Members of Carroll County's Mental Health and Addictions Advisory Committee are frustrated with the county commissioners, who in nine months have failed to respond to its recommendation to establish a nonprofit agency to coordinate services for the mentally ill.
The committee's recommendation came after 18 months of studying the concept of a "core service agency (CSA)," which is endorsed and funded by the state Mental Hygiene Administration.
The county commissioners say that, although they haven't made an official decision, they heavily favor either setting up a core service agency within the county health department or rejecting the CSA idea entirely.
In the meantime, Commissioner Elmer C. Lippy says they need more time to study the CSA concept and that, for now, the issue is in limbo.
"There's a noticeable lack of enthusiasm for creating another agency we believe is not necessary and would create another layer of bureaucracy," Mr. Lippy said.
Some members of the mental health and addictions advisory committee said they are disappointed they haven't heard from the commissioners since they submitted their recommendation in March.
"We had expected there would be a response from them, even if it was just to say it's under study," said Helen Choma, co-chairman of the panel.
Mr. Lippy said the commissioners see no need to notify the committee until they have taken an official vote on whether to establish a CSA.
County health officer Janet Neslen and deputy health officer Larry Leitch have briefed the commissioners about core service agencies.
Dr. Neslen said she hasn't decided where she stands on the issue and has not advised the commissioners on a position.
"We hoped we could get them informed enough to make a decision that is truly their own," she said.
"I've tried to figure out what truly would work best for the county, and I'm not sure I know. I'm not sure we have enough precedent behind us."
The CSA concept was approved by the General Assembly in 1991 as a way to improve the coordination of community mental health services and include mentally ill patients and their families in policy-making decisions.
Core service agencies are not required, but the state would like to have agencies in all counties by 1995, said Stacy Rudin, assistant director for planning and program development with the state Mental Hygiene Administration.
The growth of community-based mental health services in the past 10 to 15 years is the main impetus behind the state's support of CSAs.
"Community-based systems have gotten increasingly complex," Ms. Rudin said. "Having a local manager that's fiscally and clinically responsible for mental health services is a better way to than having things centrally [state] managed."
Before making their recommendation to the county commissioners, committee members looked closely at some of the 12 core service agencies that operate in Maryland serving 15 counties and Baltimore. One of the agencies serves five Eastern Shore counties.
Besides Carroll, the counties that don't have CSAs are Howard, Harford, Garrett, Frederick, Somerset, Wicomico and Worcester.
A core service agency must be endorsed by local county government. The agency can be set up within the county's health department, as a public agency within another department or as a private, nonprofit agency, Ms. Rudin said.
The Carroll Mental Health and Addictions Advisory Committee recommended a private, nonprofit CSA to be governed by a board made up of mental health service providers from the public and private sectors, mental health consumers, mental health advocates and committee members. The board would be appointed by the county commissioners.
Under state guidelines, CSAs are responsible for allocating all state and county money for mental health programs in each jurisdiction.
This may mean privatizing services currently provided by the health department.
"We certainly have not utilized the flexibility and creativity of the private sector the way other counties have," said Spencer Gear, director of Granite House, a private, nonprofit residential program for the mentally ill.
"We have instead been entrenched in the same old way of doing things," said Mr. Gear, who also served on the committee's CSA task force.
Committee members who studied the CSA concept say the private, nonprofit model would be more flexible in creating needed services and pursuing private funding for services, free from the constraints of a governmental bureaucracy.
A CSA might be more aggressive in pursuing services such as a mobile treatment team and more community rehabilitation services, said Janice Becker, a former mental health and addictions committee member who worked on its CSA task force.