TennCare cuts put mentally ill at risk

Dealing with racing thoughts and hearing strange voices, Sarah Hale was lost in the rat maze of mental illness.

She was a college dropout, without a job or any hope about the future. She couldn't even sleep.

Now — little more than a year later — the 20-year-old woman is punching a time clock, paying taxes and focusing on personal goals. The change didn't occur because of a new miracle drug. It happened because she took her old medicine while working with a therapist. Matthew Ferguson, her case manager, kept her on track.

But now she could lose that help. Once she turns 21, she falls into the adult service category, which is facing budget cutbacks.

TennCare cuts would limit case management for adults to only those coming out of hospitalization. And that service would end after three months. The cuts shave $10.5 million in state spending, savings that mental health care experts say will be short-lived.

"If these folks are not getting care, they will end up in the jails, they will end up in the hospitals and they will end up being homeless," said Ben Middleton, chief operating officer of Centerstone, which provides community-based behavioral health care. "Without tending to their issues, they could not only be a harm to themselves but to others."

The case management services save Tennessee about $86 million a year, according to Middleton, by keeping people out of hospitals and other crisis situations.

Originally just a proposal, the cuts for mental health case management weren't spared in the budget Gov. Bill Haslam sent to the legislature. Once federal matching money is figured in, the cuts to this program add up to $30 million.

But Haslam is giving the program a second look.

"We'll be reaching out to a variety of stakeholders, including mental health professionals across the state, in the coming days and weeks," said Alexia Poe, the governor's director of communications.

Middleton said he and others had tried earlier to convince officials not to cut the program.

"We can't just idly sit by and let this happen when we know the damage this will have on the populations we are serving," Middleton said.

Hale said she has bipolar schizophrenia, a condition that got out of control when she stopped taking a prescribed medication and started popping Xanax. The anti-anxiety drug, which usually calms people, had the reverse effect on her. She descended into psychotic episodes and would stay awake for three to four days at time.

"I was really angry — enraged," Hale said. "I would want to beat people up and fight, disrespect my mama and stuff like that. It made my schizophrenia worse. The voices were telling me to do things that would have me in jail for life. I was really, really terrible."

She said her first two meetings with Ferguson, who works for Centerstone, were a waste of his time. But he kept at it. He made sure she made her appointments with a therapist and had the transportation to get to them. While the therapist treated her illness, Ferguson over the past year has helped her navigate the little and big obstacles of life.

Her first goal was to get off pills. Now, she's working toward building a good credit rating so she can buy a car and move out of her mother's house into an apartment. She wants to go back to college and has her eyes on securing a management level job where she works, which would qualify her for tuition assistance.

But she is taking it one step at a time.

"Really, I have just been trying to get my head right before I make any more major decisions with my life," Hale said.

Under the requirements for case management in TennCare's recommended budget for 2016, Hale or someone 21 and older might have fallen through the cracks.

"Somehow, Sarah was never in crisis," he said. "She never actually went to a psych ward or anything like that. Under those criteria, she wouldn't have qualified for help."

She is one of between 40 and 45 clients Ferguson assists. Sometimes, those clients won't take help even though he will go their homes or even to shelters when the clients are homeless.

"Suddenly there is no one to organize appointments and transportation," Ferguson said. "No one to help them get food or cover bills when they don't have money for medication. You have very, very quickly down spirals. A lot of times, they end up in the psych hospital."

He calls Hale his golden client. She said she's grateful for his patience.

"A lot of people just give up on you," Hale said. "He's really been there for me."

Reach Tom Wilemon at 615-726-5961 and on Twitter @TomWilemon.

At issue

Potential cuts to TennCare, the state's health care plan for the poor, would limit case management for adults to only those coming out of hospitalization. The cuts shave $10.5 million in state spending, savings that mental health care experts say will be short-lived.

This story has been updated to correct the status of Sara Hale's coverage situation. The proposed TennCare cuts to mental health case management would affect those 21 and older.