Coastal Care MCO got the green light to “go live” on March 1st. It’s birthmarked the death of 1963’s Community Mental Health Act (CMHA). Mr. Peabody and his Wayback machine pointed out that every time a serviceman commits suicide or a spree-shooter unloads, we scream about mental health care. Yet, every time we get a chance, we cut research, reimbursements and prevention programs proven to work.
According to Mr. Peabody, Benjamin Rush started America’s first psychiatric hospital in Philadelphia. I spent six years there (as employee and trainee, thank you). Dr. Rush and his real Tea Party pals Ben Franklin and Dr. Thomas Bond thought it was their civic duty to care for the “sick-poor and insane” (colonial term, not mine).
But they had yet to read Ayn Rand.
Fast forward to the 1950s: In 1954 Pilgrim State in New York warehoused 14,000 people. A small island of insanity adrift in a sea of madness. Because of a combination of abuses, miracle drugs and lawsuits, Congress passed the Community Mental Health Act, birthing locally run treatment centers. Part of my training is community and clinical psychology. Unfortunately, decades of cost-cutting has crushed the “community” part to death.
It’s sad because North Carolina has a progressive history of community mental health care, dating back to Dorothea Dix herself. Michigan Law School touted 1979’s Willie M. settlement as resulting in a “state-of-the-art system for serving emotionally disturbed children with aggressive behaviors, which became a model for other states.”
Despite its flaws, Southeastern Center competently served the community and even included a 24-hour crisis center. Today’s substance-abuse crisis plan could be a guy with a cell phone. (Like the guy that sold you the junk in the first place.)
We’ve all participated in the murder of the CMHA (not merely “rugged individualists” out to kill anything “community”). We love drugs, cost-cutting and quick fixes. We’ve permitted mental-health professionals to be transformed into assembly-line workers in a drug-crazed mental-illness industry. We expect psychotherapy to fix us in one session or less (cost-cutters do, too!) and psychiatry to give us almost any drug our craving brain chemistry desires. (Except pot. Our non-intrusive state says pot’s still bad, even if you have cancer. It gives you the munchies.)
We’ve created a system in which psychiatrists can be no more psychiatrists than the dude dropping fries into the oil at McDonald’s can be a chef. They earn less than other specialties, even though your viagra or boob guy will rarely steer a potential spree shooter or suicide to safer shores. Psychiatry is relegated mostly to “med management” (a deeply personal term), even though they know that pills may get you through the darkness, but without somehow learning new skills, you’re unlikely to see the light. Worse, every mental health profession is governed at least as much by insurance companies as professional practice standards. Bob Dylan sang for all the healing arts, “20 years of schooling and they put you on the day shift.”
I’d take handfuls of Prozac or start smoking pot if it meant staying out of Dorothea Dix, but it bothers me that our drugs, de-institutionalization, and the death of the CMHA aren’t designed to foster individual healing or build compassionate communities; they’re designed to cut costs. I don’t mean to harsh on my colleagues at Coastal Care (I may need a job one day), but the MCO itself was born to cut costs, not because Southeastern Center lacked compassion or clinical competence.
Coastal Care is an insurance company designed primarily to keep our Medicaid dollars from being wasted on the “sick-poor and insane.” Our state has “reformed” (privatized) most mental-health services to, in theory, restore fiscal sanity, shrink government and grow local businesses. In practice, privatization is strangling small Medicaid providers to death with ropes of regulations and rate-cuts.
Coastal Care is not even the place where anyone in need with little means can go for help. It merely manages a maze of increasingly large practices and regional providers (it’s called a “network,” but to the consumer it’s a maze). The provider of last resort is back to being the prisons or the woods behind marketplace, like it was in the colonies. That’s madness.
“This is not madness, this is Sparta!” Nationally, we’re close to, “Trillions to kill; pennies to care.” Locally, let’s fuggedaboutit the homeless with mental illness, the spree-shootings, suicides or kids we kill with our cost-cutting, and focus on how warm our hearts will feel when North Carolina’s books are balanced.
Freedom isn’t free, but clear-headed compassion comes at a cost, too. Despite the well-intentioned folks there, it’s unlikely to come through Coastal Care. It would be better for us if I’m wrong, and the cost-cutters are right. But that’s an improbable history. It’s more likely that Mr. Peabody will be teaching about the cases the Southern Poverty Law Center filed to restore our sanity. It would be madness for them not to.