The D.C. Department of Mental Health Services has issued a plan to phase out most of the direct services it currently provides. The plan has triggered a fierce debate riddled with half-truths and some outright misinformation.
A recent article in the Washington Post reflects the rhetorical battle. Unfortunately, it does more to add to the heat than shed light on the issues.
Here’s the basic situation. For many years, D.C. has been subject to a series of court orders stemming from its failure to provide adequate community-based alternatives to in-hospital mental health treatment. DMH was created in 2001 to comply with a court-ordered plan. At the same time, a direct services unit–the DC Community Services Agency–was established within DMH.
DC CSA was deemed necessary because, at the time, the local private provider community could not provide the necessary volume of quality community-based services more efficiently than a government agency could.
However, DC CSA was never the sole provider. From the get-go, DMH has funded delivery of mental health services to a portion of its clients through a network of certified private providers. Now it proposes to eliminate the duplicative services DC CSA provides by expanding the network and the functions of some participating providers. This proposal reflects the recommendations of a recent independent study.
The restructuring will lead to layoffs at DC CSA. So, understandably, union representatives have launched a campaign against it. On the other side, nonprofit community-based mental health clinics support the restructuring because they could then be reimbursed for some portion of the costs they incur in serving low-income D.C. residents who are not covered by Medicaid.
Buried in this clash of interests are the interests of those residents–the more than 46,000 people covered by DC Healthcare Alliance, the District’s own public health insurance plan. Unlike Medicaid recipients, they have no mental health coverage. As a result, an untold number who suffer from anything less than the most severe and persistent mental illnesses go without help–unless and until they lapse into a crisis that sends them to the emergency room.
The restructuring would make all Alliance participants eligible for reimbursable mental health services. This would close a major gap in the D.C. mental health system, expand private provider capacity and promote integration of primary and mental health care.
Will it present challenges? Of course. But do these justify maintaining a more costly system that leaves many poor, mentally ill people falling through the cracks? I don’t think so.