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Oh. Well then... who's in charge?

No one is in charge. Ultimately we are each in charge of ourselves only. There is no actual hierarchy of authority, there is only acceptance or non-acceptance of the idea-symbols of others.

First, I would like to thank the News and Observer writing staff for following this story. As a mental health professional, I must say that it is time the problems with the Community Support definition are exposed.

I agree with some of the arguments presented by Ms. Mary Ellen Anderson. However, I disagree completely that cutting rates is a good idea. In fact, I think it would be catastrophic. Everyone would suffer including the mental health client especially.

I see these problems as a function of economic theory.

My solution arguments are as follows:

1) PUBLIC PROGRAMS FUNDED BY PUBLIC DOLLARS SHOULD BE EXECUTED BY PUBLIC PROVIDERS. Mental Health services are funded by the public through Medicaid tax dollars. However, the choice by the state to privatize services was partly done with the economic belief that a free market would enhance competition and therefore enhance efficientcy and mental health services. Neither has happened as evidenced by the failure in question. I believe this failure was due in part to the fact that mental health is NOT a consumer driven industry. Public dollars allocated to private providers leads one to ask the question: "Who is the ultimate customer?" The client or consumer? Mr. Joe or Ms. Jane Taxpayer? or how about the Medicaid system administrators since they are the ones who allocate the funding? To the client receiving services, he or she is economically indifferent to chosen providers. For example, if I don't like the taste of Big Mac burger at McDonald's, I can go across the street and spend my money on a Burger King Whopper. Even though state laws promote consumer choice and freedom, most mental health clients simply are referred to private providers upon in-take and they have no reason to question the quality of service rendered. Why? Because it is a free service to them. Medicaid recipients are not paying for their service, the taxpayer is. The old adage "its much easier to spend someone else's money than his own" rings true in this case. To the provider, these quesions are irrelevent. Providers in a free market are primarily interested in profit maximization from a business perspective. I would like to think that most providers out there have a mission to provide high quality mental health services and many of them in fact do. However, the problem is that in a business sense, the client is just a consumer and revenue is generated by Medicaid payments. Therefore, I conclude that any good or service that is publicly funded tends to breed inefficiency especially when demand exceeds the supply. Providers end up not competing for consumers but end up competing for Medicaid dollars.

2) GET RID OF ALL (OR AT LEAST MOST) OF THE BUREAUCRATIC RULES AND REGULATIONS THAT PREVENT PROVIDERS FROM GETTING PROPERLY PAID. As a case manager, I write many treatment plans. I have witnessed payback situations where providers do not get paid for services due to a treatment plan that has simple logistical errors on it (i.e. name mispelled, obvious date left out such as birthday of a client or a blank not properly filled in). The problem is that most providers have too many clients to serve and too little time to make sure that all the I's are dotted and T's are crossed. People are human and they make mistakes. In my opinion, Medicaid will try to find every little excuse not to pay for services so as to save money. Bureaucracy increases and the ultimate quality in mental health services decrease. They decrease because providers are spending too much time trying to make sure that they are following the rules to the T so as to get paid instead of "running the business and providing the service" The client therefore cannot receive the service. I have witnessed firsthand of not being able to provide a good service to a consumer because of red tape. Therefore, I think what also happens is that it is too tempting for providers to provide medically unnecessary services "in bulk" with the hopes of making more than the expected paybacks for not properly following a bureaucratic rule (a loss in this case). By no means am I implying that authorizations for services are not important but I believe that there are too many to keep track.

I like to think that I provide a good service to a client in need of such service. Therefore, I think more focus should be on consumer satisfaction who received mental health services. I believe more focus should be placed on surveys of providers completed by consumers. These surveys can be mathematically analyzed through statistical means to determine if a provider is not doing their job.

3) ANY IMPLEMENTATION OF PUBLIC POLICY IN A FREE MARKET WILL CAUSE "THE LAW OF UNINTENDED CONSEQUENCES." Simply put, any changed law that involve finances will affect the free market. Ms. Anderson suggested cutting Community Support costs. This is a bad idea because providers, as profit maximizing firms, will only try to make up the loss by increasing productivity. Remember, the price of service is fixed in this case. Productivity is billable time for services rendered. Revenue is billable hours X service rate. This in turn will cause more strain on direct clinicians resulting in higher turnover and higher costs for labor. Labor is probably the most expensive variable and fixed costs a firm incures. This in turn will cause the provider to look for new ways to make up any losses which leads to more inefficiency.

