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.