The long and painful process of reforming the way mental health services are delivered will revisit this area with a vote to be cast Tuesday.

That is when the Sandhills Center Area Board will consider a recommendation for a $5.5 million contract with a private provider to administer services to individuals at the organization’s access points in the eight-county area, according to CEO Michael Watson.

In Rockingham, the access point is located on Lawrence Street.

He says the move to contract the private company to provide these services would simplify the way the local management entity (LME) operates, and allow it to focus on the quality of the services being rendered and the necessity of those services.

“Up until now, I feel like we’ve been kind of caught in the middle between being a manager and a provider,” Watson said. “We’ve been worried about competition and other things we don’t need to be worrying about, and I think if we’re able to do this, we’ll be able to provide a broader array of services.”

Watson said the dual-functionality of the Sandhills Center as a LME and a provider created numerous conundrums such as: ‘How do we contract with ourselves?’ and ‘How do we provide oversight for ourselves?’

The state of North Carolina has been in the process of reforming mental health care for years, but the latest round has been in full swing since about 2000.

County facilities were combined under the umbrella of the LMEs whose purpose was somewhat unclear from the start, but was understood by many to be to manage the providers who would offer mental health services after those services were privatized.

Many of the private providers which sprang into existence operated under the guise of “community support,” which Sandhills Public Information Officer Sid Linton explained basically meant Medicaid-qualified.

He explained the way this was regulated by the government, there was only one rate, $65 an hour, there were no quotas for professional, qualified staff and they were allowed to recruit clients. So, Medicaid ended up paying for services rendered, in many cases, by unqualified individuals who only earned $8 an hour in some cases, while the community support organizations kept the rest.

In large part, this could be attributed to the “service-authorization” function, which is currently handled by one company throughout the state, and approves whether services are needed, and whether Medicaid will pay for them, according to Linton.

Last year, the North Carolina legislature mandated the service-authorization function be returned to the LMEs, which Sandhills plans to begin in 2010.

Along with taking over this function, Watson said this move will free the staff of the Sandhills Center up to provide oversight and management of service providers..

Richmond County Commissioner Thad Ussery is the current chair of the Sandhills Board, and he believes there is support for this measure among the board’s members.

“The main reason (I believe this is needed) is the more you can manage locally, the better off you are,” he said. “Nobody knows the needs of the local clients like someone who is there locally to see what is happening with them.”

He acknowledged there could be hiccups in the short-term application of yet another transfer of providers, but believes this will pay off.

“I personally think it’s going to be better in the long run,” he said. “Any time you have new programs, you’re going to have some things that need to be worked on, but we will be better off in the long run.”

Both Watson and Ussery said the crux of the transition will be keeping entry points open and accessible to those in need. To this end, the Sandhills Center is adding a toll-free crisis line, which will offer people a chance to call in and talk to a professional with any questions they have or set up an appointment.

That phone number is 1-800 256-2452.

Watson said the goal of the transition is to make it “as smooth as possible, so that the patients don’t even realize there’s been a change,” and to implement the transition at the beginning of the fiscal year on July 1.

He noted some challenges in transferring these services include staff turnover and planning and logistics, and could take time to sort out.

“This private provider will be doing exactly what we do, and it is one that has experience doing this and also has experience taking over for other programs, “ he said. “We’re really just interested in the outcomes anyway. We’re putting about $5.5 million into this contract, and we’ll be monitoring those outcomes.”