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out any insurance. For them fees are set on a sliding scale based on family income.
The Rappahannock-Rapidan Community Services Board is unique in offering full mental health services to everyone, Mr. Rafala said. Other community services boards only offer services to those whose care is fully reimbursed by the state, he added.
However, he worries this may not continue as each of the clinics is under pressure to find more clients whose care is fully reimbursed. To make up the difference between the cost of salaries and overhead to provide the clinics and the amount that is reimbursed, the Community Services Board receives help from the state and each of the five counties.
In exchange for providing funds, the boards of supervisors want the services to be available locally, and that has kept the CSB from saying everybody has to come to Culpeper for services, Mr. Rafala said. But the state is trying to cut back.
For problems of substance abuse, including alcohol and other drugs, a full range of alternatives is available from out patient counselling to a 28day inpatient program at Boxwood, a facility operated by the Community Services Board.
For problems of mental retardation, the local clinic staff becomes involved as advocates trying to get the person placed in the program that best fits his or her need. There are not enough spaces available for all the people who could benefit from programs of assisted living in group homes, Mr. Rafala said. The clinic staff also becomes involved in advocating for aj»ing clients. • Jeanie McNear, Rappahannock's paid coordinator for the Retired Senior Volunteer Program, also works out of the Clopton House. She also coordinates children’s transportation from school to see the child therapist, for example.
The clinic staff also works with the Sheriffs Office, arranging to get arrested mentally ill people into hospitals if necessary.
During fiscal 1996 there were 195 clients in the county seeing the therapists for outpatient mental health services and 38 clients seeing them as outpatients for substance abuse, according to statistics Mr. Duncan gave the Rappahannock Board of Supervisors last summer. In comparison 19 clients received services from the senior nutrition site, and another 22 seniors received meals delivered to their homes.
95.7%