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State implements new mental health care requirements

BREAKDOWN
A series on Mental Health Care in NC

This story is a follow-up to a series about mental health care in North Carolina. To read the previous stories in this series, go to carrborocitizen.com/main/breakdown/

By Taylor Sisk
Staff Writer

Reiterating his pledge that the failed 2001 reforms of the state’s mental health care system are “done and over,” Secretary of Health and Human Services Lanier Cansler has now implemented the department’s long-awaited new model of services provider.

The new Critical Access Behavioral Health Agencies, or CABHAs, are intended, Cansler said, to offer a full spectrum of mental health, developmental disabilities and substance-abuse programs under a single umbrella agency.

“The CABHA program is designed to place greater emphasis on a solid clinical and medical basis for mental health services and to assure and monitor that services that were overused in the past are better managed and controlled,” he said.

Out of more than 600 applicants for CABHA certification, 175 have been approved by the Department of Health and Human Services (DHHS). Twenty-five of those approvals are for agencies that will serve Orange, Person and Caswell counties.

Agencies must provide comprehensive clinical assessment, medication management and outpatient therapy. Additionally, they must provide two services from a list that includes intensive in-home care, community support team, child and adolescent day treatment, psychosocial rehabilitation and substance-abuse outpatient treatment.

Though there are some exceptions, agencies generally will not be able to continue receiving federal and state funds without meeting these requirements.

According to DHHS, CABHAs have been designed to begin the move to a “more coherent service delivery model.” The intention is to ensure that critical services are based on a comprehensive clinical assessment and are offered by a competent organization with appropriate medical oversight and the ability to deliver a full array of services.

Yes and no
The CABHA approach has drawn support from among the state’s mental health care professionals and advocates.

Judy Truitt, director of the OPC Area Plan, which is responsible for the oversight and management of services in Orange, Person and Chatham counties, said that OPC has “always been blessed with a strong, clinically sound provider community and that has only been strengthened by the establishment of CABHAs.”

John Gilmore, codirector of the UNC Center for Excellence in Community Mental Health, which has offices in Carr Mill Mall, said that he is supportive of Cansler’s efforts to “put quality clinical care back at the heart of North Carolina’s mental health system.”

“Strong and active medical leadership is critical for the agencies that we entrust with the care of North Carolina’s citizens,” Gilmore said, “especially in a time of tight budgets and hard decisions.”

At a Jan. 7 DHHS press conference, Debra Dihoff, executive director of the National Alliance on Mental Illness North Carolina, said, “NAMI NC is here because we support moving towards greater stability and quality in the provision of mental health services in North Carolina. And we believe the move to establish Critical Access Behavioral Health Care Agencies will do just that,” adding that, “we will remain vigilant – unintended things happen when major changes are put into place.”

Others are more concerned.

State Sen. Ellie Kinnaird, who represents Orange County, said, “I’m very worried about the CABHAs. They create one more layer of bureaucracy.” Kinnaird advocates a return to having services delivered directly by local management entities, such as OPC Area Plan, as was the case prior to reform.

“I’m for giving money directly to the LMEs.” Kinnaird said.

She’s also worried about what will happen to mental health services funding in general when the incoming legislature assembles, calling the new Republican-controlled House and Senate a “wild card.”

Truitt, too, is concerned about the long-term financial viability of CABHAs “given the fiscal realities of our system.” 

Truitt said that building the infrastructure required of a CABHA creates significant financial pressures on agencies at a time when “they are likely facing reductions in available funding from the LME, as well as possible overall reductions in rates for Medicaid-funded services.”

Bebe Smith, codirector, with Gilmore, of the UNC Center for Excellence in Community Mental Health, believes that CABHAs have the potential to restore quality treatment to the state’s mental health care system. Smith questions, though, whether they will be committed to work with individuals with particularly challenging issues and if they will be able to provide care for the uninsured and the underinsured.

“We have come to rely quite heavily on Medicaid funding,” Smith said, “and there are many people with significant mental health issues who do not have Medicaid.”

Yet another concern comes from smaller providers, who say that CABHA requirements are prohibitive and that the vetting process for certification is, in the words of Angela Annas of Annas Resources, a Chapel Hill mental health care provider, “arbitrary and unfair.”

“The state is not a good judge of quality,” Annas said.

For David Cornwell, executive director of the advocacy organization N.C. Mental Hope, the primary problem with the process was that input from individuals receiving mental health care services and their families was largely ignored. For that, he said, “DHHS and its divisions should be ashamed.

“CABHA is yet another in a steady stream of fixes over the past decade that has meant continuous disruption for provider agencies and their clients,” Cornwell added.

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