Public mental health services

Public mental health services (Full Version)

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erieangel -> Public mental health services (3/26/2012 11:11:11 PM)
After reading and commenting in a few other threads about depression and one posters' probable need of psychiatric services, I thought the issue of public mental health services deserved its own thread. Public mental health refers to those agencies that are not-for-profit and receive local, state and federal funding to cover the majority of their operating costs. For the poor and people on Medicaid, sometimes the public mental health system is the only way to obtain the help which they need. And if somebody is poor but not poor enough to qualify for Medicaid, services can still be obtained through funding directly from the county of residence. This is called (where I live) "Base Funding". Every county in the US has a public mental health system. In Erie County, PA, where I live, the mental health office is combined with the public mental retardation office within the Dept. of Health. From talking with others across the state of PA and across the country at various conferences throughout the years, I would say most people could contact their local health department to find out where to go. Other resources could be NAMI (I actually don't agree with many of their advocacy efforts) or a local Mental Health Association. Prior to 1996, when Congress passed and Clinton signed a bill to allow private insurance companies to handle Medicaid claims, and the subsequent farming out of mental health coverage to secondary insurers, all funding to local, public mental health agencies was administered by the counties. Today, most of the money is coming from the insurance company which the county pays to administer the monies and payment is received only after services are provided. As a former recipient of public mental health services and a current employee of a mental health service provider, I've seen both sides of the coin and I liked things much better before the insurance became involved. Prior to 1996, the county office received local, state and funds which they in turn allocated to the various mental health and mental retardation agencies based on the number of people served for each program. Now, payment is done after services are provided and some programs simply did not fall neatly into this model, which meant those programs had to be slashed. I mean how do you bill an insurance company for an acting group which put on 2 plays a year in a theater donated by a local college? It didn't matter that the acting wasn't about acting at all, but about improving self esteem, learning how to speak before a large group and socializing with others. The insurance company said there were other ways (based on the medical model) of accomplishing those objectives. Prior to 1996, agencies were left pretty much alone to do what they do best--treat people who were in mental and emotional suffering. Today everything that is done must be justified by a treatment plan, if it isn't on a treatment plan, the insurance company doesn't pay for it. As a co-worker once said with snark: 'Your dog died and you really don't want to do anything expect talk about your dog...sorry that isn't on your treatment plan, why don't we work on job search skills instead.' I've become fairly proficient in writing treatment plans that will cover almost anything that might come up. Recently, there was a death that affected two of my clients (what are the odds that estranged brothers, one who'd been put up for adoption, the other having grown up primarily in foster care would find themselves living at my facility within a week of one another and their birth father dying 2 weeks later?) I was able to help them sort out how they felt and to deal with the father's second wife not wanting them at the funeral, by having had put on their plans vague stuff about dealing with depression and anger and learning positive coping strategies. Back in the days when the public mental health system truly was public, there'd have been no worry about what or what was not on some treatment plan. When a mentally ill person is suffering due to some unforeseeable accident (as my clients had been 2 weekends ago) they'd be given whatever aid was necessary and a note made about the services provided. These days it is all about justifying each and every contact with a client so that the not-for-profit agency can collect their money from the for-profit insurance company which is making a fortune from the tax payers.

LafayetteLady -> RE: Public mental health services (3/27/2012 12:40:33 AM)
Sad, isn't it? It is like the "Behavioral Health Facilities" that are around here. They really offer no treatment other than "stabilization of medication and discharge." Some beaurocrat just can't see the logic in actually finding what the cause for many of the patients problems is. The concept that finding the cause might mitigate the need for medication makes no sense to them. Go figure. Likewise for these outpatient "support" groups. Patients meet once or twice a week, sit in a circle and a "counselor" asks each what "number" they are that day. There are no discussions about coping, life skills, how to alleviate anxiety. Nothing. If a patient mentions difficulties in these areas, they are encouraged to go in patient to "get back on track," but there all that will occur is evaluating and changing medication. Group homes? They essentially end up being nothing more than a place where several mentally disabled adults share a home with a full time counselor that is nothing more than a "house mother" who makes sure they don't burn the place down and hands out their meds. In NJ, you can't find any mental health professional that takes medicaid. If you want to use the services you suggest, you are put on a waiting list, unless you are deemed a danger to yourself or others. So depression won't be treated for months unless you are suicidal, at which point, of course, you are then hospitalized, given medication and then discharged. This is one of the areas where healthcare in this country is in need of a serious overhaul. Imagine how being able to obtain the necessary mental health treatment would positively affect those on SSD, and the homeless...

