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Over the past 15 years, the number of organizations that manage state and Medicaid funding for behavioral health has dropped from nearly 40 to seven. While reforms have shrunk the number of groups that provide access to those services, three panelists at a Carolina Public Press Newsmakers forum on mental health care Tuesday agreed that this has had both postivie and negative consequences.
The consensus: Many roadblocks still stand between Western North Carolina consumers and the mental-health services they need.
Christina Carter, chief operating officer for the Smoky Mountain Managed Care Organization; Sonya Greck, a senior vice president for Behavioral Health, Safety Net, Community Benefit and Project Re:DESIGN at Mission Health System; and Jack Register, North Carolina executive director of the National Alliance on Mental Illness, discussed changes to the way state funds and Medicaid dollars are disbursed and managed, the consolidation of the organizations that manage those dollars and problems with regulatory oversight, as seen in the case of a Buncombe County long-term care provider formerly known as Nutz R Us.
“Emergency rooms are inundated with people not knowing where to go,” Greck said. “We’ve done great things with our care for children and adolescents, we’re now growing more concerned about care for our older population.”
Patients who don’t know where to go to receive mental-health services, or whose mental illness makes accessing those services an insurmountable task, often end up in hospital emergency departments. Many of those patients are uninsured or underinsured, according to Carter, because of North Carolina’s decision to not expand Medicaid.
But Register said those short-term cases are only part of the picture.
“The system has transformed to where crisis service is the focus,” he said. “But mental illness is a lifelong issue. It can take 10 years just to get the correct medication balance. Services aren’t always designed for the long term.”
The panelists also discussed some of the issues that are particular to Western North Carolina, such as geography and a road system that make transportation a hurdle.
Greck said transportation “is a huge issue,” and also noted that communities lacking primary care physicians are a step behind other areas because patients there don’t receive interventions to identify early signs of mental illness.
The panelists uniformly denounced Nutz R Us, which changed its name to “Haywood Heights Family Care Home” shortly after a CPP investigation into the business in June. The company operates three family care homes catering to mentally ill adults in Buncombe County.
“I want to make it clear that this provider is not in the Smoky Mountain network,” Carter said. “We’re concerned about these consumers and their families. When there’s one agency like this, the whole system gets a bad reputation.”
The problems at Nutz R Us haven’t been limited to a name that could be seen as offensive. According to a previous CPP report, state inspectors “turned up a range of violations, including disgusting and unsanitary conditions in food areas and bathrooms, delays in building maintenance and lapses in patient services, including ‘forgetting’ the injections a schizophrenic patient needed to avoid hearing voices.”
In addition to the offensive name, CPP found evidence of at least one employee boasting about her contempt for residents on social media.
The Newsmakers event was hosted by sponsor Lenoir-Rhyne University Center for Graduate Studies in Asheville.