Sunday, December 16, 2007

What are the differences between Basic Level Services & Community Support Services for state funded client?

Thank you for your TV coverage as associated with the myriad problems re: NC mental health reform.

As a provider, I would like to direct your attention to some matters which might create some detail re: your reporting. Some background material can be found at my NC Mental Health Reform blogspot where you will find a great deal of detail information as well as letters to pertinent people within DHHS, as well as their responses.

Here is a map of all the LME's:

A significant amount of the problem, I think, is this: the Local Management Entities (LME), which primarily manage state funded clients authorizations and payments (the LME's are regulation entities), have a variety of ways of managing these funds for state funded clients. Medicaid and Medicare clients are fairly well taken care of so I do not believe that the people of whom you spoke on your program have Medicare or Medicaid.

The clients which your news program covered are probably state funded clients.

Who are state funded clients? They are the 'working poor.' They are people w/o Medicaid/ Medicare, or 3rd party insurance. They are increasing in numbers. They are people who are between jobs or w/o jobs. They are people over 21 but not yet 65 who have not have the gumption to wind their way through the disability system, if they have mental health issues. As you may know, in NC, as indicated by this past week's NYT's article, NC's diability process now takes up to 3 years.

I will give you a case in point and that client is not dissimilar to the ones you have featured on your TV show: a 26 yr old woman, married, w/o children, involved in the mental health care system even as an adolescent re: history of abuse in the home where her mother re-married to a very abusive man, and the client was severely beat. Other forms of abuse were also present.

As is not uncommon, in an attempt to re-create reality, the client went on to become dissociative (multiple personalities is the earlier way Dissociative Identity Disorder was described), w/ associated depression, rages, and self-harming.

This client is a state funded client, w/o Medicaid/ Medicare/ or any insurance of any kind and her husband works at low-paying factory jobs which are associated w/ not infrequent lay-offs.

This is what the client needs: outpatient psychiatric med follow-up and outpatient psychotherapy on a weekly basis w/ more frequent psychotherapy if there is decompensation associated w/ self-harming. This is what 'best practices' would recommend.

This is what Smoky Mountain Center LME (SMC LME) will allow: outpatient psychiatric med follow-up and heavily regulated psychotherapy.

What does 'heavily regulated' mean? It means the re-creation of 20 plus pages of paperwork every several months; it means calling the ACCESS center at SMC LME in order to speak w/ one person who is working w/ me on this client (she is frequently not there); it means I have been paid for less than half of my therapy rendered----at the client's home; it means no answers forthcoming from SMC LME re: services which were mandated by DHHS in June, 2007 but which only some LME's choose to offer.

What services am I talking about? Psychotherapy services for state funded clients are only to be had as associated w/ 2 different formats:

1. Community Support Services (CSS)
2. Basic Level Services (BLS)

What are these services? CSS includes everything from emergency services on the part of the provider e.g., calls in order to manage crises, to skill building, to outpatient therapy.

BLS includes only 2 things: psychiatric medication management and outpatient psychotherapy.

Why do some LME's refuse to advantage state funded clients to CSS?

1. CSS is being heavily managed by DHHS and Hooker Odom curtailed a significant amount of these services in April, 2007.

2. CSS is being 're-written' to allow psychotherapy to be provided by non-professional people e.g., CSS workers (see the new Service Definitions for CSS on the DHHS website in order to have an overview of what is taking place)

BLS is only provided by some of the LME's. It is not clear to me how many refuse to offer BLS. Smoky Mountain Center (SMC) LME is one. It is now the largest, in terms of counties, covering mental health services for state funded clients in NC (see the map). Western Highlands Networkd (WHN) LME is the other western NC LME and does offer BLS.

What are the advantages to psychotherapy being offered as a BLS?

1. well trained professionals are utilized, rather than CSS workers who only need have a high school education. Thus, the LME's and citizen/ clients obtain better services for their dollar.

2. psychologists and other professionals are not required to sit through 20 hours of CSS training which is completely unrelated to providing psychotherapy. This allows providers to do what they are trained to do rather than jump thru an unnecessary hoop which is a barrier to the rendering of services.

Your story, I believe, could benefit from some detail about state funded clients and how they are being served in your area, which is associated with Wake LME, I believe. The LME's main job is to manage state funded clients' services.

Thus, your story is about the mis-management of state funded client services, I believe.

And the details, in part, are associated with the understanding of the various services and who provides them.

Sincerely, Marsha V. Hammond, PhD
WBTV, Charlotte, covering mental health crisis in NC: December, 2007

A Closer Look at Mental Health in North Carolina There is a mental health crisis in North Carolina. This week, Eva Nelson was charged with shooting a Burke County deputy while attempting to serve a mental health commitment order. A few weeks ago, Selena Shiuli's children were stabbed inside their Charlotte home. Police said Shiuli fatally stabbed one child and the other one is still recovering.Advocates for the mentally ill say funding cuts and statewide mental health reforms mean there are not enough services to go around.When sick patients don't get the help they need, people around them get hurt.The two largest mental health facilities in the state are facing major problems. The Broughton facility in Morganton is always full and Dorothea Dix in Raleigh is closing next month.This puts more pressure on emergency rooms and law enforcement.What can be done and who should take the lead? How much will it cost each of us if these people are not properly treated?It is estimated that mental illness affects 1 in 5 families in America.The estimated economic cost of untreated mental illness in the United States is $100 billion annually. During our 5:30 newscast Thursday evening, we interviewed Bob Ward who is a public defender in Mecklenburg County. We wanted to get some answers to these and other questions concerning North Carolina's mental health crisis. Press "PLAY" to see this interview. Story Created: Dec 13, 2007 at 5:39 PM EST Story Updated: Dec 13, 2007 at 9:11 PM EST found at: can make your comments to:


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