it needs to be provided by local government program staff and not private for profit agencies. The case manager has primary responsibility for the development of the service plan ( what the client needs) and implementation of the plan ( what the client gets). In 1981 the State settled on a lawsuit "Willie M vs Jim Hunt". The provision of Case Management was the major cornerstone of the settlement

Third: you mention that several services such as intensive in-home are dsigned to keep people out of the hosptial. Acutally they are not. In order to keep people out of the hospital you have to have intensive srevices that can be accessed and implemented quickly. in order to implement in-home services you first access Community Support which may take a couple of weeks. If the client does not have a recent clinical assessment the Community Support worker arranges for an assessment.The community support professional calls a meeting to develop a Person Centered Plan.This may also take a couple of weeks.The CS worker then submits the Plan, along with other required paperwork to ValueOptions for authorization which will take a couple of more weeks.If authorized, a referral is made for the service. 1-3 agencies may be involved in this process.Im the meantime, the client has gone in and out of the hosptial and services are still not in place! The process has got to be streamlined for crisis diversion plans. This process is not only impacting hospitals, it is impacting juvenile detention centers and jails.

Again, thank you for your assitance and attention. The stories of clients not getting services, not getting services in a timely manner or getting inadequate or disrupted services are endless.... talk to local ( non-administrative) staff.