Legislators respond to mental health shortfalls
As The Smoky Mountain News wraps up an ongoing series on the state of mental health in North Carolina, state lawmakers were asked to weigh in on funding cuts and their thoughts on what the General Assembly can do to improve the flailing system.
Two freshman representatives — Mike Clampitt, R-Bryson City, and Kevin Corbin, R-Franklin — both said their first term in office has included an eye-opening education when it comes to the many complex issues surrounding behavioral health and substance use funding.
“It’s complicated. I’m not going to sit here as a freshman legislator claiming to have all the answers,” Corbin said, adding that what he does know is that real solutions aren’t going to come unless society as a whole changes the way it thinks about mental health and drug addiction.
“With the stigma of mental health and substance abuse, as a society we don’t look at it as we should — as an illness that needs to be treated,” he said.
As he makes the rounds in the district, Clampitt said he too is becoming more aware of the ripple effect the mental health and substance abuse crisis is having on communities.
“I’ve found out recently we have a contagious disease spreading in Western North Carolina because of drug use — hepatitis — so we’re working on getting a needle exchange program started for Swain,” Clampitt said. “This is a national health crisis across the board. We have generations involved with opioids and we can’t legislate our way or incarcerate our way out of it.”
While a majority of legislators recognize there is a problem, there is some disagreement over the best course of action. Meanwhile, local behavioral health providers in the region are making deep cuts to services to combat the funding cuts filtering down from the General Assembly.
Trickle down cuts
The Republican-majority state legislature in 2012 changed the way mental health services are provided. Instead of having a local organization in each county to directly receive state funding to provide services, seven regional Management Care Organizations throughout the state now hold contracts with the state government to manage state funding allocated for mental health and addiction services.
These “middleman” type agencies then assess and approve funding or reimbursement for services to providers in their region. Vaya Health is the MCO responsible for managing behavioral health care in the 23 WNC counties, but the agency has had to deal with $14 million in state funding cuts over the last two years. Local providers like Meridian Behavioral Health Services and Appalachian Community Services are bearing the brunt of these cuts and are in the midst of making tough decisions regarding which programs and services they can continue to provide to people who are covered by Medicaid, are uninsured or underinsured.
Providers want to know why a middleman organization — that doesn’t provide any services — eats into the limited pot of money to pay for administrative costs before it’s filtered down to the actual therapists and social workers providing treatment programs.
According to Vaya’s proposed 2017 budget, the MCO’s personnel costs account for over $41 million of its total $408 million in expenditures. About $36 million of the personnel costs are for salaries and benefits. Vaya representatives said they are also preparing for another $400,000 in cuts in the 2018-19 state budget — that’s in addition to about $31 million in non-Medicaid dollars cut from Vaya’s funding between 2009 and 2015.
The MCO system was put in place to have more efficient state oversight, but Corbin and Clampitt wonder if the regional middleman approach is the most effective way to distribute funds for mental health.
“It’s a valid point with Vaya if we have a mental health crisis and funds are being used for overhead,” Clampitt said. “Money would be better spent going directly to providers instead of another layer of administration. We need money going to the recipients as much as possible.”
With several oversight agencies at the state level to provide checks and balances, Clampitt said perhaps it’s time for the state to re-evaluate how that regional approach is working.
“We have to start looking to do business in a more efficient manner than we have in the past,” he said.
As the conversation about mental health continues in Raleigh when legislators reconvene in May, Corbin said these are questions he plans to ask and hopefully find answers.
“Whatever funding for mental health we have needs to go to treatment,” he said. “I’m not in favor of more cuts to mental health. I know throwing money at it won’t work, but I want to make sure what money we spend ends up treating patients.”
As conservatives, both Corbin and Clampitt aren’t for throwing money at a problem but agree more emphasis needs to be placed on early intervention and prevention programs, which are much less costly than crisis intervention and treatment programs.
Corbin said it’s important for people to understand that the taxpayers end up bearing the cost of these problems one way or another — whether it’s at the state level or the local level. Taxpayers will shoulder the cost of drug-related crime and an increased need for law enforcement officers, expanding jails to incarcerate people suffering from a mental health or addiction crisis or hiring more social workers to keep up with the increased number of children in the foster care system because one or both of their parents are either in jail, in rehab or dead due to a mental health issue or an addiction. The public also ends up footing the bill when people without insurance go to the emergency room during a mental health or addiction crisis — it increases hospital costs and insurance costs.
“People who are suffering are not getting the treatment they need, but we’re paying for these things now just in different way — the cost of ER visits are passed on to insurance holders and hospitals,” Corbin said. “When people don’t get treatment for mental health or addiction, they’re not being active members of the workforce like I believe most people want to be.”
The most effective treatment for an opioid addiction includes therapy and a long-term, medication-assisted program supervised by a medical professional. That treatment can take years and comes at a high cost for those who don’t qualify for Medicaid or have private insurance.
Chipping away at it
The Legislature has made some strides to get a handle on the opioid epidemic plaguing the entire country. Corbin was a co-sponsor of the N.C. STOP Act passed last summer and went into effect Jan. 1, 2018. The new law places limits on the quantity of opioids being prescribed in hopes of reducing the oversupply of painkillers leading to addiction and overdoses.
Locally, Clampitt said he supports the implementation of the LEAD program — a collaborative effort between law enforcement agencies and the District Attorney’s Office to redirect people suffering from opioid addiction from jail into a treatment facility.
“Treatment is a better avenue than doing jail time,” he said. “It costs $100 a day for someone to be incarcerated — that money can be better spent in a better direction.”
Corbin said increasing access to mental health and addiction services should be a top priority.
When someone is diagnosed with cancer, there are enough hospitals and providers available to treat them, he said. However, there aren’t enough facilities and physicians available close by when someone is diagnosed with a mental illness or is fighting an addiction.
Patients often end up at the ER and have to wait days for space to open up in a mental health or rehabilitation facility. Corbin said many people end up leaving the hospital after they’ve detoxed for a few days and then return to the same behavior that landed them there in the first place.
“In this day and age, it’s not hard to get medical treatment whether you have insurance or not — you’re going to get treated one way or another — but with someone suffering from mental health with the same level of crisis, they just put a Band-Aid on it and send them home,” Corbin said.
Clampitt agreed that the lack of facilities, especially in WNC, is a huge issue he hopes to make a priority in Raleigh.
“Hopefully we can take a look in the next budget and make some — not concessions but considerations,” he said.
Sen. Jim Davis, R-Franklin, did not return a phone call for comment by press time Tuesday.