Wake, Orange risk losing funds

Local mental health offices fall short in providing follow-up care, state report says

Only half the patients discharged from state mental hospitals received follow-up community care, a new report says.

Five mental health offices around the state could lose millions in state money for failing to make sure former hospital patients receive ongoing treatment.

At stake is nearly $1 million that goes to the Wake County mental health office and about $400,000 to the office that covers Orange, Person and Chatham counties. Those offices are in danger of losing their responsibility for ensuring follow-up care, along with the money.

State reports show that those offices are below the state average for getting patients from mental hospitals into community treatment.

"They have until the end of the month, or we will be taking action," said Leza Wainwright, a co-director of the state mental health division.

Administrators in the Wake and Orange offices say more people receive follow-up care in their areas than the records show.

The state uses Medicaid spending to track patient care, and that misses people whose treatment is paid for with county money, said Crystal Farrow, head of the Wake mental health office. Wake has been talking with the state for months about getting more accurate counts.

"I'm pretty confident that reasonable people will be able to take a look at it and say Wake consumers are seen at at least the same rate as consumers across the state," she said.

The local administrators said they did not expect their money to be cut at the end of the year because it takes months to collect and evaluate information collected.

Connecting patients to community care after they leave hospitals is a key to getting the struggling mental health system to work as envisioned. The effort is stymied by a lack of psychiatrists, a shortage of beds for psychiatric patients at community hospitals and a lack of intensive mental health programs meant to serve the sickest people.

A report by a legislative office responsible for evaluating state programs exploded a commonly held assumption that community care helps keep people out of hospitals.

The report looked at care given to patients in 2007 who were hospitalized at least once in 2006. People who received community services were more likely to be rehospitalized than those who did not receive ongoing care.

Carol Ripple, a program evaluator, said it's likely that the most unstable patients who needed at least one return trip to the hospital were also receiving community treatment.

Most of the patients receiving community treatment are in "low-intensity" programs, such as the skill-building program called community support. Only about 54 percent of patients receiving community treatment saw a psychiatrist.

The information used to track patient treatment has limitations, Ripple said. One of her recommendations was to have the state mental health division use electronic health records, which could improve care when patients move between hospitals and private providers.