South Carolina is more than two years into an aggressive plan to spend more than $200 million to partially repair a fragmented public and private mental health system that some say lacks innovative policies and programs and consistent oversight and accountability.
As the state attempts to improve mental health services, it should not overlook people with intellectual and related disabilities, mental health challenges and substance use disorders, according to a report prepared by the Boston Consulting Group that was released earlier this year.
The study also found, among other things, that the health care system has limited data sharing and poor data quality to measure and manage health goals. The report also cited the state with high turnover and attrition within the state-agency workforce.
The 34-page report — Act 60 Health Analysis — said South Carolina should especially consider the impact improvements might have on rural and low-income residents, the uninsured and the youth.
The report points to an insufficient availability of services to support people with mental health, substance use and intellectual and developmental disabilities. In the report, an unidentified Charleston-area resident, whose daughter requires care for intellectual disability and related disabilities, said: “My daughter is authorized for 60 hours of personal care assistance per week, but we only receive 10-12 hours because there aren’t enough people to do the work. We … can’t imagine how hard it is to find care in rural communities.”
A call to action
The focus on the state’s mental health system is in response to South Carolina Gov. Henry McMaster’s announcement during his 2022 State of the State address that the state is in a mental health crisis and young people, isolated during the pandemic, are hardest hit.
The governor directed the S.C. Department of Health and Human Services (SCDHHS) to study the mental health crisis. The agency formed an informal advisory committee of “public and private behavioral health stakeholders that’s working together to address behavioral health needs in the state,” said Jeff Leieritz, the agency’s director of strategic communications.
Earlier this year, two bills were proposed in both chambers of the General Assembly to restructure the state’s health agencies largely based on the Act 60’s recommendations, Leieritz said. The Senate approved S. 915, but H. 4927 was not voted out of a committee before the session ended earlier this year.
Kimberly Tissot, president and chief executive officer of Able South Carolina, said the state has “failed South Carolinians with mental health diagnoses for decades, and it is critical to invest in community-based services.”
The old ways of placing people behind closed walls and in institutions is abusive and doesn’t work, she insisted. “Currently, our system can’t serve people with dual diagnoses, and any investment in community-based services is closer to where we need to be to save the lives of people while protecting the state from violating several disability rights legislations.”
The S.C. Department of Mental Health (SCDMH) is in discussions with the U.S. Department of Justice (DOJ) to avoid a DOJ lawsuit. After conducting an investigation, the DOJ told the state in July 2023 it has likely violated the law by unnecessarily warehousing people with a mental illness when they could live independently in settings most appropriate to their needs.
Tracy LaPointe, SCDMH’s public information director, said the agency was “surprised by the (DOJ’s) findings, due to the agency’s significant efforts and successes in diligently addressing these exact issues.” Talks with the DOJ are on-going, she added.
An improvement plan
The focus on mental health systems has led to increased community and hospital-based services, the hiring of more mental health counselors in schools, a new mental health hospital in Florence and plans to expand services through Medicaid.
SCDHHS, which runs the state’s Medicaid program, will extend care to about 60,000 children in foster care and adults with serious mental illnesses by the end of the year through the Medicaid managed care plans. The change is designed to eliminate a duplication of services and reduce the need for expensive medical services, Leieritz explained.
The agency has awarded $45.5 million in grants to 13 hospitals to build specialized units by 2026 within existing emergency departments to handle behavioral health situations, he said. A unit at Trident Hospital in North Charleston is open and two units at Medical University of South Carolina hospitals in Charleston are expected to be open in 2025, he said.
The agency has awarded an additional 26 grants, costing $48.2 million, to create or improve mental health facilities in rural and medically underserved areas. The services will not be limited to mental health care, Leieritz added. None of those programs are in the tri-county.
Beginning in January 2022, the state began to increase the number of mental health counselors in schools from 600 to 1,209, Leieritz said. In the fall, the agency will survey the school districts to determine if they’ve hired more counselors, he said. Students are more likely to access mental health services in schools, he said.
A new $100 million behavioral health hospital is scheduled to open next year in Florence to serve the Pee Dee region that suffers from a severe shortage of mental health beds. The hospital is a partnership between SCDHHS, McLeod Health, MUSC and other agencies.
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