KMsAngel -> RE: Public mental health services (3/27/2012 2:51:23 AM)
treat the issue rather than the symptom? how revolutionary! how ridiculous! how dare you suggest that money be paid out for help when it's not determinable that it is necessary? what a waste of money! snark off someone i know closely has depression, anxiety attacks and a family history of possible manic depression. her male GP will get her to scale her coping ability, how long she's been feeling depressed and then perscribe meds. no querying of what meds she's tried already, what the core issue is that started the anxiety and depression, no follow up on supposedly required counselling, follow up for adjustment of medication if it's not working, what her coping methods are that haven't worked, what counselling she may or may not have received already. her female social worker asks the pertinent questions, signs her up for counselling for those issues, gives her a break from job searching and makes herself available. after she'd been on the social workers casebooks for several months, she started looking for jobs on her own (wasn't legally required to at that point), interviewed about 2 dozen times, accepted a job and has worked there approx 2 months so far, and started a course that will hopefully help her in her further job searching. treat the core. mental health is controllable and treatable. get them feeling better so they can go back to work, so they can earn taxes and become more productive citizens. oh, btw, i live in one of those countries that has socialised medicine - the only thing she pays for out of all of the above? medications. and that is heavily subsidized while she's on a mental health pension...

erieangel -> RE: Public mental health services (3/27/2012 2:59:57 AM)
I spent some on the Erie, PA county mental health/mental retardation board as well on the advisory counsel when the insurance company first came into the county to "deliver" services. Why some politicians think privatization improves services is beyond me. We actually have pretty good services here in Erie, except for the wait times at the outpatient clinics. But I do believe the quality of the services, not to mention the variety of treatments, has suffered with for profit companies being in charge of essentially doling out government funds. I recovered under the old system. Without the services I went to, the community center where I learned to socialize again (I needed a social coach to get started even), the choir called Baracka (means "blessed" in some African language) and the acting troupe called "Stepping into the Act", that recovery would have taken much longer. And a few months before the community center closed, I took charge of the food pantry. Staff had to approve of the foods I ordered from the food bank and made the pick up, but I kept inventory, did majority of the ordering and passed out food bags. I work residential, group home if you'd like, and sometimes I feel like nothing more than a glorified babysitter. I don't pass out meds, though. The guys are all adults and as such, they are responsible for their own meds. If they need help, another service either delivers the dosages on a daily basis or helps with "med packing". I do living skills, everything from daily household chores to cooking to job searching. I find it ironic that I teach these guys how to keep house when I've never been so great at keeping my own house clean. And you wouldn't believe some of incompetence I've faced. I had one guy shortly after I started who didn't even know how to put sheets on his bed. He told me he'd never had sheets, just a pillow, blanket and bare mattress. That guy didn't last long in our program. He found the demands that were placed on him to promote recovery were too much, referred the program and me personally as being too strict, aggressive and overbearing. My boss and I were both happy to see him leave when he decided to go back to mom's where he could sit on his fat butt all day, play video games and collect SSI. Not that I have anything against people who get SSI, I was on it for 15 years; but there are those who try and fail and those who simply don't try. The age group I work with, 18-24, is far too young to give up. As to overhauling the public mental health system...when the debates started about health care reform first started, I pointed out to a lot of people that the public mental system has been around almost forever and for the most part it works just fine. More problems have started since the for profit insurance companies have become involved. Combine that with the constant budget cuts year after year and agencies are finding their operating capital shrink more and more. At the same time, with the insurance companies involved, there is much more oversight and consequently more regulation than when agencies here were funded totally by the county. Things have gotten so bad that two years ago the agency I work for had to totally close the Therapeutic Support program. This is a program that many people have benefited, including people I know and in one month they lost that support. And last year, the insurance company (only one company oversees mental health care in each county of PA) claimed to have made an overpayment to the agency. Rather than fight a prolonged court battle, the agency return over $200,000. As a result, they also had to lay off 25 administrative personnel. These are the secretaries, claims officers and even supervisors. Direct care, which is what I do, was not affected that time, but they are talking more lay offs in July if Corbett's budget is passed in which direct care will be affected. What really makes me sad is that people's lives are at stake and the politicians don't seem to care. Neither do the insurance companies. Even while there are budget cuts at the state and federal levels, the insurance companies demand more and more of the ever shrinking pie and all they do is deny service when they can, tell us what treatments are "acceptable" and billable, tell us exactly how the paperwork has to be done, continuously give us more paperwork and dole out the portion of tax payer money they are not keeping for themselves. Overhaul the public mental health system? Yeah, make it truly public again. Erie county knows what the mentally ill in Erie County need, not some insurance company based in AZ.

