I started writing a comment two weeks ago and went back and edited it several times.  I wanted to make sure I was clear about why I oppose the Emergency Regulations changing Mental Health Supports to Mental Health Skill-building Services.  I asked a colleague to proofread my comment today.  He gave some constructive feedback and then called it what is was – “fluff.”  He then asked what I really want to say.  Here goes… 

I had to step in and assist at one of our sites last year when we were short-staffed.  I fielded a phone call from a client who shared the distress he was under after his former clinician who was no longer at our agency came to his home and tried to solicit him for the agency she had gone to work for.   I talked with the client about what “Choice of Provider” means and that it was up to him and that no one had the right to pressure him in any way.  He went on to tell me how the former clinician brought him a soda and kept asking, “Don’t you like me and want to work with me?”  The clinician also offered to take the client to the movies and other “non-MHSS” activities.  After my assurance that no one at our agency would be upset with him, regardless of his choice, the client chose to terminate services with our agency and went to the other agency.  About six months later, the client contacted the office in tears and asked to come back.  We reopened the case and made a new clinician assignment. 

A couple months ago, another agency solicited several employees.  The owner took employees to dinner and bribed the clinicians, making promises to have all of their paperwork done for them and offered monetary incentives for bringing on new clients – a “bonus” if you will.  We lost several clinicians to this other agency.  Then, we lost each of those clinicians’ clients.  The clinicians were offered a job but could not get a start date until they “produced” a caseload.  These clinicians took their clients that had been longstanding clients of our agency.  One client did not get opened with the new agency but did stop in to our office to let us know that her former clinician (and our former employee) does have her over to her house for dinner on occasion and said she would help her out but didn’t want to open her to services at the new agency. 

Today, a current client contacted one of our sites to discuss closing and going with a new agency.  His former clinician (our former employee terminated for Medicaid fraud) was with that agency and he wanted to work with him again.  A member of our management team talked with the client and explored the reasons behind his desire for the change.  He said he missed going to the movies and to sporting events and that his former clinician always took him to those places.  We terminated his clinician for failing to provide appropriate MHSS. 

These are just 3 small examples of how our service delivery system of mental health services is failing our consumers.  The answer is not in stricter regulations.  The answer lies in increased oversight of service provision, fair auditing practices for all agencies, and just plain enforcement of the regulations.  Yes, the changes are a hardship on agencies but agencies will overcome them.  Some agencies will just find another service to provide, while other agencies will find a way to manipulate the new regulations.  However, our severely mentally ill Medicaid recipients will feel the true wrath of these changes just as they have felt the wrath of a poorly enforced/managed service. 

I want to end on a positive note.  And that is a note about the wonderful accomplishments and successes we see with so many of our clients.  Many clients refer to our agency as their “family.” A client told us that he was hospitalized several times a year prior to starting MHSS with our agency.  He has been hospitalized just once in the four years we have provided MHSS.  One of our clients moved out of state and contacted me asking how she could get MHSS started in her state because we saved her life and wanted others to get to experience the same amount of support and education she received.  For every unethical/disheartening story I give, I could provide twice as many success stories.  I don’t have to credit MHSS for the success, our clients tell us daily and we see it in the smiles on their faces.  Don’t punish consumers for others’ mistakes!