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Adventures in mental health reform 

My brother has schizophrenia and lives in North Carolina (outside the Triangle). For the past few years, he has been going to his local mental health center for treatment. Recently, my mom called me for advice because I am a social worker with many years experience working in public mental health.

Mom became concerned after calling the center to confirm my brother's appointment and was told, "Oh, that doctor is gone." My brother now has to come in to "do paperwork" before he can see a new doctor. She also says there was an article in the paper about the local mental health agency "closing." I remind her about mental health reform and "divestiture." I read the article on the newspaper's Web site. It says that the mental health center is "closing its doors" and names the private company who is taking over services--a company I have not heard good things about.

I decide to call the county's "Local Management Entity" (LME) to see what's up. Under the state's reform plan the LME is responsible for overseeing services rather than providing services.

Me: "My brother has been a client at the mental health center for several years ... I understand that Private Company A has taken over services..."

LME: Interrupts and announces somewhat proudly, "No, not just Private Company A, we have a choice of five different agencies."

Me: "This is for an adult ..."

LME: "Oh ... that would be Private Company A or Private Company B."

Me: "... and he needs medication."

LME: "Well ... that would be Private Company A only, and they are swamped. He may have trouble getting an appointment."

Me: "So how about private providers? I went to your Web site and they all seemed to be children's agencies."

LME: "Yes, the private providers don't like to take Medicaid because of the high 'no show' rate and all the paperwork. I know one doctor who takes Medicaid, but I don't know if he's taking new clients."

Me: "Is the LME recruiting more private psychiatrists?"

LME: "Well, I have a list ...(gets off phone to look for list ... can't find list ...) They gave us a list but it wasn't much help. I know most providers on that list don't work in our county anymore."

Me : "Hmm ... it sounds like there's not much choice then."

LME: "Yes, we'd love to have more providers, but they don't want to take Medicaid with reimbursement rates so low and high 'no show' rates."

I find the phone number for the one private psychiatrist she knew who takes Medicaid. His secretary tells me, "He is taking new patients, but not new Medicaid patients." So ... in the course of five minutes we've gone from a "choice" of five agencies to one agency that "is swamped" and a non-existent list of private providers. I'm afraid that may essentially sum up the empty promises of North Carolina's mental health "reform."

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