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Mental Health Meltdown

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Kids killing kids.
They get their hands on dangerous weapons and act out their anger and aggression in hateful, evil ways.

From Columbine to Aurora to Newtown, the evidence is clear, and though it's killed too many, it's started a discussion in America.  
But is it the right one?  
We're talking so much today about guns. Who can have them, how many they can have, what style?
But if guns don't kill people, people do, then why aren't we focused more on the kids and their mental health.

9 On Your Side is taking an in depth look at North Carolina's mental health system, particularly as it pertains to kids.
To some families, it's effective. To others, a failure.  
And making a complicated system simple, is not an easy task.

"I think any parent that has a child with problems should be able to bring it up to somebody and get help," said one anonymous father.

Sounds simple enough. But for one local father, it's been anything but.

"Beaufort County Child Development," he continued.

His teenager's threatened to kill his teacher. And everywhere he's turned, after a point, he's turned away.

Experts say, there was a time when help was easy to find and pay for.

"Under one roof we had developmental disabilities, children services, adult services, after care services, case management services… under one center, under one roof, it was the perfect one-stop shop," said Bob Moore, Licensed Clinical Social Worker.

"And the state funded that, or," 9 On Your Side asked.

"Yea, state and federal," answered Moore.

But as lawmakers do when dollars are involved, they saw the need to save and change. Change the U.S. Supreme Court, quite frankly ordered.

In 1999, under the Americans With Disabilities Act, the court decided people with mental disabilities should live in the community, instead of restricted in an institution.
That paved the way for reform.
And in October 2001, then-Governor Easley signed legislation that made North Carolina's public mental health system private, hoping to save tax dollars and better coordinate care locally.

"You could see services deteriorating, staff were getting nervous.  People were wondering what to do.  We started fielding more complaints and from the community, where to go, how to get there.  And it was a period of uncertainty, and still is," said Moore.

The thought was pushing services to the community, while saving money, would better serve patients.
Thousands of providers, be it psychologists, drug rehabilitators, you name it, as with privatization of anything, saw the potential to make money and came running.
Now thousands all across the state offer some kind of service under the control of a state-authorized organization.

North Carolina started privatization with 41 mental health authorities; state-funded centers created in the 70s, providing many services under one roof.  
After privatization, many shifts in policy downsized those 41 authorities to 23 and then to 11 manage care authorities or MCOs, overseeing thousands of local service providers throughout designated counties.

 "I don't think they were thinking about what was going to happen to all of these people that were being pushed out of the system and didn't really have a place for them to go," said Moore.

Reform to save money.     
But since then, those costs have been all over the place; from $581-million before reform to a high of $743-million in 2008 to $664-million in 2010.
Many more of your tax dollars spent than when it all started.

"There were some fairly spectacular failures where the new private company that came in tried to operate just like the old area authority had operated," said Leza Wainwright, Exec. Director, ECBH.
Wainwright is the executive director of East Carolina Behavioral Health.  

"Operating more like an insurance company," asked 9 On Your Side.

"We are operating, ECBH is operating more like an insurance company but our providers are still acting like providers," said Wainwright.

Here's the challenge.  

With so many providers, finding qualified workers to staff their centers is tough. In a system like this, teams like Wainwright's have a tough task to not only understand the massive amount of policy changes over the years, but ensure these private organizations do as well.  

"Could this model affect the quality of care," asked 9 On Your Side.

"Sure, at the end of the day, yes. There kind of isn't a way to get around answering that could it affect it, yes," answered Wainwright.

A process those who worked under the old system say isn't working.

"The people that have tried to get appointments and get quality mental care, they've been shuttled from pillar to post and very frustrating," said Moore.

"I don't want to be the family on the news saying, why did my son go and kill everybody.  What was the reason?  Why didn't I get him some help," said the anonymous father.

 "I don't think that you'll ever get it perfect because we are dealing with human beings with really significant challenges.  I think we are absolutely on our way to getting it a whole lot better," said Wainwright.

"I'm gonna pin you down to a date," said 9 On Your Side.

"I would say let's get back together in two years," answered Wainwright.

Two years of growing pains is too long for a lot of families to wait.

But the system's undergone so many changes. The main message from those who've had success in other states is we're on the right path. Simply stay the course.

Families are struggling with finding care and many of these local providers say the real problem is when it comes to helping families.   

"I have a son and I realized very early on that he had some anger issues," one mother told 9 On Your Side.

To share her story, she asked 9 On Your Side to protect her identity.

"About the time we were realizing that he was going to need some help with his anger, the mental health system in North Carolina was disbanding," she said.

