I have many concerns regarding the changes to MHSS. As someone who has worked in this program for 8+ years I would like to give some feedback regarding the impact of these changes during day to day service delivery.

The move from Mental Health Support to Mental Health Skill Building appears to be more a move to decrease clinical interaction and promote only the increase of independent living skills. MHSS has always been a unique marriage of understanding and addressing a diagnosis while encouraging independence. You can't have one without the other. To provide training in independent living but fail to provide training in how to cope with the Axis I is a disservice. These clients experience problems with independent living precisely because of the Axis I. To pretend otherwise is to not provide client centered services.

Excluding certain Axis I diagnoses is to exclude many people suffering from a severe mental illness. As mental health professionals we see clients in the context of more than just their diagnosis. It should be relegated to the Licensed mental health practitioners to make the determination and not be bound by specific diagnosis. Providers will adjust and simply give widespread diagnosis of Major Depressive Disorder or Bipolar I in order to fulfil the requirement. This again will not be client centered and will cause clients to have treatment designed and administered around false diagnosis.

It is no secret that in the Roanoke Valley there are many clients who come to us from other states. The documentation of prior psychiatric treatment is a huge barrier to those clients receiving services. As each state manages their own Medicaid funds, states are different in the programs they offer. The terms 'crisis stabilization, PACT, or ICT' are often unknown to clients even in our own state much less to clients from other states. As for the psychiatric hospitalization, I personally have spoken with two separate hospitals in the past two days in our area who have reported that the records for our client have been destroyed. I understand the need to document previous interventions and establish the chronicity of the mental illness but barriers in the healthcare system will cause clients to fall between the cracks.

I implore the powers that be to make appropriate changes to these regulations so that the clients will not be the ones to suffer. It is apparent to everyone that these services have grown exponentially and as with any household the budget must balance. The ultimate responsibility should fall to the providers not be bore on the backs of the clients. Implement tighter quality control measures. Mandate training. Consider creating a step down program.

I believe the scope of the program has grown so exponentially due to the fact there are really no other long term one on one services available for the adult mentally ill which provide sufficient support. Everyone agrees there are many problems with the current system. However, the proposed solutions are targeting the wrong problems.