Paul Brinich, a psych professor at UNC, is against privatization because of the experience with mental health reform since 2001. But the problems he describes are not the result of privatization:
The LMEs [local mental health care managers] were supposed to be the new architects of local services; but the LMEs did not have the money necessary to attract a full range of providers, nor could they properly coordinate their efforts.
The lack of funding was because politicians decided mental health funding was a low priority.
Despite this, one LME has done a better job taking care of its patients at less cost than the rest of the system. PBH (Piedmont Behavioral Health) was able to operate under a Medicaid waiver that paid it per person served instead of for each service provided. PBH was then able to work with providers and consumers to find the right mix of services, pay for things not normally covered by Medicaid, and avoid paying for care that consumers did not need.
PBH’s success was all but unnoticed until the community support services fiasco a couple years ago, but management documents its success keeping people out of state hospitals and on track with their treatment. The budget this year finally expands, to two more LMEs, the Medicaid waiver under which PBH has been able to accomplish this.
Given the performance of state-run mental hospitals before and since 2001, can anyone seriously suggest that the unreformed system would have done better?
