by Gerald D. Klee, M.D.
[Winter 1997; Vol. 24 No. 4]
Community Mental Health Centers (CMHCs) are disappearing throughout the state. The few remaining centers are threatened with collapse. CMHCs in many counties have closed their doors due to altered reimbursement systems initiated by the Mental Hygiene Administration (MHA). Their staffs and patients are scattered. In many cases no one knows what has become of patients. As reported previously in the MPS News (December 1997/January 1998 issue), these developments have resulted from federal and state actions to save mental health dollars by privatizing care. MHA selected Mental Health Partners (MHP), a joint endeavor of CMG and Green Spring Mental Health, to administer this function. Recently Merit Behavioral Care Corporation purchased CMG.
The chaos resulting from privatization is exemplified in Harford County. There, with only a few months notice, the Mental Health Center closed on December 5, 1997, allowing no time to plan an orderly transfer of patients to other providers. Mental health workers in Harford County are demoralized and frightened, and unwilling to be quoted by name. All expressed deep concern for the mentally ill, many of whom are seriously impaired patients, incapable of navigating the chaotic system that now exists.
Harford County, however, may come through the crisis better than some others. Ralph D. Scoville, M.D., for many years the outstanding head of the now closed Mental Health Center, now works for Key Point Health Services, one of several private companies that have sprung up to fill the vacuum in Harford County. Key Point collects from MHP for its services (with luck) on a case by case basis. The Sheppard Pratt Health System has become a major provider in Harford County in recent years and may pick up many of the pieces. So far, the fate of many patients is unknown.
In Baltimore City, community mental health services are on life support under the coordinating body, Baltimore Mental Health Systems (BMHS). Subjected to drastically reduced reimbursement and crushing administrative demands of MHP, the mental health centers in Baltimore may not long survive. Peter J. Coleman, M.D., president of the North Baltimore Center (NBC), paints a grim picture. At a recent meeting of the Maryland Joint Commission for Interprofessional Affairs, Dr. Coleman outlined in detail the devastating problem his center now faces. Serving a diverse population of 160,000, NBC has 130 staff members and a budget of $8 million. It provides a wide range of services to a thousand active cases at any one time. Many of its patients are among the most seriously impaired, including a large proportion who would require long term institutional care without the center’s services. New and burdensome administrative requirements now hamper the clinical staff. The staff’s effectiveness in reducing hospital days for the sickest patients from 365 days per year to an average of nine days has resulted in huge savings. The new managed care environment seriously threatens these successes.
Financial problems created for North Baltimore Center are crippling. Demands upon staff to justify payment are labyrinthine and unending. Reimbursement rates are too low to meet expenses. Worse yet, delayed payments from MHP have prevented the center from effectively determining its fiscal position for the year.
Dr. Coleman, using great restraint, remarked that the present situation under managed care is like “a night terror–those are nightmares that children have from which they cannot be awakened, it just never ends.”
Speaking of managed care for the Medicaid system, Dr. Coleman quotes H. L. Mencken: “For every complex problem, there is an obvious and simple solution, that is wrong.”
Dr. Coleman blamed no one. He hopes that the MHA will come to the rescue. Probably, he has been too busy to notice the involvement of Merit Behavioral Care Corporation (part owner of MHP) in a political scandal lately. In a series of front page articles, (December 3, 4, 5, 6, 9, 10, 1997), The Baltimore Sun reported that the chairman of the Health Subcommittee of the Senate Finance Committee, a political ally of the governor, had received substantial payments from Merit for his services as a consultant. This revelation triggered an ethics investigation in the Maryland Senate, while the attorney general’s office is conducting a criminal investigation. On January 16 the Senate voted to expel this member. What role have politics played in producing the present mental health disaster?
What can be salvaged from the ruins of community mental health and who will undertake it? The suggestion that managed care will fix it is without merit.
Dr. Klee is editor of The Maryland Psychiatrist.