Private Nonprofits Stepping in to Fill Void in Mental Health Services

“Private nonprofit organizations are stepping in to fill the void in services created by Rockland County’s decision to dismantle its mental health case management program to plug budget holes. In the most recent round of layoffs, the county eliminated 15 case management positions from its mental health unit, a move that took apart the state-funded program, which provides counseling and other services for mental health patients.

Two nonprofit groups, the Rockland County Mental Health Association and Jawonio, have since taken over responsibility for more than 180 mental health patients from the county and are getting the state funding the county used to receive.

Stephanie Madison, executive director of the Mental Health Association, said her nonprofit organization is hiring five case workers — four have already been hired — to accommodate the dozens of new clients.

“This is just an expansion of services we are already providing,” she said. “We just had to complete the paperwork.”

She said money for hiring the new case managers will come from state Medicaid, which had previously gone to the county. Both nonprofits offered the case worker openings to the laid-off county workers, but only one was hired, by Jawonio.

Madison said the process got under way before the layoffs, when county officials reached out to the nonprofit sector to inquire if they would be able to assume responsibility for the patients who would have been left without services.

She said the move reflects a shift in mental health services that has been under way for several years, as cash-strapped local governments have turned to the private sector to provide services they can no longer afford to offer.

Several years ago, nonprofits took over Rockland County’s chemical dependency programs after the county cut them.

“This is happening in many communities, not just Rockland,” Madison said. “Local governments just can’t afford the cost and can’t be as nimble as nonprofits can in terms of creating new programs and being lean and cost-effective.”

Jawonio, located in New City, has doubled the size of its case management program, adding four new employees to handle the caseload from at least 97 participants from the county, according to Chief Executive Officer Jill Warner.

“This isn’t a stretch for us, because of the relationship we have had with the county and our existing programs,” Warner said. “People will continue to get quality services from people who know how to deliver those services.”

The patients in the program are people who have already been diagnosed with a mental health condition and require additional treatment and support, from counseling to vocational job training. Some of them are living in group homes, others independently. Case managers typically meet with the patients several times a month.

Mental health advocates said it remains to be seen whether nonprofits will do a better or worse job than counties in running the programs.

“I would think that the nonprofit sector would do a better job,” said Elaine Levin, associate director of The Empowerment Center, a mental health advocacy group that works in Rockland and Westchester counties. “It’s much less bureaucratic.”

Still, she said, it costs less for private-sector organizations to run these kind of programs, because they don’t have to pay into state retirement systems or provide union-negotiated benefits that county workers traditionally receive.

“Working for the state or county is usually a more secure and better-paying job,” Levin said.

Madison said that in the past two years, her organization has seen a dramatic increase in its workload, which has doubled to more than 1,000 clients. She attributed the increase to a combination of factors, from local government downsizing its workforces to more people seeking care and health care providers referring more patients for mental health services.

By far, the county’s mental health department fared the worst in the county’s job-shedding plan, which concluded last Friday with 64 employees laid off and dozens of vacant positions eliminated.

County Executive C. Scott Vanderhoef said the layoffs were necessary to plug a budget deficit — which at the time was estimated at $21 million — because the county was unable to get approval from the state Legislature to increase the sales tax and issue a deficit bond. The county Legislature approved Vanderhoef’s job-shedding plan at a June 5 meeting.

Union leaders were critical of the layoffs, which they argued spared top management. Some even accused Department of Mental Health Commissioner MaryAnn Walsh-Tozer of retaliating against union members in her department by targeting case management workers in mental health who had been outspoken at budget hearings about previous cost-cutting initiatives.

Walsh-Tozer didn’t return a call Wednesday seeking comment.”

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