A major shift in Wake County mental health services takes place Monday, when nearly 2,000 patients will be handed off from the county’s Human Services Department to doctors and therapists at private agencies and UNC Health Care.
The move is the latest step in a mental health overhaul effort that started in 2001, when the General Assembly aimed to trim costs by allowing private agencies to care for patients receiving services through Medicaid and other public funding sources.
Alliance Behavioral Healthcare, a nonprofit managed care organization, will oversee services for patients in Wake, Durham, Cumberland and Johnston counties. The change means most patients will be heading to different offices and seeing new doctors and therapists at their next appointment.
“We know this kind of thing is really hard for patients,” Peggy Terhune, executive director of Monarch Behavioral Health, a nonprofit founded 55 years ago in Stanly County. “Many have been seeing the same therapist for a long time and don’t like change.”
Monarch won a contract from Alliance to provide treatment for 1,100 of Wake County’s former patients, and staff members have been visiting Wake County Human Services offices to introduce themselves to them over the past few weeks. Monarch also opened its walk-in clinic on Whitaker Mill Road on June 17 to provide quicker access for new patients. More than 20 walk-in patients were seen in the clinic’s first week, Terhune said.
Monarch also has offices in Cary, Fuquay-Varina, Wake Forest, and Zebulon.
Terhune said about 100 of the patients assigned to Monarch have yet to be notified of the change because of incomplete or missing contact information in their files. “We have outreach specialists going out right now to try to find those people,” she said. “We don’t want to drop anybody.”
Similar efforts are being made by UNC Health Care, which will take on 500 Wake County patients and is assuming operation of WakeBrook psychiatric hospital, which was opened by Wake County in 2011 to serve mentally ill patients in crisis.
UNC’s participation in the new system is encouraging to advocates for the mentally ill, including Gerry Akland of the Wake County chapter of the National Alliance on Mental Illness.
“UNC has expertise that is world class,” Akland said. “Their clinical research will be incorporated right into the program. They can bring money to the table in a way that no other provider can afford. We are really excited about this.”
UNC therapists will be working with some of Wake County’s more “fragile” patients – those whose conditions are most severe or their medical treatment plans especially complex, said Jack Naftel, vice chairman for clinical affairs in the university’s psychiatry department.
Each of those patients has been sent a letter about the change and is being invited to an open house for patients and their families. Fifty of the new patients have already been seen by their UNC provider, Naftel said.
“We’re reaching out and trying to catch everybody up on what is happening,” he said.
Alliance has awarded several other contracts to agencies serving special populations. These include Hope Services for children; Triangle Family Services for sex abuse victims; Fellowship Health Resources for adults in the criminal justice system; Carolina Community Mental Health for clients needing family and group therapy; and Community Connections for those with mental retardation and other developmental disabilities.
The shift in care has cost Wake County Human Services about 220 staff positions. Some counselors were hired by Monarch or UNC, while others retired or were laid off.
Margie Sved, a psychiatrist working with Wake County for the past 12 years, is among those who will take early retirement. Sved said the Wake Human Services Department has worked hard to provide good services for mentally ill residents, especially as more patients wound up in the community after being discharged from the former Dorothea Dix psychiatric hospital in Raleigh.
The state began phasing out programs at Dix in 2001 with the intention of providing less-restrictive environments for mental patients as well as saving money through treatment in community settings. Dix housed about 400 patients at that time; the last of its residents were moved to Central Regional Hospital in Butner last year.
The deinstitutionalization efforts shifted mental health responsibilities from state institutions and mental health centers to local management entities, or LMEs, typically an office of local government charged with contracting with private agencies to provide care. Some LMEs worked well, and others proved to be “a fiasco,” Sved said.
State audits and other reports, including an investigative series by The News and Observer, documented at least $400 million in tax dollars wasted under the LME system, with private agencies billing for services that either were not needed or not performed. Meanwhile, patients with mental illness increasingly sought care in emergency rooms or wound up in jail.
With new legislation in 2011, the state began to switch from the LME model to managed care.
The county initially intended to create its own managed care organization, but that plan was rejected by the state due to concerns over a potential conflict of interest with millions of dollars flowing through the quasi-governmental agency, said County Manager David Cooke.
“So we had to get out of the mental health provider-of-service business,” Cooke said.
Cooke said Wake County will continue to contribute about $25 million annually for mental health services, the same as in recent years.
Alliance CEO Rob Robinson said his agency expects to bill Medicaid about $138 million for services to Wake County patients this year. The state is expected to provide approximately $20 million.
The total budget for Alliance is about $400 million, which includes patient services for Cumberland, Johnson and Durham counties.
UNC’s involvement in WakeBrook will help fulfill its commitment to open hospital services to help serve the crisis needs of mentally ill patients in Wake County, part of an agreement the university negotiated with nearby WakeMed. In return, WakeMed agreed to halt efforts to purchase Rex Hospital in West Raleigh, which is part of the UNC system.
UNC staff at WakeBrook will provide crisis care and patient assessments, in-patient acute care, sub-acute residential care, and substance abuse treatment.
Naftel said UNC also will enhance WakeBrook services by creating a step-down option for patients who are no longer in crisis and developing a medical unit that will allow patients to have their physical health care needs addressed while they are at WakeBrook.