State defends change to mental health help
Health groups say they are concerned about the effects on Waianae and the neighbor islands caused by a "business decision" that changes the way state services are provided for severely mentally ill people.
The Department of Health is abandoning the once highly touted method of Assertive Community Treatment teams to provide specialized services to seriously mentally ill people.
Poka Laenui (Hayden F. Burgess), executive director of Hale Na'au Pono, the Waianae Coast Community Mental Health Center, and Colleen Wallace, Mental Health Association in Hawaii executive director on Maui, protested termination of the ACT program.
"It's very sad to lose our ACT teams, especially on Maui where so many people have been underserved so many years," Wallace said.
Eight ACT teams statewide cover 425 clients out of 15,000 islanders receiving state mental health services, officials said yesterday. The ACT clients will be shifted to community-based case management teams with case managers linking them with appropriate services.
"We have been cast as having made frivolous, overnight decisions, and that is not the case," Michelle Hill, deputy health director for behavioral health and Adult Mental Health Division acting director, said yesterday. "I believe we have made appropriate business decisions ... to better insure good outcomes for consumers and accountability to the public," she said, explaining that ACT programs have experienced problems nationally.
She said providers were not following the ACT model and that the department was paying for a full array of services whether clients needed them or not.
Because ACT services were not being provided, Medicaid had to be billed for a lower level of services, Hill said.
As a result, she said, the Health Department lost $2.7 million in federal funds it could have obtained with ACT claims for 12 months up to February, plus 56.5 percent in matching Medicaid funds. The state also paid $1.75 million for services to clients that would not have been needed if the assertive treatment programs were working correctly, Hill said.
The Health Department is meeting with providers and consumers to get feedback for a smooth transition to case management services when the assertive treatment team contracts end Aug. 31, she said.
"Our team was just beginning to find these people and stabilize them," Wallace said. "Intensive case management was never able to hang on to these people or help them. What about these people who used to be served in the State Hospital and are now on the streets, in beaches, in the jails, in the court system and the hospital? You need outreach."
Wallace sees the Health Department action as a cost-cutting measure. She cited a letter to mental health providers in January from Brian Higgins, chief financial officer of the Adult Mental Health Division, saying the division was "facing a funding crisis" and exploring methods to address the shortfall.