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New Model For Delivering Mental Health Care

With the beginning of the new year, yet another big change came to the state mental health system. January first marked the implementation date for a new type of provider agency to deliver services. They’re called CABHAs… and they’re intended to lower cost and improve quality. The question is… will CABHA’s work?

This morning, in a room filled with state mental health officials, advocates and representatives from mental health provider agencies, secretary of health and human services Lanier Cansler made an audacious statement.

"Reform is over. Now, we’re about building a mental health system, and doing the things we need to do to build a strong system across the state."

The new agencies for delivering mental health services are called critical access behavioral health agencies, or CABHAs. The idea is that these agencies will deliver quality care… without the abuses that marked the community support system.

Several years ago, investigations found community support providers delivered mental health services to patients using un- and under-qualified personnel. The state wasted hundreds of millions of dollars on the program. Assistant secretary Beth Melcher says CABHAs will replace the multitude of small providers that sprang up to deliver services under the community support model. And she says right now, every county has access to at least one CABHA

"We had 603 agencies apply to become CABHAs over the past year. And of those, 175 agencies have been certified to become CABHAs."

Requirements to become a CABHA are steep. Agencies need to provide an array of so-called core services that range from clinical assessment to crisis services. CABHAs require doctors to be in multiple leadership roles. That’s an expensive proposition for small agencies, and many will disappear. Some have already, says Karen McCloud, head of Children and Family Services – an organization of providers.

"Change has been hard, it’s also been especially Hard for small, quality providers. Org leaders trained to differentiate themselves… from their peers because they’re competing for funding… what CABHA has done is it’s required a departure from the past as small agencies asked to consider mergers."

McCloud says many of her member agencies weren’t happy about CABHAs. But she says small providers also realized there were just too many of them. And some providers had to admit that they were part of the problem under the community support system. One is Dan Zorn, who runs a provider agency in the western part of the state. His company did well under community support…

"The state said look, we want you providers… me… to provide core services, not just services that are attractive financially. So we had to recommit. And that was a tough pill for a lot of companies."

With the state budget facing massive cuts, providers realize they have to support the new model.

So does Debbie Dihoff, who heads of the North Carolina chapter of the National Alliance on Mental Illness. But Dihoff says some mental health consumers and their families are wary.

"The consumers and the family members across the state of course, have exhibited some fear. We’re hearing worries and concerns about will they lose their provider and that’s not unexpected. But I think the really interesting part of the story is that the deadlines have come and gone, and nothing really bad happened."

Dihoff says so-far, so-good, but there’s still a need to keep watch. She sits on a state-level review committee.

"We need to remain vigilant in our advocacy to make sure this works. I think one of the biggest things they need to concentrate on is how will CABHAs make referrals. How will they make sure they use other provider services that are really indicated from the assessment about what people need, and don’t just get complacent in using the CABHA only services."

And that’s has been the worry all along for some providers that do only one core service, do it well, but can’t really become a CABHA… like clubhouses for adults with severe and persistent mental illness. Irene Dwinell from Durham’s clubhouse Threshold says her agency is already seeing negative effects from CABHAs.

"We did like our own kind of internal study, if you will… And we’ve seen a huge hit… for example, we went from roughly 65 people a day, to if we see 50 a day, we’re in good shape, and that’s literally since the CABHAs began."

Clubhouses around the state are organizing in order to make sure they’re not left out. But like many other providers and consumers, they’ll just have to wait and see if mental health reform is really over.

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