Public-Private Turf War Consumes Mental Health Reform
The intent of the 2003 law seemed clear: The state’s 39 Mental Health and Mental Retardation authorities would, wherever possible, stop offering direct medical services and start recruiting and managing networks of private providers.
The goals seemed simple: to cut costs, increase choice and serve more patients in a historically under-financed and overwhelmed sector of Texas health care. The MHMRs would become “providers of last resort,” only stepping in to offer care when their attempts to create a competitive marketplace failed, according to the law. But the slow-motion political scrum that followed the law's passage has become a ...
Comments (4)
Hilmar Moore via Texas Tribune on Facebook
I thought jail and prison were the fall-back provider of "mental health." Oh yeah, we're privatizing prisons, too. So far every attempt at privatizing public services has been a total disaster. But bad ideas have a much longer shelf life than good ideas, and the worst idea is that you can get something for nothing or half-price. Ain't gonna work.
Marshall Burt via Texas Tribune on Facebook
I don't think it matters much who does what. Unless or until we make a choice to force the so-called "mental health care" profession to teach and practice evidence based mental health care, nothing matters.
Psychiatrists will need to start practicing mental health rather than pharmacology.
Psychologists will need to start practicing psychology rather than one hour weekly chat sessions.
And at some point Psychiatrists and Psychologists will need to start reading research and keeping up with research. Particularly brain research which is successfully identified the underlying mechanisms of brain cell dysfunction in the big ticket items of mental health [ie. schizophrenia, manic depression, major depression, etc, etc, etc].
"The U.S. mental health system is in crisis....according to a federal report."
"The fundamental problem: emphasizing medicating people over fostering ways to help them lead productive lives."
Associated Press, The Daily Texan [September 17, 2002]
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"Practice is not reflecting the research. Ninety to 95% of programs have no research base. The gap between what is known and what is being provided in routine care is huge."
Kimberly Hoagwood {New York Office Of Mental Health] Associated Press, The Daily Texan, April 11, 2002
Marshall Burt via Texas Tribune on Facebook
"The researchers found that the drugs did have a positive impact on people with mild depression - but the effect was no bigger than that achieved by giving patients a sugar-coated "dummy" pill."
BBC News [February 26, 2008] Anti-depressants'... Little Effect
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"Spending on antidepressants and drugs....nearly tripled from $7.9 billion in 1997 to $20 billion in 2004...."
Nature Medicine....Volume 13 #5....May 2007.....pg 520 - 521 [News In Brief]
texasdoc
Most MHMR centers have lots of private contracts; when they make sense and work. The authority is all about trying to save money. A few items not fully addressed in this article:
1. MHMR centers can simply give up the "authority" role and be a provider. The authority is less than 10% of the budget
2. There have been instances when private providers took over some MH services, just to go out of business leaving the authority holding the bag with no staff to service those patients. That is why they are required now to keep the infrastructure in place for when this happens again in the future (thus this is part of the less than Medicaid rate)
3. Keeping the rate low and Medicaid costs down are the reasons the state does not want to open up rehab services to private providers. They control the numbers now; MHMR centers cannot simply see more people and bill more Medicaid. It is basically capitated and rationed. If the state loses control of this, watch the Medicaid budget go sky high. This is why Republicans support the MHMR system. It simply saves money. If the goal is privatize, increase Medicaid to market rates and open it all up.
4. MHMR centers and private providers lose money on Medicaid psychiatric services; the private sector wants to take the rehab services, not the money losing medical services. MHMR centers need that revenue to offset losses in the provision of medical services.
5. Where the system is fully privatized (Dallas), 80% of patients remained with the community mental health center which serves as a provider, not the authority.
6. Explaining #1 a little more: Community MHMR centers are a designated non profit entity in law. It has nothing to do with the authority. The authority role was delegated by the state to the centers. Centers can choose to just be providers, and will successfully out compete any private provider because of being a non profit, non tax paying entity.
7. Private providers don't like the strings that the MHMR centers have had to live with. As the authority, the state will fine the MHMR center if the private provider fails to comply with the requirements. Thus another reason for the sub Medicaid rate. If private providers don't like it, then private providers should avoid it.
8. All Medicaid, Medicare, and insurance patients currently being served by MHMR centers are already privatized when it comes to medical, non rehab services. Patients can simply leave the MHMR, go to a private psychiatrist, and all should be happy, right? After all, 80% of MHMR services are medical. Oh, wait, see #4 above again.
9. MHMR centers are the experts in treating the most seriously ill patients using evidenced based practices as required by the state. Many patients seek help and some gladly pay cash outside of the state contract to be seen by MHMR psychiatrists because of this level of expertise.