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The state’s two-handed approach to outpatient mental health care is failing


Those being treated for mental illness who need assistance to get to day habilitation programs will be out of luck after June if the state doesn’t reverse a decision to no longer pay for transportation.

The St. Lawrence County Community Development Program has for decades been overseeing transportation to day programs for those who are prescribed them as part of their treatment, and has continued to pay for it on its own dime in the absence of state funding. But CDP is running out of money, and cannot and should not be expected to turn to the county’s property taxpayers to foot the bill.

The state Health Department for some reason does not recognize these programs as medically necessary, and has decided to no longer pay for transportation to them. We don’t know the reason because the state Health Department hasn’t responded to our multiple requests for comment on the matter.

The state Health Department is flat-out wrong to make this policy change, especially since there has been a shift in policy by the state Office of Mental Health to better coordinate medical care with mental health care. Doctors have prescribed day hab programs because they will aid with socialization and life skills. They help with recovery so that people can get their lives back.

If that is not a medically necessary course of treatment, I don’t know what is. It should be viewed as just as important as getting somebody with a heart problem to a hospital for an electrocardiogram. This is a clear case of one hand not knowing, or caring, what the other is doing.

Many of the people this policy affects live in group homes, and the people with whom they live simply cannot handle taking the five or six or more people living with them to doctor’s appointments and other places they need to go unless they have a fleet of vehicles and an army of people to drive them.

I could understand this policy change if we were talking about an urban area that encompassed multiple agencies that offer opportunities for socialization, occupational and life skills training and also provide medical services. It would make sense to not pay for transportation to some programs to ensure that there is no redundancy in payment for services that could be provided by another agency that also provides medical care.

But in rural areas like ours, those agencies don’t exist. We by and large have day habilitation programs that have been severely underfunded for as long as they have been in existence and offer what services they can based on the limited dollars they have. Most urban areas also have a substantial public transportation system. We don’t.

What really takes the cake, though, is that some of the programs that are not Medicaid approved — which is what they have to be for the state to pay for transportation to them — are located at the St. Lawrence Psychiatric Center.

The north country’s state elected officials have been asked to intervene, and I hope they can talk some sense into the state Health Department before funding runs out at the end of June.

CDP Executive Director Norma S. Cary said last week that if the transportation program is discontinued, people will in all likelihood be wandering the streets. She is absolutely correct.

Even worse, without being able to get to a day habilitation program, more people will regress in their treatment and need to be hospitalized.

The state needs to do the right thing by its most vulnerable residents and make sure they are able to get the care they need to recover. In the absence of adequate outpatient care — which includes day habilitation programs — the need for inpatient care will increase exponentially. A state Health Department decision to save a few bucks will undo the good progress the state Office of Mental Health has done to provide better community supports for people with mental illness so they can avoid hospitalization. One hand will be not only not care what the other is doing, but will undermine it.

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