The main provider of mental health treatment in Orange, Person and Chatham counties is cutting most of its services in the region over the next six weeks.

Caring Family Network provides psychiatric services, outpatient therapy and a community support mental health service to about 1,500 clients and employs 75 workers in the three counties. It has been the main provider of such services in the region for 18 months, taking over outpatient therapy that the public regional mental health office used to provide. The public mental health system is used primarily by people on Medicaid and others without insurance.

The regional mental health office was required to stop treating patients and hired Caring Family Network to do its old job.

Sean Schreiber, development director for Carvaka, the company that provides management services to Caring Family Network, said Caring Family Network cannot continue the services under rates paid by the state. The network intends to end its outpatient services and community support services at the end of February and would stop seeing psychiatric patients in mid-March.

The company, a private non-profit with a division office in Durham, will keep its therapeutic foster care homes in the region.

Caring Family Network has offices in Chapel Hill, Roxboro, Pittsboro and Siler City. An additional office in Hillsborough is open two days a week.

Schreiber and Judy Truitt, director of the Orange-Person-Chatham mental health office that hired the company, said they were looking for other providers to fill the void that will be left when Caring Family Network moves out. They are also talking to other companies about hiring the displaced workers.

"This is a very big transition, and we're going to do everything we can do to make it work out for everybody," Truitt said. The goal is to have companies in place by the time Caring Family Network closes its doors. "We're certainly moving toward that," she said. "I'm not going to guarantee that."

The local office and the company will work to see that the neediest patients get treatment from other companies first.

A fragile, unworkable system

The volatility in the mental health system worries doctors and other mental health workers.

There's a flaw in the assumption "that private companies can be financially solvent and provide good, quality care in a system where there's not enough money and not the prospect for more money in the future," said Dr. John Gilmore, a psychiatry professor at UNC. "The whole system needs to be rethought."

Caring Family Network signaled last year that it would have trouble staying afloat in the region after the state cut the rate for a mental health service called community support from about $61 an hour to $51.28 an hour. The company did much of the work that the former public mental health office did -- outpatient therapy and psychiatry visits -- where it is hard to make money. It used the profitable community support services to help make up the losses, but it had trouble covering costs after the rate cut.

Caring Family Network took the hardest patients to reach and serve, Schreiber said. He described the company's job as "almost an impossible task."

Other providers that tried to act just like the old mental health offices found they couldn't survive, said Flo Stein, chief of community policy at the state mental health division.

Truitt said it was a mistake to ask one company to replace the public mental health office, which served patients who did not have insurance and whose treatment was paid with state money.

"In today's world, that's not a workable system," she said.