A public mental health system moving patients out of institutions and back to their communities, getting their treatment from for-profit organizations.

 "They are private companies, most of them are more interested in making money from what I can see than helping kids," that same mother told us.

North Carolina started privatization with 41 mental health authorities, state-funded centers created in the 70's, providing many services under one roof.  

After privatization, many shifts in policy downsized those 41 authorities to 23 local management entities responsible for managing both providers and public funds to 11 manage care authorities or MCOs, overseeing thousands of these private companies.

"Um, it is very complicated," said Dr. Kaye McGinty. She's a child and adolescent psychiatrist and professor in psychiatric medicine at ECU. "I'm not sure I can say it helped or it didn't help.  It changed the system so much that it got even more confusing for families."

With the old system, you could walk in a mental health center and have access to it all.

"It was very, very good. Had some marvelously qualified therapists that work closely with psychiatry, psychology, social work. They had the whole gamut of services under one roof," explained Moore. "Now, it's very hard to find a place where everybody is coordinated, which is one of the other barriers.  We really need to go back to working with community systems of care."

Now without that centralized, coordinated system of care, two trends appear to be emerging. Kids are ending up in one of two places; either in jail, part of the criminal justice system, or in an emergency room.

Neither, ideal frontlines for those suffering from mental issues.

"Emergency rooms are very important for emergency care.  But they are probably not the best place to get most of child mental health care," said McGinty.

Something that anonymous mom found out the hard way.

"You know I was just stunned," she told 9 On Your Side. "What do you mean?  He needs to be admitted.  He needs to be under a physician's care?  He said, "Unfortunately what has happened is we don't have adolescent mental health services here anymore."

Now families have to find services from one of these private providers.

The managed care entity that services the east is East Carolina Behavioral Health, tasked with recruiting, managing, and paying these private providers for the care services they offer.

Leza Wainwright is the executive director.

"Part of the problem was everybody was going into the mental health business.  They saw it as an entrepreneurial endeavor.  We can get into mental health," said Wainwright. "If you aren't truly scrupulous you might be inclined to serve a whole lot of folks who have more minimal needs and not serve the people who truly need the service."

Here's where it gets even more complicated.

9 On Your Side did the legwork to try and simply it for you. A Medicare waiver program is being implemented in these companies right now. All areas of North Carolina should be live with it by July.

The short of it is that MCOs, like East Carolina Behavioral Health, become more powerful, deciding which private provider can and cannot participate in their network. It also changes when these providers get paid.

And that's freaking these providers out.

9 On Your Side spoke with representatives from more than a dozen of these private companies. None of them are willing to go on camera to talk about their situation.

They're scared. They're afraid they'll lose their contracts with the MCO if they speak out.
But they all sing the same song. Many are afraid they'll be run out of business.

They used to get paid in 5 days. Under the new changes, it can take up to 48 days to get paid. And how do you pay a staff when you don't get the money?

That's causing a huge number of them to teeter on the edge of financial ruin.

And what's sad is all these providers serve a mentally ill child.

If, and, or when they're gone, that family loses the team that's spent time healing the child. And that's part of what's angering families so much. They have to start all over finding a new provider.

It appears on the surface to be more about money than helping kids.

 "Is North Carolina's mental health system melting," 9 On Your Side asked.

"No, I don't believe that it is," said Wainwright. "But there's also are we adequately funding mental health in this country?"

"Are we," asked 9 On Your Side.

"No," answered Wainwright. "But there's probably lots of other things as well as a nation, we have to prioritize."

"Wouldn't you think mental health would be pretty much at the top of the list," asked 9 On Your Side.

"Obviously, from my perspective, I would hope that it would," answered Wainwright.

 "I would put it back under one roof.  I really cannot see how spreading it out as thin as it is can be more cost effective, at least not for quality care," answered Moore.
"But I'm hoping with this new change with the MCO's that the quality of care is given more emphasis, perhaps now that it will be locally controlled more, we can do that," said McGinty.

"Do you think it's moving too quickly," asked 9 On Your Side.

"I really don't, but I am probably somewhat in the minority on that. I think if we've been at this since 2001, it's about darn time to get it right," said Wainwright.

And a lot of people believe we are moving in a better direction. It's just taking too long.
Since 9 On Your Side has been promoting this story, so much more has come to light. So look for more in the future.
Feel free to email 9 On Your Side's Jeff Varner with any questions or concerns you have.

And if you're concerned about your child's behavior, tell someone. Get them to their primary care physician or call ECBH at 1-877-685-2415. They'll refer you to a provider.

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