angelikaJ -> RE: Public mental health services (3/27/2012 6:19:53 AM)
quote: ORIGINAL: LafayetteLady Sad, isn't it? It is like the "Behavioral Health Facilities" that are around here. They really offer no treatment other than "stabilization of medication and discharge." Some beaurocrat just can't see the logic in actually finding what the cause for many of the patients problems is. The concept that finding the cause might mitigate the need for medication makes no sense to them. Go figure. Likewise for these outpatient "support" groups. Patients meet once or twice a week, sit in a circle and a "counselor" asks each what "number" they are that day. There are no discussions about coping, life skills, how to alleviate anxiety. Nothing. If a patient mentions difficulties in these areas, they are encouraged to go in patient to "get back on track," but there all that will occur is evaluating and changing medication. Group homes? They essentially end up being nothing more than a place where several mentally disabled adults share a home with a full time counselor that is nothing more than a "house mother" who makes sure they don't burn the place down and hands out their meds. In NJ, you can't find any mental health professional that takes medicaid. If you want to use the services you suggest, you are put on a waiting list, unless you are deemed a danger to yourself or others. So depression won't be treated for months unless you are suicidal, at which point, of course, you are then hospitalized, given medication and then discharged. This is one of the areas where healthcare in this country is in need of a serious overhaul. Imagine how being able to obtain the necessary mental health treatment would positively affect those on SSD, and the homeless... In Massachusetts group homes for the mentally ill are run substantially differently. They work very hard on stabilizing people : getting them on the right meds and working on both their coping and life skills with the goal that they will be able to move out on their own and be a contributing member of society. Once they are out on their own there is a case manager and independent living coaches who provide a high level of supports.

ShaharThorne -> RE: Public mental health services (3/27/2012 6:25:59 AM)
Eire, I am bipolar as well and receiving SSI. As long as I get my meds, I am happy (Depokate and Geodon). I am also under treatment for pain management as part of my fibromyalgia. I do receive both Medicare and Medicaid because my SSI checks are below average. My MHMR consider me high functioning so I don't do group therapy but I do see the counselor and the NP every 3 months. One of my goals is to become a peer support specialist. I feel that I have reached that level and I want to give something back to the community in helping out. I will approach this idea with my counselor on the 16th when I go see her. Perhaps the facility needs one but don't have the funds or the personnel to do it. I hope they will help me out on it.

erieangel -> RE: Public mental health services (3/27/2012 6:36:10 PM)
quote: ORIGINAL: ShaharThorne Eire, I am bipolar as well and receiving SSI. As long as I get my meds, I am happy (Depokate and Geodon). I am also under treatment for pain management as part of my fibromyalgia. I do receive both Medicare and Medicaid because my SSI checks are below average. My MHMR consider me high functioning so I don't do group therapy but I do see the counselor and the NP every 3 months. One of my goals is to become a peer support specialist. I feel that I have reached that level and I want to give something back to the community in helping out. I will approach this idea with my counselor on the 16th when I go see her. Perhaps the facility needs one but don't have the funds or the personnel to do it. I hope they will help me out on it. Your counselor should know what you would have to do or with whom to talk about getting on the list for one of the next trainings your county sponsors. When I did my peer specialist training, the county MH/MR screened applicants, these days it is done through a program with the local mental health association. Or go to your office of vocational rehabilitation, in some states, the counties have stopped paying for the trainings and turned the screening and costs over to OVR. Either way, the trainings are fully subsidized in most cases. I took my training on short notice when another county had some openings. Erie County MH/MR paid for my transportation, lodging and meals. But the trainings are few and far between because there are only 2 agencies in the country that do trainings--1 out of AZ, the other out of Philly. If you're good at regurgitating facts, aren't shy about self-disclosure and can pass a couple simple tests, you should be fine for the 2 week training. My next goals are to become a WRAP facilitator, which my employer doesn't want to pay for because I can already do WRAP 1 on 1 and take my CPRP exam. My boss happens to be encouraging the CPRP and it will mean far more future job opportunities as well as a raise in the job I currently have. ETA: CPRP= certified psych rehab professional

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