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The public mental health agency that serves patients in Rockingham, Alamance and Caswell counties could lose the authority and funding to coordinate care for severely ill patients, a top state mental health official said Wednesday.

Ideally, patients who leave a mental hospital are tracked by and meet with mental health workers once they are discharged, said Leza Wainwright, one of two co-directors for the state’s Division of Mental Health.

Across the state, that only happens about 54 percent of the time for patients who rely on the publicly funded mental health safety net, an average Wainwright called “unacceptable.”

But five of the state’s 24 local mental health agencies, including the Alamance-Caswell-Rockingham Local Management Entity, fell below even that mark for what is called care coordination during a six-month study period this year.

So those five agencies were put on notice Oct. 1 that state officials needed to see better efforts, Wainwright said. That started a 90-day clock ticking, and the state is due to evaluate their performance again at the first of the year.

If the agencies fall short again, Wainwright said, they could lose the authority to coordinate care for those severely ill patients and the funding that comes along with it.

“Once they lose that, and they lose the funds for that, the potential for getting it back is a big challenge,” Wainwright said.

The agency’s executive director, Daniel Hahn, was out of the office and could not be reached Wednesday.

The agency’s clinical director, Alicia Graham, referred questions about the Division of Mental Health’s concerns to Victor Armstrong, who leads care coordination for the agency.

Armstrong did not return messages.

Robert Middleton, who leads Rockingham’s mental health center, said he was aware of the problem. The center is an agency of the

Rockingham County government but falls under the Alamance-Caswell-Rockingham LME for purposes of state-funded services.

“I know this LME is putting more attention on it,” Middleton said.

Follow-up is not totally within the control of local mental health agencies or providers, he said. Sometimes, Middleton said, patients don’t show up and there’s little therapists can do to force the issue.

Still, he said, between 80 and 90 percent of patients should get some follow-up care when they leave the hospital. The agency’s rate is about 45 percent, according to the state.

Rockingham County soon will have a discharge clinic, a one-stop shop for those leaving hospitals and in-patient substance abuse programs, Middleton said. That will be funded by a separate mental health agency and located in the Rockingham Mental Health Center building in Wentworth.

“My attention is very local ... but that will be a big help here,” Middleton said. He could not speak to the agency’s work in Alamance or Caswell counties.

Wainwright said she thought the LME was taking the challenge “very seriously,” but state officials won’t know if problems have been corrected until the 90-day window is up.

Follow-up once a patient leaves the hospital is important for a number of reasons, according to mental health officials.

In addition to assuring patients follow proper treatment plans and get their medications, contact with mental health staff can help avoid return trips to the hospital.

Reducing the number of repeat hospitalizations was a subject of a report given to the General Assembly’s Program Evaluation Committee on Wednesday. And follow-up, or the lack of it, was a key measure studied in the report.

That report was part of a larger effort by the General Assembly to correct what many describe as a botched effort at mental health reform earlier this decade.

The changes were supposed to make sure patients could find care closer to where they live and reserve the state’s psychiatric hospitals for only the most severely ill.

But a combination of funding shortfalls, lax oversight, bureaucratic confusion and an occasional shady mental health provider has complicated those efforts.

The Alamance-Caswell-Rockingham LME is a recent creation, a merger of two separate systems mandated by the reform efforts.
If the LME were to lose the ability to undertake care coordination, Wainwright said a merger or reorganization might be necessary to avoid having two sets of mental health agencies providing services for one group of clients.

Contact Mark Binker at (919) 832-5549 or mark.binker@news-record.com