I am writing you on behalf of the board of directors of Catawba Mental Health Center, one of 16 such centers in South Carolina, which provides mental health services in Chester, Lancaster and York counties to approximately 3,000 clients.
Senate Bill S.399 proposes merging the S.C. Department of Health and Environmental Control’s (DHEC) public health sector with the S.C. Department of Mental Health (SCDMH) and the S.C. Department of Alcohol and Other Drug Abuse Services (SCDAODAS) to create the Department of Behavioral Health and Public Health.
This merger would prove extremely problematic for several reasons. Firstly, this merger would create a massive agency in terms of staff. The public health sector of DHEC currently employs approximately 2,000 staff. SCDMH currently has approximately 3,544 staff, but should have closer to 4,626, and SCDAODAS has approximately 50 staff. This makes for a total of nearly 6,000 current staff. If SCDMH was operating at full capacity, there would be well over 6,000 in staff.
If SCDMH becomes a division in such a massive agency, it would likely dilute the mission and subsequent funding of specific mental health programming. Both the potential loss of funding for programs and staff for those programs would ultimately affect the care and services clients receive.
In the wake of the COVID-19 pandemic, the last thing that needs to happen is to make it more difficult to get funding for mental health care. The need for mental-health-care professionals and programs has dramatically increased since COVID.
As mentioned earlier, SCDMH isn’t staffed to max capacity. Despite being understaffed, underpaid, and overworked, the House Legislative Oversight Committee evaluated SCDMH for 18 months in 2019-20 and found it to be an “exemplary state agency.” SCDMH has continued to provide excellent care to clients, a majority of whom cannot afford mental health care and live in more rural, underserved areas with few resources for those living with mental health conditions.
Since COVID, the patient-to-provider ratio in South Carolina has decreased from 610:1 in 2019 to 520:1 in 2022 (countyhealthrankings.org). Even with a decrease in caseload, South Carolina’s average of 610 clients for every one mental health professional is still nearly double the national average of 310:1. If this merger is successful, valuable positions and services that are funded completely or in part by grants and other sources could cease to exist.
In 2019, the number of those seeking help for anxiety and the reported severity of that anxiety, increased dramatically. By 2021, the total number of anxiety screenings in the U.S. was 422% higher than the total number of anxiety screenings in 2019 and 56% higher than the number of screenings for anxiety in 2020. In response to COVID, many programs were enacted to mitigate negative impacts, but reported rates of moderate to severe anxiety remain consistently above pre-pandemic reported rates. (mhanational.org/mental-health-and-covid-19-two-years-after-pandemic).
Dr. Edward Simmer, director of SCDHEC, created the taskforce SHaPE SC to determine how DHEC, as well as other state agencies, could improve currently provided services. Some of the recommendations included that DHEC hire and appoint capable leadership and staff with appropriate experience; supplement services through active public and private partnerships to ensure resources across the state; increase interagency coordination in key areas to eliminate gaps in services; address communication gaps between DHEC’s central office and regions, specifically in regards to agency-level directives; and preserve efficiencies established during the COVID-19 response. DHEC has taken steps to address these recommendations, but with the current necessary improvements that should be made, it is ill-advised to pursue a merger, as it will likely compound many of the aforementioned, pre-existing issues.
As previously stated, the merger would create the Department of Behavioral Health and Public Health, a massive government entity with a governor-appointed director. The restructuring of SCDMH in a cabinet, as S.399 proposes, could have detrimental effects on a service agency. Every time a new governor is elected, leadership could change to a political appointee who has little to no knowledge of mental-health concerns. A service agency needs stable leadership and input from the local community to best serve its constituents.
In the midst of the most significant mental-health crisis in our history, S.399 seems unplanned, ill-timed and fraught with the potential to negatively impact the lives of tens of thousands of South Carolinians and their families.
Melanie O. Saxon is vice chair of the Catawba Mental Health Center Board. Other board members include Chair Georgette Fuhr, Cherie T. Barton, Sandra Calhoun-White, Dr. Troy Fitzpatrick, Pamela Giardiello, John H. Gregory III, Marija Mack, Victoria Nolph and Bennie Thompson.