For nearly five years, Carroll County mental health advocates have been working to establish a nonprofit agency to coordinate services to the mentally ill.
The process has run into repeated delays as proposals to establish a Core Service Agency have been drafted, submitted to the state and county, returned with questions, rewritten and resubmitted.
Now the effort is back to the drawing board once more.
Project organizers have abandoned the idea of creating a separate agency to function as Carroll's Core Service Agency (CSA) and are writing a new proposal that calls for Human Services Programs to manage the CSA.
Human Services Programs is a nonprofit agency that serves the the county's low-income population through several avenues, including homeless shelters, emergency rental assistance and a family center.
"HSP is already an established nonprofit. They already have a management infrastructure, and it wouldn't require setting up a whole new system," said Jolene Sullivan, director of the county's Department of Citizen Services.
Sullivan is on a committee established by the county's Mental Health Advisory Board to develop a model for the CSA.
The committee is working on a revised CSA proposal and plans to submit it to the County Commissioners for approval by the end of the month.
The state Mental Hygiene Administration must also approve the proposal in order for the CSA to receive $150,000 in state money for salary and operating expenses.
"We're under tremendous time pressure to get this thing up and going," said Spencer Gear, a CSA committee member and director of Granite House, a Westminster agency that provides housing and rehabilitation services to psychiatric patients.
"The new mental health system is starting in three weeks, and the CSA is a central piece of that," Gear said.
New Maryland plan
Beginning July 1, Maryland's publicly funded mental health delivery system will be overseen by Maryland Health Partners, a partnership between Green Spring Health Services Inc. of Columbia and CMG Health Care of Owings Mills.
The two companies will form the Administrative Services Organization (ASO), which will determine who is eligible for care under the new system and how billing claims will be processed.
The new state system calls for CSAs to manage mental health care at the local level and work with the ASO. Carroll's CSA was expected to be in place by July 1, but now organizers say a September starting date is optimistic.
Until that time, the ASO will handle Carroll's mental health funding with no local input.
Project organizers said they decided to rewrite the CSA proposal because the county attorney's office had concerns about liability with respect to the nonprofit agency, which would have been defined as an "agent" of the county.
The decision to revise the CSA proposal to have Human Services Programs administer the agency has some mental health advocates worried about whether it would weaken the program's effectiveness.
"The CSA would lose a certain amount of autonomy by having to answer to the director of Human Services Programs," said Richard Blackwell, a regional coordinator for the Mental Hygiene Administration.
Under the original plan, the CSA would have been organized as a separate entity with its own executive director.
The new CSA model would have a program director who would report to Sylvia Canon, executive director of Human Services Programs.
"I'm concerned that the mentally ill will be lost in the shuffle again," said Janice Becker, a long-time mental health advocate. "Human Services Programs already deals with so many large programs."
Canon rejected that notion and said that she would rely heavily on the advice of the Mental Health Advisory Board members to write a job description for the CSA director, interview candidates and make a hiring recommendation.
"The Mental Health Advisory Board would have a lot of input at the beginning of the program," Canon said. "This is all new ground we're looking at."
The CSA concept was approved by the General Assembly in 1991 as a way to improve the delivery of publicly funded mental health services by putting funding and policy-making decision in the hands of local administrators.
A CSA has more flexibility in creating needed services and pursuing private funding for services, free from the constraint of a governmental bureaucracy, state mental health officials say.
Counties lose money
Besides Carroll, Blackwell said the only counties without CSAs are Garrett, Wicomico and Somerset.
Over the years, Gear said Carroll has lost "hundreds of thousands" of dollars in state mental health funding because no CSA was in place.
For example, in the current fiscal year, the state Mental Hygiene Administration included approximately $200,000 in its budget for crisis mental health services in Carroll.
But Gear said the money reverted to the state because of the county Health Department's cumbersome regulations governing bidding for services.
Pub Date: 6/04/97