Friday, April 11, 2008

Is there a shortage of mental health providers in Western NC: (avoid the red herrings on the menu)

The red herring created by Smoky Mountain Center LME :
Mental Health Provider shortage in western NC?

Smoky Mountain Center (SMC) LME's administrative staff, Tom McDevitt, Doug Trantham, and Steve Puckett, PhD, have been cited in the Smoky Mountain News as outlining a shortage of mental health providers in their catchment area. Admitting to a "lack of a broad range of services", with Dr. Puckett indicating that there are "a smaller menu of services....they may get a more generic service”, is to elude the problem.

Basic Services, created in July, 2007 by NC DHHS, consists of psychotherapy and medication management. This is the spine of mental health care. Period.

However, SMC LME, with its rather unique single stream funding of funds, specifically created by the NC State Legislature-----so that they can move their money around to where it is needed----does NOT provide Basic Level Services. Maybe there is a reason but I don't know it.

The clients don't need a greater array of services, rather, they need a greater NUMBER of the generic services, which are not available at SMC LME.

At SMC LME, after the basic and preliminary 8 therapy sessions--- all that's allowed by NC DHHS--- therapy services can be obtained to some degree but they are housed under Community Support Services (CSS). The pay is less, the paperwork is greater, and the personnel who provide the therapy under CSS must receive 20 plus hours of unpaid, non-essential to the matter of therapy, training.

You guessed it: this necessarily draws fewer professional providers (gosh, we're short on providers).

I personally am owed over $1200 by SMC LME associated with a state funded client, in the most severe category. As I refused to spend my professional time sitting in 20 plus hours of CSS training, I was refused payment. Prior to that, the Quality Management Director threatened me with an audit if I would not put up with non-paid, 20+ hours of CSS training.

I severed my relationship with SMC LME.

I always wondered by this LME could not express itself to NC DHHS and point out these kinds of difficulties. Contrarily, SMC LME seems to have mastered the 'its not our fault' stance.

Besides this significant barrier, SMC LME, as Western Highlands Network (WHN) LME, will not authorize (pay) for more than 8 therapy sessions/ year/ state funded client. NC DHHS determined this.

SMC LME will pay for therapy under CSS after Dr. Puckett goes over the PCP, insisting that the client move progressively more into peer support services provider (only) by Meridian Behavioral Health Services, directed by a former employee of SMC LME.

More therapy sessions for the WHN LME client is on the way but only under the guidelines created by NC DHHS as associated with Dialectical Behavior Therapy (DBT), a psychoeducation model of therapy (one hour/ week/ 3 mos/ state funded client).

Nevermind that good therapy, as associated with the treatment of personality disorders, which are rampant and associated with depression, folds in DBT; it does not stand separate. Yet, NC DHHS has created this non-generic DBT category of something that looks like therapy, for personality disorder clients.

No, rather than an array of services, NC DHHS created a menu of choices and then when you asked for the item they decided they had run out and shut down the kitchen.

Please amuse me again about just why SMC LME bemoans the fact that there are fewer and fewer providers for needy clients in western NC. The providers cut bait after losing money and went elsewhere.
associated article in the Smoky Mountain News:

"Help for the sufferingA lack of trained mental health professionals means there isn’t always enough care to go around" By Julia Merchant • Staff Writer


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