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RALEIGH State legislators intend to phase out a program that had become a symbol of waste and inefficiency in North Carolina's troubled system of mental health care.
But some advocates for the mentally ill say that program has improved from its early days and now provides basic but vital services that might not be available otherwise.
“It's not the same program,” said Jennifer Mahan, a lobbyist for the Mental Health Association in North Carolina.
The program is known as “community support,” an array of services provided by a network of private companies working under contract with the state.
It is on the chopping block as legislators try to assemble a state budget in a lean economy. The legislature has yet to approve a final budget, but House and Senate leaders have agreed to end the program by reducing state costs by $65 million this year and $97.5 million next year. The federal government picks up about two-thirds of the program's cost for Medicaid patients, with the state responsible for the rest.
The cuts are an attempt to control community support's costs while the state Department of Health and Human Services designs a replacement, said Sen. Doug Berger, a Franklin County Democrat and a budget subcommittee co-chairman.
“We want to phase out community support and replace it with a program that provides more professional service,” he said.
In 2006, state officials began allowing private companies to offer some basic mental health services as part of an effort to shift treatment from state hospitals and government offices to homes and community-based centers. Community support was designed to help people with mental illnesses or addictions to gain skills, such as how to manage bus schedules or a household budget, or to help a child stay out of trouble in school.
But costs grew quicker than legislators and state officials imagined.
Providers billed for questionable activities such as taking groups of children to sports events and movies, and taking clients for repeated trips to stores and the gym. Audits by state and local officials found that about 36 percent of the services provided were not medically necessary.
An investigation by The News & Observer last year found that the state had wasted $400 million on the program. A legislative evaluation released last year said the state Department of Health and Human Services did not have a clear idea how much the program would cost and was slow to catch ballooning expenses.
The state put more restrictions on the service in an attempt to cut costs, limiting the hours adults could receive the service, requiring more professional and experienced staff to spend time with clients, and telling the private company that approves the service to more carefully examine requests.
That has helped turn the program around, say some mental advocates, and so mental health providers and patients have appeared in rallies around the state defending community support as a valuable service that should not suffer deep budget cuts.
Debbi Ferro, who lives in Cary, said community support is the best service she can get for her 11-year-old son, who has a developmental disability and has been diagnosed with mental illnesses. He has twice been hospitalized for being homicidal and suicidal, she said, and he has been in a therapeutic foster home since April.
Ferro said she has tried more intensive services that did not help her son. She wants to enroll him in a Medicaid program that would allow for comprehensive care, but that program has limited money and no slots are available.
“Community support is the best thing they have to offer right now,” she said. “In a lot of respects, it's been a life saver.”
Ferro said her son gets six hours of community support services a week. The workers have helped him get used to daily routines and take responsibility for his actions.
The family can now go out without fearing outbursts from her son that used to bring abrupt ends to trips outside the home.
“It has gotten so much better,” she said. “We can go to restaurants and be able to make it through without a major meltdown.”
Database editor David Raynor contributed to this report.