I totally agree with Mental Health services are funded by the public through Medicaid tax dollars.People are human and they make mistakes. In my opinion, Medicaid will try to find every little excuse not to pay for services so as to save money.
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sanjeeda
Addiction Recovery Rhode Island

Addiction Recovery Rhode Island

It is a very good website because it is very informative for users and viewers................................ Addiction Recovery West Virginia

It is very important for patients to consult doctors and avoid self medication.

Addiction Recovery West Virginia

I am new visitor to this site. I like this site. I really agreed to mental health reform. It gives good information to our society. Every one have a mistake in fat someone are mentally mistaken. After the good treatment they will come to the previous stage. I think society is the main thing for mental depression. Our government conducts any public programs for the reformation of mentally depressed persons.

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Bless

Addiction Recovery South Carolina

A lot that is not going well in America today is the result of greedy CEOs who leave "their" company with millions stolen from the company, yet the NC legislators turned a CMH Center system, that was working well, except for turn over being high from low pay in many areas (the pay varied greatly from area to area) to greedy private interests!

It should be noted that almost all Mental Health professionals in private practice received their practical experience at the Community Mental Health Center, under the supervision of Psychiatrists and experienced psychologists (I have 30 plus years at CMHCS and other state agencies), social workers, counselors and addiction counselors. It is these experienced professionals that were never asked if the system needed changing and how or how much.

Yes, the professionals providing the services were not asked.
I have worked as a therapist and director in SC,Fla. and NC
and I can tell you the CMHC system in NC was the most effective of all three and provided the most quality services from children to the elderly and everybody in between.

The standards for licensing in NC is so rigid that many qualified and very competent Mental Health professionals were eliminated from working at MH Centers. Now there appears to be very low standards. The standard for the Community Mental Health Centers, which started in the 60tys under President Johnson, was that no one could be turned away. And no one was at the centers I was employed.

Some services were contracted out to private resources: group homes that frequently closed down after a few years because of all the crisis the private providers could not cope with and private inpatient services; etc.

If the state wants it done right, this time create a state board of consumers(includes families), MH professionals and
business professionals. Return mostly to the system (it will cost to initially repair the system) of public non-profits centers and controlled and reasonable salaries, with work goals(this already existed). Tie the system in much closer with the state health and pension system and state standards. Some services would be contracted as it is demonstrated to be appropriate.

For the last 3 decades states (Tenn.'s made a mess)have tried to fix a system that was not broken, with the myth that "private" (means private interests and not public interests is the energy source) is "cheaper". None have been changed truly because the intent was to make it better.

Who suffers from the ineffective changes? The children, families and adults, who desperately need these services.
The US military is now finally working to make sure there are services for our returning soldiers who repeatedly are called back to a wasteful(money and soldiers) war, who need emotional support and treatment that includes the need for family support and treatment. Hopefully the state of NC will not be as slow to recognize a severe need as the US government was.

I don't mean to pick on your argument, because you are making a valid point. I just wanted to point out a minor dicrepency. The Community Support worker, or as the state calls them, Paraprofessional does none of this. The Qualified Professional, formaly known as the Case manager in the old system, submits paper work on behalf of the Person Served. Also, Intensive In Home services are seperate from community support. An assesment is done first and foremost before anything (hours) can be authorized, and this is what is so time consuming. Yes, there is a problem with the way services must be accessed, because the process is much too long. I believe the main problem is the state dropped the ball. They thought it was a good idea, and just let people run with it. No one thought to monitor or train any of the providers to make sure they were doing things correctly. And to make matters worse, they allowed people who had not experience in the field whatsoever, to start these provider agencies and bill fraudulently; all the while not knowing how to implement services correctly. For those of us who are legetimatly trying to provide a quality service for the health of others, most were treating it as a profitable get rich quick scheme; and believe me plenty of people did get rich quick. It's sad, because I understand what they were trying to do, they just didn't execute it properly.