Wednesday, November 12, 2008

Macon County Mental Health 2008 Report : surmountable barriers but will the Macon County Mental Health Task Force tackle them?

Macon County Mental Health Task Force, June, 2008:

What are the Barriers to mental health care in very rural Macon county in western NC?

"Barriers identified during this survey included: Stigma, income/poverty, lack of integration of mental and physical health services, shortage of mental health professionals, need for funding of community based prescription medications and psychological service programs regional disparities, and cultural diversity."

All of these Barriers can be tackled fairly quickly but I guess it means they have to get into a fight w/ SMC LME because SMC LME does not offer Basic Level Services. I submit that SMC LME does not offer Basic Level Services as they want to protect Meridian from an influx of other professional mental health providers.

The main complaint from any and all non-Meridian providers under the SMC LME catchment area is that the paperwork is killing them. Of course its killing them. that's because SMC LME must require professional providers to submit the 5x lengthier Person Centered Plan instead of the Basic Level Services Person Centered Plan.

see WHN link, cut and paste:
bulletins/Communication_Bulletin_73.doc :

Western Highlands Network
Communication Bulletin #73
January 11, 2008

Basic PCP Usage

Western Highlands Local Management Entity (LME) has modified its current policy around the use of the Basic Person Centered Plan (PCP). With this change individuals that receive only Basic Benefit services require only the 4-page Basic Benefits Service Plan. Should the individual's needs warrant utilization of Enhanced Benefits Services, the 13 page Person Centered Plan (PCP) must be completed by the Qualified Professional (QP) through a person centered process.


An associated article on that Macon County task force matter:

Funding, local control needed
Snow: State needs to stay the course of mental health reform

Special to the Cherokee Scout

Tuesday, November 11, 2008 8:05 PM CST

"Local control

However, Macon County Commissioner Ronnie Beale, also a Smoky Mountain Center board member, remains concerned that there isn’t adequate local control.

“The system needs to be less complicated and have more local involvement,” Beale said. “Our needs may be different from Rutherford County, which may be different from Wake County. And with local input and local control, you have to have the local funding.”

In a unique move, Macon County took aggressive steps this year to help ensure its involvement in the state’s mental health system. In June, a commission-appointed board, formed at Beale’s request, released a report by the Mental Health Taskforce on Mental Health Services in Macon County....."


These are the Barriers as outlined by the Macon County Mental Health Force Task, summarized in June, 2008:

1. shortage of mental health professionals : (they had 26 mental health professionals show up for a meeting in January, 2008, as associated with their concern; imagine all the others that did not come to the meeting wwwaaaayyyy out in rural Macon county).

2. psychological service programs regional disparities : this is associated w/ the numbers of professional mental health providers. I imagine that it was proclaimed to be a separate category, for instance, in that substance abuse, in particular, seems to be dependent on an organized program which is probably in short demand in this very rural county w/ a spread out populace.

3. cultural diversity: professional mental health providers supposedly have some significant training as associated w/ the matter of cultural diversity. Certainly for psychologists and the American Psychological Association, you cannot pick up a publication without running into matters associated with this issue.

4. income/ poverty: this was supposed to be what the state funded client system and NC mental health reform was about. In that it is not attending to these people, I'm afraid I lay the blame squarely at the feet of SMC LME and its clinical arm, (since McDevitt spilled the 'official' beans---as he's leaving anyway)Meridian Behavioral Health, headed by retired employee SMC LME, Joe Ferraro. Meridian contracts w/ SMC LME to provide ALL the state funded clients' mental health care. Sad fact is, they do not. There are many providers, such as myself, who have fought tooth and nail to obtain authorizations and reimbursement (read: get paid) to see state funded clients. That's right: the professional mental health providers who VOLUNTARILY and WILLINGLY went to the houses of the state funded clients----for no extra money than the regular pay for a therapy session----threw in the towel after years of trying to weave our way thru the morass of the SMC LME authorization trivia. We gave up!

5. need for funding of community based prescription medications : there are several ways to tackle this:

a. Meridian houses a company associated w/ obtaining discounted bulk medications which may or may not be part of Meridian but is frequently used by patients. These are MAILED to the house of the patient.

b. Every medication is associated with a pharmaceutical company. Every pharmaceutical company has a service---online---wherein one can print out a document which can be sent to the pharmaceutical company so that the patient can receive deeply discounted medications. This must be signed by the prescribing provider.

c. India and Canada have discounted medications to be had, in bulk.


SMC LME's Utilization Review Department, headed by Charles Barry, requires, as per SMC LME non usage of Basic Level Services e.g., therapy/ medication management----and instead their usage of Community Support Services (CSS), which is constantly being defunded----that mental health providers sit thru 20+ hours of unpaid, unnecessary training in order to offer professional mental health services in accord with their licenses.

If you want to remove the biggest barrier to professional mental health care under the SMC LME catchment area, this matter MUST be tackled. These are some suggestions:

1. Ask NC DHHS's Department of Mental Health, co-directors, Mike Lancaster or Leza Wainwright, to allow SMC LME to release professional mental health providers from having to go thru 20+ hrs of CSS training----when they are not offering CSS.

Tip: SMC LME will not allow this to happen. Why not? Because they have a 'special relationship' between themselves and Meridian which effectively blocks professional mental health providers from working w/ state funded clients within SMC LME's catchment area.

Tip: Western Highlands Network saw the need for Basic Level Services (duh)and therefore created a much smaller amount of paperwork.

2. Ask NC DHHS's Department of Mental Health, co-directors, Mike Lancaster orf Leza Wainwright, to make SMC LME offer Basic Level Services.

Tip: this won't happen either. Why? Because by putting all the therapy services into the CSS basket, professional mental health providers outside of Meridian are blocked from working w/ state funded clients. Besides, this, as per mental health reform (law or not, I do not know; I suspect law), the LME's have been allowed to tailor their services as associated with what they perceive to be the demands of the populace of their catchment area. Maybe this will change w/ McDevitt gone. Maybe this is an extension of the 'conflict of interest' waaaayyy beyond any real estate matters associated w/ his wife or the hiring of his daughter by SMC LME. If I were a good reporter, I'd want to know how someone had profited from this 'special relationship' w/ Meridian, headed by the retired SMC employee, Joe Ferraro.


3. OR, the various counties associated and stuck w/ SMC LME could DEMAND that Basic Level Service be made available in order to free up professional mental health providers.

Tip: Guess what will happen. Steve Puckett, PhD, the Clinical Director at SMC LME, will then go over all the Person Centered Plans, as he did w/ mine, in an attempt to keep throwing back the plans so that the state funded clients do not get services and thus Meridian will be protected.



Post a Comment

<< Home