Lean payments are causing some providers to drop out of a home-based program for Minnesota's mentally ill.
Theresa Dolata first thought about suicide at age 5. A history of childhood assault left her ravaged by post-traumatic stress syndrome, then depression, then bipolar disorder -- and eventually she wound up homeless.
Today, at 37, she's living on her own and even counseling other patients, thanks to a caseworker who comes to her home to provide therapy, skills training and help with medications.
But mental health advocates worry that the program serving Dolata -- and nearly 15,000 other mentally ill Minnesotans -- is in danger of unraveling because of low state reimbursement.
Community Involvement Programs, a Minneapolis nonprofit that serves 150 mentally ill clients in the Twin Cities, will suspend services under the program in four metro counties Aug. 1. More than 20 providers have dropped the program since 2007.
"We just reached a point where we were exhausted trying to keep the program afloat,'' said John Everett, executive director at Community Involvement. "We weren't in a financial position to fill the gap."
"The cost of delivering the service is more than the reimbursement," said Ron Brand, executive director of the Minnesota Association of Community Mental Health Programs.
Adult Rehabilitative Mental Health Services (ARMHS) was created by the Legislature in 2001 to help patients avoid costly, traumatic institutional care by giving them help with medications, skills training and daily living assistance. Without it, advocates fear, some patients will wind up in crisis or in hospitals.
Before enrolling in ARMHS about 18 months ago, Dolata said she had a hard time with even basic daily tasks such as brushing her teeth. She's happier now, enjoys playing Scrabble and even helps educate others about mental illness.
"If I could have had some of the support a lot sooner ... I might have had a different life," Dolata said. "I don't want people to have to go through what I went through."
State human services officials say they understand the problem and are organizing a meeting in August with advocates, providers and insurance companies.
"We know ARMHS is a very important service," said Maureen O'Connell, assistant commissioner at the Minnesota Department of Human Services. "We think it's important that we continue to have a really robust community-based mental health service to avoid deep-end services like hospitalizations."
Other organizations will continue offering ARMHS at about 320 locations statewide. And Everett is making sure his clients can go to other providers.
But if more agencies drop out, it could result in patients requiring more expensive forms of treatment, said Sue Abderholden, executive director of the National Alliance on Mental Illness (NAMI) in Minnesota. Other services are available, but they are either not as extensive or are designed for people with more debilitating conditions.
Part of the problem is a dwindling pool of state funds. Minnesota's mental health budget fell from $218 million in 2011 to $204 million in 2012, according to a NAMI report.
Even some agencies that will continue in AMRHS are concerned about low reimbursement rates.
"We're really stretched to be able to cover these services," said Cindy Guddal, a manager at Courage Center, which provides the service to 120 people. The organization has a three-month waiting list for the program.
'Needs are still there'
Providers worry that the state's response could be too little too late. It's unclear how long it will take to implement strategies suggested at the August meeting. And since the program was created, reimbursement rates have risen only once, in 2004.
Vail Place, the organization that connected Dolata with ARMHS, dropped out in 2008 because it, too, was losing money.
"Whatever formula [the state] used really didn't work. ... The problem has been going on since the program started," said Kathie Pierce, director of community development at Vail Place.
"This leaves people who are already underserved at a disadvantage," said Abderholden. "It's not like people are going away. The needs are still there."
Daniela Hernandez • 612-673-4088