Judge orders mental health service for child

Case spotlights needs in rural regions

Four-year-old Kyle Collier, diagnosed as autistic and bipolar, needs therapy to help him cope with his oversensitivity to light, touch and sounds.

Kyle is not toilet trained; he kicks, hits and bites when his daily routines are disrupted or when he is in a room with all fluorescent and no natural light. He needs summer enrollment in a center to teach him skills that will make it easier for him to continue living with his family in rural Harnett County.

But Kyle's mother, Orbie Etheridge, said she has spent more than a year trying to find long-term professional help for her youngest son outside school. An agency in Fayetteville is working with Kyle, but it has not been able to arrange all the specialized help he needs.

"I found myself completely alone and frustrated," Etheridge said.

That was until a judge ordered Dec. 22 that the state must get Kyle the help he needs.

"The state may not fail to provide a medically necessary service to a Medicaid-eligible child because it is too expensive, not listed in the state plan of services, or difficult to provide," Administrative Law Judge Fred G. Morrison Jr. wrote.

Kyle's case highlights the lack of specialized mental health services for children in the state's rural communities. A consultants' report in December on the state's mental health system put in writing what has been known for years: Rural areas get the least service.

The state Department of Health and Human Services may reject Morrison's order. A department spokesman said Mike Moseley, head of the state's mental health office, had not seen the order and could not comment on it. If DHHS decides not to go along, Kyle's attorneys could ask for a state Superior Court review.

Etheridge, however, hopes Morrison's order not only will force the state or the local mental health office to get Kyle the help he needs; she hopes it ends up helping other rural children, too.

"If we can make any difference at this point, it would be a wonderful change," she said.

The local mental health agency, Sandhills Center, agreed that Kyle needs the therapy. It's just that what Kyle needs isn't easily available.

Statewide changes in mental health care, in which local governments gave up providing direct care in favor of private agencies, are the reason Kyle isn't getting what he needs, his attorney Lewis Pitts said.

"The so-called mental health reform has been deformed," Pitts said. "They're not making the services available for high-need kids."

Michael Watson, chief executive officer at the Sandhills Center, the local mental health office that covers Harnett, did not want to discuss Kyle's case. But problems with getting highly specialized services to rural areas aren't related to the mental health changes instituted in 2001, he said.

"The issue is: Can you put together a package of services; can you create a specialized program for one person?" Watson said. "How do you deal with distance? We're into issues of distance and availability, which is very difficult."

Morrison's order says Kyle should have occupational therapy in the afternoon, so he can stay in school at least until 1 p.m. In the summer, Kyle should have day treatment at a place no more than 45 minutes from his home.

A few years ago, Pitts sued the state on behalf of a teenage boy in the mountains over the lack of crisis care near his home in Fletcher, south of Asheville.

Pitts, a legal aid lawyer in Durham, sees a thread running through the cases -- the lack of rural mental health care for children.

"We're going to keep taking them one at a time," he said. "We're trying to get someone to listen."