CAN YOU SAY “CLASS-ACTION LAW SUIT?”
By Mickey Skidmore, ACSW, LCSW
In the past year alone, the woes of North Carolina’s state mental health system have been widely reported. Although state officials would have us believe that they are in lengthy and difficult process of transforming the system, many (especially those who work in the field) have concluded that we are literally witnessing the disintegration of the North Carolina state mental health system.
Limited resources and lack of funds have certainly contributed to many of North Carolina’s difficulties when it comes to providing mental health care. Recent reports have estimated that the state is nearly three quarters of a billion dollars short on this year’s budget. The history of this issue also points to other variables as well, including: poor management of the overall state mental health system; inept management of mental health funding; lacking of political vision and will to adequately address mental health issues in the state as a priority just to name a few.
North Carolina has had the dubious distinction of being on the losing side of two class action law suits in recent years (Willie M: involving the mental health care of aggressive youth, and Thomas S: involving the mental health care of mentally retarded and/or mental ill adults). After several years, North Carolina has positioned itself strategically to side step the Thomas S suit and seems well on its way to going back to business as usual.
It seems that the state wants it both ways. On one hand they want to follow the procedures which benefit them financially (divert potential Thomas S class member from admission to state psychiatric hospitals – as this confirms them as members of the class action suit), yet they say that they have incorporated all Thomas S programs into MR/DD Services.
On a practical level, this plays out in some interesting ways. When a Thomas S (or potential Thomas S class member) requires psychiatric hospitalization for acute care stabilization they are diverted from state psychiatric hospitals to private hospitals. Many area programs either have inadequate case management resources to serve these clients, or worse, provide poor or little case management support. Furthermore, there are fewer group home or appropriate spaces to place them following stabilization. Area programs desperate for any resource for these clients will embellish, fabricate, or flat out lie to “dump” these patients onto hospitals and then wipe their hands of the immediate problem.
The way the system was/is suppose to work, is the area program is responsible for finding appropriate placement for these clients (with the best chance to lead independent lives) while the hospital stabilizes their psychiatric crisis. Increasingly however, hospitals are left with patients with disposition problems, and even when they can place them somewhere, there is rising recidivism as the clients often experience another psychiatric crisis because there placement was inappropriate or inadequate and return to the hospital.
Considering the cost and expense of an acute care psychiatric hospital versus the cost of appropriate case management services and appropriate group home or other placements, one can clearly see, that the end result of this systemic break down is probably causing the state even more expense than if it buckled down and figured out how to meet its responsibilities in the first place.
Unfortunately, it appears that the only way North Carolina will do this, is if it is forced to by another class action law suite.
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