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Role of Community Mental Health Centers as Rural Safety Net Providers
From 1963 until 1981, community mental health centers (CMHCs) received categorical federal grant funding which enabled them to serve all members of their respective communities, regardless of their ability to pay, effectively creating a safety net for basic mental health services. The Omnibus Budget Reconciliation Act of 1981 redirected federal mental health funding away from the CMHCs and toward state mental health agencies. Under this arrangement, many CMHCs were expected to focus services on the needs of people with serious mental illness, often to the exclusion of other community members.
This project will study selected CMHCs serving rural communities. Our selections will be made on the basis of the presence or absence of county government in mental health financing and the presence or absence of managed behavioral healthcare contracts with the CMHC. Our research questions are as follows:
- 1) To what extent do CMHCs act as a mental health safety net? Where do uninsured community residents not covered by targeted funds receive mental health services?
- 2) Do CMHCs include in their missions a commitment to provide mental health services to all in the community who cannot afford to obtain them from private practitioners? and
- 3) How great is the variation among CMHCs in terms of the services they provide and the mission? To what extent is this variation explained by the role of county-level governance and/or managed care?
Publications
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Role of Community Mental Health Centers as Rural Safety Net Providers
Author(s): David Hartley, Donna C. Bird, David Lambert, John Coffin
Report Number: Working Paper No. 30
Date: 05 / 2002
Investigates the extent to which those organizations formerly designated as community mental health centers (CMHCs) currently act as a rural mental health safety net, e.g., provide mental health services for free or at reduced charges to rural populations not covered by public or private insurance or grants. Findings: Based on three comparative case studies, CMHCs continue to believe that it is within their mission to act as a mental health safety net, but all three also acknowledged that their priority population is now SPMI (serious and persistent mental illness) adults and SED (seriously emotionally disturbed) children. Their ability to serve indigent clients who do not fall into these categories depends on their ability to cross-subsidize such services with funds designated for their priority populations. These providers were also able to fund some safety net services with grant funds made available through federal and regional programs, often targeted to outreach and prevention. In Minnesota and Oregon, county government and county funded social services also supplemented the safety net in meaningful ways. Lacking such county involvement, the Maine CMHC was forced to use waiting lists to manage the demand for free care. We conclude that county funding and grant writing are two ways that CMHCs have been able to plug the otherwise widening hole in the rural mental health safety net. Based on the findings, the report recommends an explicit discussion of the mental health safety net, both urban and rural, using the Institute of Medicine's report on America's Health Care Safety Net as a model. Also recommended are outreach programs to facilitate access to services for rural residents experiencing stress, depression and anxiety, and a shift from diagnosis-specific funding to the use of a family systems approach for those thus referred.
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