Publicly Operated = Coordination and Continuity in the Community
While AFSCME has advocated to preserve public inpatient services for people who continue to need institutional care, AFSCME has also worked for the development of a full range of community-based services to a growing population and for the direct involvement of AFSCME members in service delivery. AFSCME’s intent has been two-fold: to ensure coordination of services and continuity of care to meet the needs of persons who are discharged from state institutions and to ensure a role in community care for experienced men and women who have dedicated their lives to serving people with severe mental illness and people with developmental disabilities.
It is well documented that as service delivery moved from large, state-operated institutions, labor standards for unorganized private-sector workers who deliver services to people with disabilities deteriorated dramatically.
Where states were once the primary providers of services for people with mental illness and those with developmental disabilities, counties and communities now play a major role. Unfortunately, some states have used deinstituionalization as an opportunity to shift responsibility (without adequate funding ) for patients to local governments and for wholesale privatization through private-sector purchase-of-service arrangements for community-based care.
AFSCME believes that publicly operated community-based services for individuals with mental illness or developmental disabilities provide a variety of advantages over a patchwork of private providers who may be here today and gone tomorrow. In states where administrators and legislators have understood the value of the public provision of community services, AFSCME, advocates and state officials have built quality publicly run, community-based systems of care.
A community-based safety net ensures:
- Availability of services
Having publicly run services means that all who need care will get it, not just those who are easy or inexpensive to care for or who can afford to pay their own way. The most vulnerable are protected and do not have to worry that they will be denied care if a private provider sees them as a “money-loser” who cuts into their profit margin. The public sector and its experienced workforce is well equipped and willing to serve those with the most complex needs. - Continuity and quality care
The public-sector workforce that serves individuals with mental illness and those with developmental disabilities is a stable, experienced and trained workforce. These factors promote high-quality care. Poor working conditions, low wages and few or no benefits for workers in the private sector lead to high turnover rates and, in turn, less stable and continuous care for persons with chronic conditions. Also, private-sector providers can go out of business, change ownership and management, and leave clients and their families scrambling to find alternative care. - Cost effectiveness
By providing appropriate community-based services to individuals with mental illness and/those developmental disabilities, state and local governments can avoid increased social costs that occur when there is no effective community safety net. The lack of community-based mental health programs, for example, means that jails and prisons are now housing a growing number of individuals with severe mental illness who otherwise would not be in the criminal justice system. Likewise, loss of employment and homelessness can occur when those with mental illness or developmental disabilities have no access to safety-net programs that help them remain productive citizens in their communities. - Accountability
A public safety net of community-based services means that families have direct assurances that their loved one will continue to receive services and supports that they need. Taxpayers have accountability for how dollars are spent and there is less opportunity for financial abuse and conflict of interest to occur. The local community can feel confident that its concerns will be heard.
The public-sector workforce that serves individuals with mental illness and those with developmental disabilities is a stable, experienced, and trained workforce. These factors promote high-quality care.
Publicly run services provided by AFSCME members across the country include:
- residential (including halfway houses, group homes and individual apartments);
- mobile outreach services;
- assistance with independent living activities;
- attendant care;
- crisis and case management;
- day treatment;
- income maintenance;
- vocational rehabilitation and employment assistance;
- transportation;
- recreation;
- counseling;
- special assistance; and
- medication maintenance.
FOOTNOTES
- Lakin, K.C. Braddock, D. and Smith, G “Trends and Milestones,” Mental Retardation, February 1997, p. 65
- Community Services Reporter, National Association of State Mental Health Program Directors, April 1998.
- Prouty, R. and Lakin, K.C. (Eds.). Residential Services for Persons with Developmental Disabilities:Status and Trends Through 1996 (Report #49), University of Minnesota, Research and Training Center on Community Living, Institute on Community Integration, 1997.
- Ibid.
- Smith, G.A. and Gettings, R.M., Medicaid Home and Community-Based Waiver Services and Supports for People with Developmental Disabilities: Trends Through 1997, National Association of State Directors of Developmental Disabilities Services, Inc., April 1997, pp. 10-11.
- Braddock, et al., The State of the States in Developmental Disabilities, American Association on Mental Retardation, 1998, p. 27.
- Smith and Gettings, op. cit., pp. 20-21.
- Braddock, et al. op. cit., p. 12.
- Ibid. p. 44-45.
- Torrey, E.F., MD, The Harvard Medical School Mental Health Letter, August 1989.
- National Association of State Mental Health Program Directors Research Institute, State Mental Health Agency Profile System Highlights, November 1996.
- Ibid.
- Ibid.
- Isaac, R.J. and Armat, V.C., Madness in the Streets: How Psychiatry and the Law Abandoned the Mentally Ill, 1990.
- National Alliance for the Mentally Ill (NAMI), Stand and Deliver: Action Call to a Failing Industry, The NAMI Managed Care Report Card, 1997.
- Alvarez, F., Ellis, V., “Wilson Orders Probe of Transfers of Developmentally Disabled,” Los Angeles Times, May 17, 1997.
- Martesian, C., “After the Asylum,” Governing, March 1998, p. 33.
- Schlesinger, M., Dorwart, R., Hoover, C., and Epstein, S., “The Determinants of Dumping: A National Study of Economically Motivated Transfers Involving Mental Health Care,” Health Services Research, December 1997.
- Rothbard, A.B., Schinnar, A.P., Hadley, T., Foley, K. and Kuno, E., “Cost Comparison of State Hospital and Community Based Care for Seriously Mentally Ill Adults,” American Journal of Psychiatry, April 1998.