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Hurried Transition For Wake Mental Health Clinics A Long Time Coming

a pharmicist
NC Department of Health and Human Services

Behavioral health clinics in Wake County are shutting down today. That means about 2,000 people who have mental illnesses and rely on Medicaid are transitioning to treatment from private providers, but the county has been under a time crunch to transfer patients and some doctors worry theirs are falling through the cracks.

Margery Sved is a psychiatrist with Wake County Health and Human Services and one of 200 people who are being laid off today.
"I'm packing boxes in my office, deciding what stuff do we leave here for the people who are moving in, what stuff is owned by the county that should be returned in some way..." she said earlier this week.

Sved is falling back on her private practice after 12 years as a Wake County clinician.  Most of her patients will now get their treatment from UNC Health Care and Monarch NC.  Since February, the two providers and the county's managed care organization have been sending notices to patients with a number to call to make appointments with their new doctors.  Sved says the process has been rushed.

"I just wish that by the time we close our doors that all of my patients, all of our patients, at least would have an appointment of knowing when they're next going to be seen, not just a phone number of who's going to see them," Sved said.

As of Thursday, UNC and Monarch said more than 800 did not have appointments.

Wake County's transition is part of a statewide shift toward a community-based mental health system.  The General Assembly passed a law to overhaul mental health care in 2001.

"What used to be public mental health centers needed to segue into Local Management Entities (LMEs), which means that they would manage a network of providers, authorize care and develop things within the community, but they would no longer hire clinicians.  They would contract with private providers," explains Deby Dihoff of the National Alliance on Mental Illness in North Carolina.

Between then and now, current officials in Wake County say their predecessors decided to work around some provisions in the law.  They fell back on outpatient care in other places, like Dorothea Dix Hospital, which shut down in 2010.

"And now there's a sudden rush because they simply were not moving along with the changes in the law," Dihoff said.

The county eventually partnered with Alliance Behavioral Health Care to be its Local Management Entity (LME).  Alliance also serves Durham, Johnston and Cumberland counties.  The plan for Wake was to keep sending patients to the county's behavioral health clinics, but the state ruled that created a conflict of interest, so the county had to start over.

Assistant county manager Denise Foreman says Wake started making plans to sell off its mental health services last summer.

"It's a several-month process.  We came up with the plan of what needs to be divested, how we go through the divestiture process, who's in the lead, what are we looking for in these new companies so that we don't just hire somebody who does this, that we find the right company that can do the services that we need, so it just took a while to get that changed," Foreman said.

Alliance says there are measures in place to make sure there's no lapse in treatment for people who don't have appointments yet.  A small team of Wake County volunteers will be available to treat patients over the next few months.  And UNC and Monarch are trying to reach out to people they haven't heard from.  The providers also say patients who walk in to one of their treatment facilities will get to see someone regardless of whether they have an appointment.  

"We are - I don't know whether to say - confident or hopeful that it'll work, but it is a real challenge," said Carlyle Johnson, who's been managing the transition at Alliance.

"The concerns I have are when someone doesn't get the word or if the letter isn't received or read.  We think it's going well, but it depends on how you define it.  For me, even one person who doesn't transition and ends up in the hospital means it's not going well."

And the Wake County doctor, Margery Sved, says she's bringing three longtime Medicaid patients under her personal care and absorbing the financial blow.

"I'm eating that and I'm providing their case management.  I just made the decision that I'd rather provide the continuity of care," she said.

In the meantime, the General Assembly is still deciding how much to spend on mental health over the next two years.  Gov. Pat McCrory's budget proposal increases spending on mental health.  The House and Senate's plans cut it.

Will Michaels is WUNC's Weekend Host and Reporter.
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