Op-Ed: Behavioral Health Doesn’t Have to be “Managed”
April 23, 2014
Op-Ed Submitted by State Senator Gerald Ortiz y Pino (D-12-Bernalillo)
Santa Fe, NM — It seems clear that the next legislature will be asked to deal with the difficult and divisive issue of mandated, out-patient treatment of the mentally ill. Recent police shootings of homeless and mentally ill persons have predictably elicited calls for New Mexico to pass some version of “Kendra’s Law,” which many states have enacted to impose treatment on those who aren’t willing or able to seek it themselves.
The advocates of Kendra’s Law would have us believe “treatment” for mental illness is as simple as popping a pill or holding still for an injection. In practice, though, effective treatment for behavioral health problems entails an entire network of supports, assisting with housing, hygiene, finances, family, employment, safety and education that go far beyond just seeing a shrink for 15 minutes and filling a prescription.
While there are many reasons to be cautious about passing a law mandating treatment, the legislature has to get realistic about the dreadful state into which we have allowed our behavioral health system to devolve. We desperately need services in the community for those with psychiatric, alcohol or drug problems. The bitter irony is that we are now spending far more on those services than we did in the ‘90’s, and have many fewer services in place than we did then.
How can this be? It happened gradually, in stages. First we used Medicaid dollars to provide much of our behavioral health budget. The federal money this brought in tripled the budget for those services. But then we got cold feet over the explosive growth in the Medicaid budget and during the Johnson years converted it to Managed Care, and gave the contract for managing the program to a series of for-profit corporations.
Last year the Martinez Administration completed the conversion of our previous service system by terminating the contracts of local non-profits who had together provided New Mexico with 85 percent of its behavioral health services and bringing in companies from Arizona to replace them.
This year we will spend about $650 million on Medicaid behavioral health contracts and $65 million on non-Medicaid behavioral health contracts, all managed by HMO’s. The entire system has been converted to per visit payments. HMO’s get paid monthly capitation amounts to provide for the needs of those enrolled in their systems. But they dole out the payments to individual providers only when someone makes their way to the doctor or therapist’s door. Keeping the difference as overhead or profit is a system exquisitely designed to make sure minimum service is provided at maximum cost.
In the old system, global budgets were established for Community Mental Centers. Within budget they had to provide all the services needed in that community. Through creativity, they established outreach teams and housed them in neighborhood clinics and housing projects. They initiated day treatment programs and drop-in centers where the mentally ill could find trained volunteers, a friendly atmosphere and perhaps engagement in their own rehabilitation. They fostered self-help approaches.
That system cost less than our current managed care system…and worked better.
A simple way to increase services in our state, would be to end the managed care contract for non-Medicaid behavioral health and use that $65 million ($12 million of which goes for corporate profit) for global budgets to re-create the network of outreach, day treatment, drop-in and crisis line services that together could provide better access for the mentally ill when they want to be treated. We don’t need a lot of new money; we need to spend existing money more wisely.
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