Friday, June 20, 2008

The Monster We Have Created Called Mental Health Reform

The Monster We Have Created Called Mental Health Reform

By Marsha V. Hammond, PhD, Licensed Psychologist, NC

Almost 200 years ago, a 19 year old woman, Mary Wollstonecraft Godwin, was holed up with her to-be husband, Percy Bysshe Shelley, at Lord Byron’s place outside of Geneva, Switzerland. Like many others, instead of hiking during that summer of 1815, also known as the "Year Without a Summer"---due to the volcanic explosion of Mount Tambora far away in Indonesia--- these writers made a bet as to who could create the scariest story.

And so Mary, daughter of Mary Wollstonecraft, who wrote in 1792, "A Vindication of the Rights of Woman", wrote the first science fiction novel. Her famous mother had died birthing her. The daughter then created with pen and paper the famous monster so well portrayed by Boris Karloff in 20th century Frankenstein movies. While they did not realize it, Mary’s creation was due, in part, to pollution and self-imposed isolation. Day after day during this sunless summer, she envisioned something fantastic and unique, with a transportable theme.

In her book, Victor, the mind behind the monster, a well educated man also harboring a desire to create life, created something living, though out of odd body parts that didn’t exactly fit together. As you know, the monster was horrible to behold and in his loneliness, the monster demanded that Victor create a companion to relieve his loneliness and alienation.

Time moved along, the monster had his own life, and things took place----as they do----such that Victor became convinced that the monster which he has created had murdered another human. The heat was on Victor to do something and so he spent years tracking down his creation in order to destroy it. This, understandably, sucked the wind out of Victor and the story ends with the monster standing over the dead body of Victor full of remorse, sadness, and loneliness.

In the waning days of the 20th century in NC, advocates of privatization within the state legislature as well as consultants and key personnel in NC Department of Health and Human Services (DHHS), under the supervision of Governor Easley, were captivated by the idea that mental health treatment might be an avenue for reform which might even kick-start privatization of health care across NC. Blue Cross/ Blue Shield NC (BCBSNC), a non-profit insurance company, overseen by the state legislature with a CEO earning three million/ year, and basically the only game in town outside of Medicare and Medicaid, was undoubtedly pleased with this idea.

There had been some spotty problems associated with the providing of mental health services in the state and these creators believed that a better system could be had out of the various usable parts associated with the community mental health centers which had been the on-the-ground, community based settings for the provision of emergency as well as mundane mental health services.

The stirrings of life for this new project gave optimism to the project and mental health reform was created legislatively and made manifest over the course of seven years under Governor Easley.

NC DHHS, under Secretary Carmen Hooker Odom, wrote the Service Definitions which were the blueprints for how mental health services were to be provided to the "working poor", state funded clients. A new service, entitled Community Support Services (CSS), would replace Community Based Services (CBS), commonly and previously provided to developmentally disabled citizens. CSS would fold into its Service Definition federal mandates which denigrated ‘hand-holding’, instead requiring citizens to be ‘rehabilitated.’ Never mind the chronicity of mental health issues.

In fact, CSS was seen as such an exciting avenue for taking mental health care directly to the citizens who would---or better----- undoubtedly step up to the plate of their responsibilities, serving the dual tenets of privatization as well as usage of non-professional mental health workers, admittedly to be supervised by professionals, that accolades abounded. Criticism was seen as unwanted, spiteful, inappropriate, and even corrosive to the creation of this new endeavor which had all the earmarks of a successful enterprise. Reporters were leashed; critical opinion pieces by psychiatrists, psychologists, and other mental health workers, were not accepted. Secretary Hooker Odom cut ribbons across the state associated with various new projects.

The years wore on and the discombobulation entitled NC Mental Health Reform veered off the road and hit some potholes. A few people got killed at the indirect hands of this monster.

Seeing the carnage of expenditures, Secretary Hooker Odom lamented loudly in March, 2007, about the bad apples amongst the private, Endorsed Provider companies whom were obviously over-utilizing CSS. Post payment reviews were created and the LME’s, wolfing down a great deal of the mental health dollars just to operate and oversee the Endorsed Provider companies, became the whipping boys for the Secretary. Endorsed Provider companies collapsed as they had paid their employees and themselves and the money was basically gone/spent/ used up.

The public stirred as advocates and excluded mental health professionals spoke out. Secretary Hooker Odom got out of town without having to repair or kill the monster. The professional organizations who were supposed to be representative of the professional mental health providers whistled past what was sure looking like a stinking corpse, alluding to the fact that the monster had been in circulation so long now that there was no going back. Peeeyeww!

Unlike the creator in Mary’s novel, no corrective moves were made until it became obvious that CSS was being vastly utilized, particularly as there were no longer any professionally driven, basic, mental health services, to speak of, any longer. When the massive, shocking bills came due in March in March 2007, with the state legislature, seeing their re-electibility as hoisted on the petard of the expenditure of this bits-and-pieces CSS, this magnificent creation then became the monster to be tracked down (don’t lose your life, your job, or your elected seat over it, of course).

Forays deep into the forest were made by the co-chairs of the Joint Legislative Oversight Committee, Verla Insko (D-Orange) and Martin Nesbitt (D-Buncombe). Though they didn't come back dragging the corpse, this legislative committee and their champion overseers, resurfaced with pieces of the monster’s shirt; they demanded to know by January, 2009, why so much of the money was being returned to the state as associated with the non-use of previously professional rendered services.

Stay tuned; there’s always a sequel.


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