Saturday, January 24, 2009

Georgia 'Solons' get nervous about privatizing the public psychiatric hospitals : TAKE SOME TIPS ON MENTAL HEALTH FM YOUR NEIGHBORS IN NC

I was a licensed clinical psychologist in Atlanta for a few years and my family hails for many generations from that city. I am interested in what takes place within Georgia’s mental health care system. (The Atlanta Journal & Constitution is the only paper I've ever read that used that outdated word for legislators, 'solons'----words from a by-gone era replete with mint julips and driving Ms. Daisies.)

When reviewing NC’s difficulties associated with mental health reform, which was a privatization of outpatient mental health services and not the privatization of hospitals---such as Georgia seems to be considering----some lessons were learned. Instead of re-creating the wheel time and again, perhaps we can learn from each other.

It is not possible to make money off of caring for people with mental health challenges. Why? They mostly do not have any health insurance and what they have is Medicare or Medicaid or a combination of both.

They mostly cannot work and/ or they can only work part-time. Why? Because if they work more than a minimal amount, they lose their social security disability checks and probably their Medicaid and the psychiatric medications are expensive. Trust me: very few people can live on about $600/ month, the usual amount of a social security check. Oh yeah: you get Food Stamps and Section 8 housing.

If you wanted to free people with mental health challenges from being stuck in this place of poverty, they would have health insurance and their subsistence social security checks and they would be allowed to work as much as they could.

It’s the same problem as associated with the Veteran’s Administration system: if a veteran has been able to obtain a service connection, which is to say a monthly check based on the severity of the health matter incurred while in the Armed Services, if they get significantly better, they run the risk of having it removed or reduced. I saw some pretty amazing attempts to portray schizophrenic symptoms when I was working at the VA Birmingham. This is not to say that there are not persistently, seriously ill mental health problems of vets who are cared for by the VA.

So, if you are going to privatize the public psychiatric hospitals, while it may look good on paper in the beginning, what will not have been taken into account is the nature of the population that is utilizing the service.

Neither will the background information have been taken into account, specifically, ‘what will I lose if I get better’---- which could also be termed the ‘secondary gain’ of remaining ill.

This means that privatizing psychiatric hospitals will go bust and/ or the churn created in the mental health system will be so great that the hospitalization rate will increase (as it has in NC since privatization efforts began in 2001) and then you will have a situation like you have in NC. Related to that churn and burn-out of people working in the mental health hospitals in NC, 3 out of the 4 public mental health hospitals, such as you have in Milledgeville, GA, have lost their CMS (Centers for Medicare and Medicaid Services) accreditation and the only fall back is for the state to pick up the tab to the tune of approximately $2 million/ month.

If you want to pay MORE for mental health care and want to see the mental hospital system collapse (just about the time that the next governor comes in), you definitely need to move down this path.

The goals behind NC mental health reform were associated with these main tenets: 1. we want mental health services to be available to everyone; 2. we believe that competition will provide more efficient services; and, 3. we want clients or consumers to have a choice about their mental health care.

From what I understand about Georgia’s consideration of privatization of the public mental health hospitals, it is simply an attempt to get some other sucker to pay for mental health care of indigent clients while they go back to the state legislature via well-paid lobbyists, with their hands open, bleating demands for more money and blackmail of, ‘you don’t want us to go bust, do you?’

In NC, in the beginning of privatization of outpatient mental health care services, this is what happened: the state funded clients (the ‘working poor’ without even Medicaid or Medicare) could sometimes get mental health care but as the system became more and more stressed related to the truckloads of money that were flying out of the coffers of the state, their choices were minimized or severely curtailed. Private providers ‘buddied up’ in order to create their own referral networks. More money was spent.

When the NC State Legislature put into place privatization of outpatient services----in an attempt to service more citizens (in NC these are known as ‘state funded’ clients or the ‘working poor’, with no health insurance, not even Medicaid or Medicare)----there was no efficient way to create a private provider infrastructure.

Moreover, the Secretary of the Department of Health and Human Services for 7 years, Carmen Hooker Odom, excelled in writing memos that contradicted each other such that the private companies could never depend on what was going to take place next. There was no well outlined vision, replete with actuarial tables and expectations. Instead, what took place was a dog-eat-dog provider race to consume the mental health dollars made available.

Competition is only useful if there is something desirable to be competing for.

Nevertheless, it is incorrect to state that ‘400 million dollars was wasted’ as related to NC mental health reform movement. This money was associated with the providing of Community Support Services, a Service Definition sloppily created by NC DHHS under Governor Easley, that allowed and condoned practices which today have been judged to have lead to spending by the private provider companies who were trying to get up to speed as they learned the ropes which were put in place by NC DHHS. If you don’t want money to be ‘wasted’, then you need to anticipate what the problems might be given the framework you have suggested.

Dear Georgia, take a tip from your neighbors to the north or you are doomed for a whole lot of misery : an initial big ‘hurrah’ as you think your system is surely working; increased mental health hospital admissions; increased expenditures; accelerated jailing of people with mental health issues; clandestine deals made by the private psychiatric hospitals who care not a whit about bettering the health of Georgia citizens; then a long, constant stream of newspaper articles outlining the entire mess until you will be quite convinced that it was a very very bad idea after all. But hey! The next governor can deal with all of that.

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Article of reference:

‘Privatization may not be the Panacea’, DHR budget presentation moves from total privatization, gives few answers to tough questions by Daniel McDonald http://www.unionrecorder.com/local/local_story_023220201.html

1 Comments:

Blogger Derek Bullard said...

Ms. Hammond,

Not sure if you read the minute from WHN's last few board meetings. Of particular interest, especially with our poor economy is that the CEO of Western Highlands was recently given a 5% salary increase in December. In addition, it appears they approved a $300,000 Grant/ Loan ? to Families First.

This week, as I'm sure you are aware they made more substantial cuts to consumer IPRS benefits in an effort to save almost 2.0 million dollars.

I find it offensive that with people losing jobs, mental health vastly underfunded, that their CEO would take a salary increase.

I wonder how many WHN employees have taken a salary decrease? Was this even considered before cutting benefits to consumers?

We no the answer to that question. See minutes of Board Meeting on WHN Website

11:05 PM  

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