The mentally ill in North Carolina will have less access to care as the state makes dramatic changes to save money in the recession.
The budget approved by the legislature Wednesday cuts about $40 million, or 12 percent, in mental health treatment for people without other insurance. The cuts come despite the state's goal of providing more treatment to people where they live.
The cuts and changes rip holes in an already-weak mental health system, advocates say. They predict it will be harder for poor people without insurance to get community mental health care, and more could end up in emergency departments and jails.
Other changes are under way:
The legislature is phasing out a mental health service called community support, low level services to help people with mental illnesses or addictions to gain skills, such as how to manage bus schedules or a household budget, or to help a child stay out of trouble in school. Lawmakers are cutting money for the service and eventually will replace it with one that has not yet been developed.
The state will reduce spaces in group homes for children and adolescents, with plans to start a new program of high-intensity therapeutic foster care. Local mental health offices would work harder to return children to their homes, enrolling them in high-level services. Some children would be eligible for admission to community psychiatric treatment centers.
These new services have not been tested or approved by the federal government, which must OK all services paid by Medicaid.
The $40 million reduction to aid for uninsured patients surprised patient advocates.
Michael Murray, director of the Disability Action Network, an advocacy group, said such a cut could lead to more admissions to state mental hospitals, patient pileups in emergency rooms and more mentally ill inmates in jail.
"I think there's the potential for overcrowding in places they don't need to be," Murray said. "They can't stay in the least-restrictive environment because of the lack of support."
Doomed to repeat it?
The state does not seem to have learned from its failed efforts to improve mental health care, said Frank Edwards, a co-president of the National Alliance on Mental Illness' Wake County chapter. Programs and policies should be tested before they are launched, he said.
In 2001, a state mental health reform resulted in increased short-term stays in hospitals and expensive, poorly monitored care in local communities.
"They didn't plan it well then, they're not planning it well now," Edwards said. "That really does honestly scare me."
Legislature 'being forced'
The legislature has no choice but to make changes, said Rep. Verla Insko, a Chapel Hill Democrat who helps run an oversight committee on mental health.
"The problem is right now, we're being forced into this," she said. "We don't have the option of taking a lot of time doing in-depth planning. What we can do as an alternative is watch very closely and be ready to make adjustments."
The cut in community support, the basic mental health service, will be particularly hard on rural patients, said Barry Graham, chief operating officer at Advantage Behavioral Healthcare, which provides the service.
Rural counties don't have the therapists with advanced degrees that the more intensive community care programs require, Graham said. That leaves community support, Graham said, which legislators have targeted for cuts because of past financial abuses by providers.
A News & Observer investigation last year found that the state had wasted more than $400 million on community support in less than two years. A recent legislative report said the state wasted even more.
Cuts will hurt patients, Graham said, while companies committing fraud will find a way to survive.
"They are the ones who will suffer from reform," he said of patients. "A crook will find a way to beat the system."
Hospital pay increased
One of the few significant increases in the mental health budget is $12 million to allow the state to pay local hospitals that agree to short-term treatment for mentally ill patients.
Last year now-Gov. Beverly Perdue campaigned on how she would handle the mental health system, promising accountability and a focus on rural and underserved areas. She promised to develop mental health courts, programs that seek to keep mentally ill people out of trouble. She also said she would improve care by creating "centers of excellence" at colleges and universities. There's no additional money for courts in the budget and no mention of "centers of excellence."
Perdue's spokeswoman, Chrissy Pearson, pointed to the money that will open more local hospital beds as evidence of Perdue's attention to improving care.
With money from past budgets, the state was able to reserve 75 local hospital beds, according to DHHS, though 19 fell into disuse at the end of June because the budget had not passed.
The new $12 million will increase the number of beds to 175, said Lanier Cansler, secretary of the state Department of Health and Human Services.
"The concept of trying to have enough beds to keep people in the community is a solid concept," he said. "The goal is "having the beds at the community hospital where people don't have to travel across three or four counties to get care."