Mental health services may decrease under redesign
By STEPH TAHTINEN
Mt. Pleasant News
Henry County currently funds mental health services above and beyond the core services mandated under redesign, and when the changes go into effect on July 1, 2013, residents could potentially lose some of those services.
“Henry County would back-pedal in what people have available to them,” Sarah Kaufman, Henry County CPC administrator told the Henry County Board of Health on Thursday.
Kaufman was at the board of health meeting to update the board on mental health redesign in the state, which requires counties to form regions and provide certain core services.
Those core services include:
• Treatment services such as: assessment and evaluation, mental health outpatient therapy, medication prescribing and management and mental health inpatient services
• Basic crisis response such as 24-hour access to crisis response, evaluation and personal emergency response
• Support for community living such as home health aid, home and vehicle modifications, respite and supportive community living
• Support for employment such as day habilitation, job development, supported employment and prevocational services
• Recovery-orientated services such as family and peer support
• Service coordination such as case management and health home services
• Sub-acute and crisis
The sub-acute services will be difficult, said Kaufman, because no county in the state currently provides the service and it is still being defined.
“It’s a core service come July 1, and it doesn’t exist, and I don’t believe it will exist July 1 of next year,” said Kaufman, noting it will take probably two or three years to set up a functioning program.
In addition to the core services, there is a list of expanded services that regions should provide when funds are available:
• Comprehensive crisis response services such as a 24- hour hotline, mobile response and crisis residential services
• Sub-acute services that are facility-based and community-based
• Justice-involved services such as jail diversion, crisis intervention training for law enforcement and civil commitment pre-screening
• Evidence-based practices such as positive behavior support, assertive community treatment and peer-self-help drop-in centers
Services can also be provided beyond the core and expanded core services as long as those services are in place, person-centered planning demonstrates the need for such services, there is demonstrated efficiency of such practices and it is an effective alternative to existing services.
Kaufman commented that these expanded services seem to go against the original intent of redesign, which was to level the playing field and make sure that the same services are available in each region.
“When you start anything above the core, then you’re going to get back into the inequity again,” said Kaufman. “But at the end of the day, people are different, and I don’t see that any service delivery — psychiatric, behavioral, medical — is ever going to look the same no matter where it’s implemented because people are different and they aren’t going to need the exact same thing in the exact same way.”
Henry County will be part of a seven-county region with Des Moines, Keokuk, Lee, Louisa, Van Buren and Washington counties, and the CPCs and boards of supervisors have been working together to decide how the region will function.
“The tough decision will be what can we afford to continue to pay for? What are we going to cut?” she continued.
She used the example of developmental delay clients, as three of the seven counties do not pay for developmental delay and four counties do. She estimated there are around eight to 10 people classified as developmental delay clients in the region.
“That’s not a lot of people, but that’s one person too many if it has a negative impact on them,” said Kaufman.
The seven counties have developed a list of guiding principles to develop efficient and consistent service for residents within the region. The region will need to create a governance board comprised of boards of supervisors, family members of clients and providers of services, Kaufman explained. Each county will only get one vote, she noted, so that all seven have an equal voice.
Kaufman noted that the CPCs will still keep doing their jobs and help to run the region, and it is likely that every couple of years the CPCs will rotate the CEO position within the region.