Wednesday, January 16, 2008

Smoky Mountain Center LME's 'perfect storm': the big pile-on: YOU SHOULD HAVE LISTENED SOMETIMES TO THE PROFESSIONALS

my comments to Julia' Merchant's article on mental health care problems in western NC:

The state of mental health careA fractured system is in danger of breaking down completely, leaving officials wondering — how did it get this bad?By Julia Merchant • Staff Writer
Smoky Mountain Center LME Could Have Done a Better Job with Outpatient Services

I have seen clients for 4 or 5 years associated with the catchment area of Smoky Mountain Center (SMC) LME.

In the article by Julia Merchant, the Director of SMC LME, Tom McDevitt, a very bright, capable man, acknowledged that it has been much more difficult over the past year or two, to get people admitted into the psychiatric hospitals. It is inferred and assumed that outpatient therapy, if rendered dependably and by professionals, will address issues that might have lead to hospitalization. NC DHHS formally created these services, Basic Level Services, consisting of psychiatric medication and follow-up and outpatient therapy, in June, 2007. SMC LME does NOT offer Basic Level Services.


Mr. McDevitt outlined the notion of outpatient therapy as being perceived as the stop-gap measure such that people would require less inpatient treatment.

Bear in mind that SMC LME, like the other LME's in NC, does not deal with Medicaid or Medicare clients in terms of authorization and payment. They attend, mostly, to state funded clients.

I know the people who work for the LME and have observed them for a few years now, as NC mental health reform came on board. They are hard working people who care deeply about mental health matters.

This is not intended to slander their good efforts; however, I would like to state that SMC LME has morphed into an entity that has irresponsibly managed its state funded clients, the 'working poor' (those w/o Medicare/ Medicaid/ or third party insurance) as regards outpatient services.

Some of the 'why' as regards this matter appears to be associated with the strategy that SMC LME adopted several years ago which was to create a capitated contract (I assume it is capitated which means that the agency is paid a certain amount and no more, regardless of how many patients are seen) with Meridian Behavioral Health Services.

Meridian was founded by a retired, former employee of SMC LME. Meridian created cohort (similar people, not professionals) driven services called WRAP services for state funded clients.

Its a great idea! It allows the sharing of information and the upgrading of psychosocial skills for those with mental health challenges. It takes place in a group therapy format. This being said, neither is it a substitute, when necessary, for professional intervention on an outpatient basis.

My speculation is that because of this relationship with Meridian, providers, such as myself, who were referred state funded clients by the ACTT team (the most severely, persistently mentally ill clients are seen by the travelling ACTT team, which has a psychiatrist)---who were perfectly willing to work with state funded outpatient clients---- even to the point of seeing them in their homes----were locked out of being able to provide outpatient services as SMC LME's Clinical Director, Dr. Puckett, kept trying to drive the state funded clients into Meridian's Recovery Education Program----the group therapy format, managed by non-professional, minimally trained, cohorts.

Why did he so persistently try to drive the clients away from outpatient therapy, causing me to write into the Person Centered Plan, even though not requested by the client and even though the client couldn't even get to Meridian?

Specifically, SMC LME has made it so difficult for providers such as myself to work with state funded clients, providing outpatient therapy, that I, for one, have simply thrown in the towel and will not work w/ their state funded clients-----which is the population which they assumably manage.

When I attempted to hammer on the matter of the difficulty of working with state funded clients in terms of rendering outpatient therapy, in the client's home, far away from any town or city, I received nothing but requests to submit more and more paperwork. Not just a little paperwork but Person Centered Plans whose usual length is 15-20 pages. There is no pay for creating this paperwork.

I was threatened with audits. It was suggested by Charles Barry, the Quality Management Director, that I was acting 'unprofessionally.'

When I was able to obtain outpatient therapy authorization (read: I could get paid) , a brief burst of outpatient therapy services would be authorized; then one or two months later, I'd have to do the whole thing again: calling up the ACCESS Center, speaking to a particular person who was frequently not available (no point in talking to anyone else as they would simply direct me back to that person).

Our relationship became so contentious that it was wiser to simply stop seeing any SMC LME state funded clients.

When I attempted to inform the SMC LME CFAC (Consumer and Family Advisory Committee composed of consumers and/ or family members of consumers) of the difficulties of working with SMC LME pertaining to my state funded client, they told me to send my comments to a staff member who would give these to the SMC LME CFAC members. I was able to find the business address of the chairman of the board of SMC LME and I sent him my concerns.

I have never heard a single thing from SMC LME CFAC or the chairman of SMC LME Board, and when I pressured Leza Wainwright. Mike Moseley's deputy in the Division of Mental Health, she was able to finally get SMC LME to post on their website minutes from the CFAC meetings. What was revealed was that very few members of the CFAC even attended meetings.

Admittedly, SMC LME serves a very wide geographical area. However, by law, the LME must create a system such that the CFAC is functional. A few people showing up does not look very functional and moreover, absolutely no response from 10 plus mailings to various members of the SMC LME CFAC is evidence that the SMC LME CFAC basically does not function.

This means that the LME does just as it pleases.

Forgive me if I am a little irked by SMC LME's personnel statements about how difficult it is to get consumers mental health beds when they decompensate without access to outpatient services.

What I would really like to know is just how much money in terms of contracts has been consumed by Meridian Behavioral Health Services as associated with their (assumably) capitated contract to service state funded clients under SMC LME catchment area? How does that amount of money compare to funds that Western Highlands LME (there are only 2 LME's in western NC) utilizes to provide Basic Level Services to state funded clients?

If you want my opinion, SMC LME chose a format to address state funded consumers mental health concerns via its (assumably) capitated contract with Meridian which, while neat and tidy and in accord with Mr. McDevitt's accountant training, was not a substitute for professional outpatient services and now that the 'perfect storm' of Broughton's difficulties are upon them, they want to pile on regarding NC mental health reform's tawdry performance record.

You should have listened to the mental health professionals, SMC LME. Ditto for NC DHHS.
Marsha V. Hammond, PhD: Clinical Licensed Psychologist


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