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Wednesday, June 14, 2000
If you live in a community, as opposed to a vacuum, you've probably bought or sold plenty of stuff for a good cause: gift wrap for the pre-school; cookbooks for the senior citizens center; candy for the softball league.
But have you ever bought an auction item to help pay for a depressed teen-ager's therapy?
Me neither. I never even heard of such a concept, until I got a phone call about a fund-raising event for a mental health center, and along with it an education on the brave new world of managed care.
In my mind, at least, fund-raising is usually for extras -- books, field trips, Little League uniforms -- or, in the case of an institution, capital projects like a new wing.
Then came the call from Olivia Zitelli, director of human resources at Turtle Creek Valley MH/MR, asking me to plug their on-line auction of celebrity autographs, taking place on eBay now through June 20. It's an experiment, she said. They hope to raise $1,500. (Turns out that eBay has yet to post the promised link on its Charity Auction page. The correct address is members.ebay.com/aboutme/hr-at-tcv.
The proceeds, Zitelli said, will help with things like the new roof that cost them $27,000 last year -- $15,000 of which they raised via a golf tournament. But they will also go toward direct services.
How could that be? County MH/MRs get millions of dollars from the state. Could the need suddenly have outstripped supply to such an extent that treatment for people with schizophrenia is now riding on the bidding for Troy Aikman's autograph?
Not exactly, but kind of.
"Fund-raising didn't begin with managed care," noted Pat Valentine, director of the Office of Behavioral Health for the Allegheny County Department of Human Services. "Providers have always done fund-raising. We encourage it to enhance their services and also to make the community more aware of what they're doing."
Still, managed care has hit some parts of the mental health delivery system hard. Centers used to get program funding and a degree of flexibility in using it. Now they have to bill individually for every service. And the reimbursements don't always cover the costs.
"A service might cost $80 to provide, but the reimbursement might only be $55," said Brenda Lee, director of the Mental Health Association of Allegheny County, which advocates for consumers.
"There's a gap there," Lee said, "so they end up with a deficit. They can make it up by reducing staff, which impacts the people they serve. Or they can raise funds."
Salary cuts aren't an option, said Judy Monahan, Turtle Creek's executive director. "We have a terrible problem retaining staff because salaries are so low and the economy is good. That's a problem nationally. We're paying direct care workers the same as Burger King, and our workers need a high skill level."
Some services aren't reimbursed at all. Say a mobile crisis worker talks a distraught man named Fred down off a bridge. The center can bill for that. But now Fred's mother is distraught, too. The crisis worker isn't a therapist, so his agency can't bill for the hour he spends calming her down.
Therapists, on the other hand, can't bill for case work, such as making sure Fred gets to his doctor appointments. But the case worker who can bill for that has a long list of other clients, some in worse shape than Fred.
The agency can bounce Fred around in the name of billable hours and risk losing him through the cracks, or it can provide the services, eat the costs and try to fund-raise the difference.
In the case of Turtle Creek, the $7 million budget covers treatment for 3,500 adults, 800 adolescents, 2,200 people with substance abuse and 300 with mental retardation, plus 12,000 outreach clients.
It's not enough money to do everything they want to do, Monahan said. And Turtle Creek is by no means the only MH/MR in that position.
"I don't know if they're all fund-raising to this extent," said Lee of the Mental Health Association, "but nobody has enough."
Maybe there's no such thing as enough funding for mental health treatment, but there certainly does seem to be such a thing as too little. It'll be a good thing if Carol Burnett's autograph can tip the balance in a depressed kid's favor. But in light of Columbine, Paducah, Grove City, et al., it does seem kind of sad that this is the best we can do.