Mental Health Reform - Jones: System will continue to improve services
By Matthew Whittle
Published in News on August 21, 2007 1:46 PM
Mental health reform has been a hard and controversial process -- a fairly indisputable fact, Eastpointe Director Ken Jones admitted. But he also said he believes the mental health system is improving.
"I know the reform process hasn't been easy, and I know there are clients falling through the cracks. But we took the model that was provided to us of what a local management entity (LME) should look like, followed it almost to a T, and now, I think we have a model LME."
The current problems, he explained, were caused not necessarily by bad ideas, but because of the speed with which the reforms were put in place.
"Everything just changed so quickly," he said. "But I have to believe it's going to work. If not, I wouldn't be here."
And with the General Assembly having just completed its legislative session this year, the mental health system finally looks as if it might be headed toward firmer ground.
"The mental health system has gotten a whole lot of publicity, good and bad, and for those reasons, our legislators paid attention," Jones said. "I do believe that they moved us in the right direction, and that with some of this legislation, there will be some improvements to the system.
"We got everything I was expecting."
Included in the new changes are a greater emphasis on crisis management, supported employment, in-home care, housing and provisions to place more control back in the hands of the LMEs.
Of those items, Jones explained, the two most important are the crisis management and the greater LME control.
The latter will give the local management entities more flexibility in spending state dollars as needed on the local level. It also directs the state Department of Health and Human Services Division of Mental Health to begin coming up with a set of statewide standards for all LMEs to resume authorization of Medicaid services by 2009, once Value Option's state contract runs out.
"That's a major plus," Jones said. "There have been a lot of services authorized by Value Option over the last year that we never would have authorized. They did not screen the clients as well as we would have. We know the providers, and we know the types of services they should be providing.
"We will be able to manage the client and the services much better."
By the end of September, they also will likely be dealing with a smaller number of community support providers -- those businesses teaching people with mental illnesses how to live more independently -- as they finish a series of post-payment and endorsement reviews of everyone doing business with Eastpointe.
Jones explained that he expects those reviews, the new service definitions and the recently lowered rates to weed out any remaining businesses not able to provide adequate services -- many of whom only recently got into the field.
"It's a process that I think has to happen," he said. "But I feel like we have a good group of providers, and if we do lose some, we've got some who can step up to the plate."
But that is about the only area that Eastpointe can afford to lose providers.
Psychiatrists and substance abuse counselors are both at premiums.
In the psychiatric field, there is simply a need for more full-time doctors, especially in Lenoir, Sampson and Duplin counties.
In the substance abuse field, the dearth of providers is a little more severe. The problem is that providers don't get paid if clients don't show up for treatment, and those in need of substance abuse help are notoriously unreliable.
The best provider group, however, Jones explained, is probably the one serving developmentally delayed patients.
"That is a very solid group of providers who have been around a long time. There also wasn't as much change in their service definitions," he said. "It was not the same type of change as the substance abuse and mental health populations."
Overall, though, as mental health reform continues and evolves, he is confident in Eastpointe's provider network, especially in Wayne County.
"In Wayne County, we are fortunate to have the number of providers we have, and we have some good providers here -- probably better here than in some of the more rural counties we serve," Jones said. "But just because we are in transition, the system is complicated and not everybody's used to it. There will be some clients who fall through the cracks."
But, he added, that's where the increased funding to crisis management services should help.
"We have a lot of clients going into crisis. At this point in reform we need to focus on crisis stabilization," Jones said. "We need that right now, more than ever. I think that will do more to stabilize the system than anything else, and then we can move onto the rest of the process."
And so for now, he's hoping the latest round of changes will be among the last.
"I believe we're in a period of time in which the system is fragile," Jones said. "I feel like our biggest problem was that there was too much change, too quickly. I'm not saying it was all bad, but it was too much, too quick.
"I believe, though, that the legislature has made some positive changes that will help stabilize the system and get us back on track over the next year."