Counterpoint: Private providers are needed for treatment of mental health, substance use

"We have seen great innovations in mental health care provided by community nonprofit organizations," the authors write. "They can respond more nimbly and make changes to provide new evidence-based care. We have seen new BIPOC providers emerge to meet the needs of their communities." Photo by Getty Illustrated.

Editor’s note: This is a response to a recent Reformer Tax and Spend commentary that argued privatization of government services has enabled fraud and waste. Read it here.

The premise of a recent Reformer commentary decrying the privatization of government services was that due to some bad characters, we need to have “government agencies complete these tasks direct.” The incursion of private entities into public services, the piece argued, “creates opportunities for waste and fraud that are inherently absent in a government-run system.”

We strongly disagree. Recent fraud calls for better government oversight — not abandoning collaborations or contracts with nonprofit organizations or with entities that have specialized knowledge and skills. Medicaid pays for services delivered by a variety of professionals and organizations that support people with disabilities and mental illnesses to live in the community.

We hope the author isn’t suggesting that all these programs should be run by the state or the counties. There is a risk in accumulating too much control under any single entity, despite best intentions. This model lacks checks and balances. Neither state nor local governments are designed to be health care or direct service providers.

Or perhaps the author intended to single out private Medicaid managed care? There is a profound difference.

There are certain situations where we do not want government providing services directly — including mental health and substance use disorder care. There is an inherent conflict of interest if government is regulating while also paying for and providing direct care all under one roof.

Although state-operated services are better now than before, we cannot forget the licensing violations and poor institutional care that went on for decades. Facilities were built in locations due to political considerations — not based on needs or where the workforce is.

We have seen great innovations in mental health care provided by community nonprofit organizations. They can respond more nimbly, make changes to provide new evidence-based care, integrate services — such as housing and mental health care — and respond to the changing needs of the community. We have seen new BIPOC providers emerge to meet the needs of their communities. This could not have been done if all mental health and substance use disorder care were run and directly delivered by the state.

There is great value in inviting different perspectives of our system — from community-based providers, people with mental illnesses and their families, and government. And this is our shared system. No one government agency can be the provider nor meet the mental health needs of Minnesotans.

Our nonprofits have people from the community on their boards, so they are responsible to the community. They operate under a tangled system of regulations for providing care along with strict billing procedures. Today, a robust majority of mental health care is provided by community providers – many nonprofits, a few for-profits. By and large they do a good job of delivering good care despite being grossly underfunded.

Our inability to meet the mental health needs of Minnesotans rests with low Medicaid reimbursement rates, lack of enforcement of the mental health parity law, and limited funding for grants. The role of government is not to increase state-operated services but to increase funding for our community providers and to increase funding to expand our mental health workforce.

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