I am concerned about what the ‘qualifying mental health diagnosis’ may be defined as, as there are significant impairments for any full DSM IV TR diagnoses.  I am concerned that it may be limited to affective or psychotic disorders, since they are not the only mental health population with significant impairments i.e. panic disorder, social phobia, conversion disorder.   

I have worked with numerous clients have no idea about or require significant assistance & encouragement to access available resources. Also, some clients even with impairments as significant as frequent suicidal thoughts, mania and psychosis  refuse to access services due to paranoia, fear of negative consequences especially those with children, the nature of mania and have to be constantly encouraged to access services.  I worry about limiting the service to those that have had recent more serious interventions such as hospitalizations, ECO / TDO, residential treatment since some clients may not have accessed more serious interventions with support of MHSS to stabilize them. 

Many clients have paranoia, co-occurring substance abuse, co-occurring development delay or cognitive issues that combine with mental health issues that results in lack of understanding of the need for, fear that others are trying to hurt them with, fear of medications causing relapse to substance dependence such that they refuse to access psychotropic medications sometimes for years, or are prescribed them and are chronically non-compliant. I often have to encourage clients to access the services that could assist in stabilizing their symptoms, but there are some clients that do not do so despite on-going symptoms and recommendations, but still need services. Plus, DMAS should think about client rights and how do these criteria fit into (or do not fit into) client rights.

There needs to be thought on how to mitigate the negative impact of limiting hours / units on providers and clients in rural areas with limited resources to meet mental health & medical needs. If you support client rights and the right to choice, there must be ability to access providers or community resources even if they are 1.5-2 hours away.  As a provider living in a rural area, the limitations to units would make it difficult to assist clients and could even result in harm to clients that are significantly impaired to the point of not accessing services without a supportive other.  While the end result of mental health support services is to support independence, there should be ability to approve overage units for those clients in rural areas even if the overage units able to be approved progressively reduce over time in order to teach independence.

I am concerned that the proposed changes along with the reduction of mental health beds in hospitals and ability to access other services will result in increased legal issues in the community, jails instead of treatment, resurgence in hospitalizations, and will result in an increase in spending in other areas since services act as a protective factor to reduce these issues. This could result in harm to our clients as well as our community, and I am not in support of changing the criteria to be so limited that clients that need the service cannot access it.