By Chris Fitzsimon
The crisis in North Carolina’s mental health system is center stage this week in the state’s political debate, something long overdue considering the woeful performance of the system that is supposed to provide care for people with mental illness, a developmental disability or addiction.
The Raleigh News & Observer kicked off a five-part series Sunday about the ongoing problems with the 2001 mental health reform efforts under the bold banner headline “Reform wastes millions, enriches providers, fails to serve mentally ill.â€
All but two of the candidates for governor and lieutenant governor were scheduled to answer questions about mental health policy Monday before an audience of mental health advocates, patients and providers at the RBC Center in Raleigh.
More details about the candidates and their proposals, or lack of them, in a future Fitzsimon File and on the Progressive Pulse, the N.C. Policy Watch blog, but early presentations were less than reassuring, filled more with clichés and slogans than displays of meaningful understanding of the system’s problems, much less solutions to them.
The first part of the News & Observer series included more disturbing revelations about a mental health system plagued by problems since the 2001 reform effort began.
Thirteen people have died since then from suicide or overdose shortly after leaving a state mental hospital, numbers that may have been reported before, but still raise serious questions about access to community services, hospital discharge policies and the lack of effective reentry programs for patients.
The first installment of the series highlighted two new pieces of information: one the determination that the state has wasted $400 million on one category of mental health services, called community support, designed to help people with mental illness or a developmental disability with a variety of life skills, with the goal in many cases to help the patient live independently or with less-intensive care.
The state launched community support services in 2006 and expected it would cost $5 million a month, according to the News & Observer report, but a year later the bill was more than $90 million a month, prompting a state audit of a small sample of providers of community support services.
The audit concluded that more than a third of the services provided were not “medically necessary.â€
The News & Observer extrapolated the numbers to come up with the $400 million in waste and assigns much of the problem to a decision to pay companies $61 an hour for services actually provided by employees with a high school diploma.
The state tried to lower the reimbursement rate to $41 last year, which provoked a firestorm of protest, so the state compromised with the current figure of $51 an hour. No one disagrees that providers shouldn’t be charging high rates for services provided by low-wage workers, but the community support issue is more complicated than portrayed in the News & Observer.
The story includes anecdotes of workers taking patients to the mall or out for breakfast and charging the top rate. The rate is a legitimate issue, but helping people with mental illness or a disability shop for themselves or overcome their fear of interacting with other people in public is a legitimate service that must be part of treating people in their communities instead of in large institutions.
The story doesn’t explicitly say the services shouldn’t be provided, but many readers are likely to seize on the activity itself as waste, not the reimbursement rate.
There is no confusion over the startling claim by Gov. Mike Easley that his administration opposed the 2001 reform efforts, led by Health and Human Services Secretary Carmen Hooker Odom, who Easley says “vigorously†opposed the plan in the General Assembly. That must certainly be news to state lawmakers and the media who covered the debate. The Sunday story quoted Easley from a December meeting with reporters, saying that reform “just happened sort of overnight in late October and we never thought they would do it.â€
That’s troubling enough — that the governor of the state, with a huge staff monitoring the General Assembly every day, missed one of the biggest pieces of legislation in the last 20 years that directly affects the biggest department in his administration.
But whether Easley knew the reform effort was happening or not, he signed the legislation that created it. Signed it, not vetoed it, not held a press conference to condemn it, but signed it.
And as for Hooker Odom, who resigned last year, she was a fixture at the General Assembly and was involved in every step of process to craft the reform legislation. That might explain why she wrote an op-ed column in November 2001, just after Easley signed the bill, saying she had made “fixing the mental health system a top priority†and that “reform has been attempted many times, but this effort is going to succeed because the time is right.â€
Doesn’t sound like very vigorous opposition. The newspaper series resumes Tuesday, so maybe we’ll find out more about the governor who opposed reform but didn’t tell anybody.
One thing Easley has done is unite politicians from both parties, judging from the presentations by candidates to mental health advocates Monday. To a person, every one agreed on the biggest problem with the state’s mental health services — a lack of leadership. Hard to argue with that.
Chris Fitzsimon is director of N.C. Policy Watch. www.ncpolicywatch.com
My letter to Governor Easley’s financial advisor, Dan Gerlach, who has thrown me off (temporarily) using his e mail spaminator. The US Mail will work fine. And if a journalist would follow this up, that would be useful also.
*******************************
Where did Governor Easley hide the Mental Health Trust Fund money, Mr. Dan Gerlach, Governor’s Easley’s financial advisor?
Dan Gerlach, financial advisor for Governor Mike Easley, has stated, regarding accusations that Governor Easley has done very little to address the problems within the mental health system: “Gov. Mike Easley and his administration have been working to make sure it gets fixed.”
Money doesn’t fix everything and money won’t buy you love but money will buy professionals’ time (no more silly $800,000 consultant reports please) which could have been used to create a superior system that would not implode—-which is where we are now.
We’ll be lucky not to have a Republican governor. The smell of blood is in the air and the Democrats created it themselves.
Instead, mental health professionals have been excluded every step of the way and have been assigned the role of robber barons by Hooker Odom, Benton’s predecessor, who sure high-tailed it out of town—-since she had to pay attention to her job up in NYC, where she had been moonlighting for a few years (during the time she was Secretary of NC DHHS).
So, non mental health professionals, seasoned administrator types at NC DHHS, have created messes like the most recent Community Support Services outline of what the ‘high school graduates’ Associate Professional Paraprofessionals are supposed to do which reads like a format for psychologist doctoral training. And not a word out of NC Psychological Association.
NC DHHS has attempted to get doctoral level services for a third or less of the price, pinning the problems on the Endorsed Provider companies when NC DHHS stupidly created a list of Service Definitions, changing them frequently so as to keep everyone from doing their work, turning around and gigging the Endorsed Provider companies when they didn’t do the doctoral level work at the high school level reimbursement rate.
Too little, too late, governor. You should not have robbed the kitty when mental health reform was being created so that the system could have been more carefully laid out—-and we would not have the problems we are experiencing—-everyone stupidly accusing every other someone of deficiencies. And Dr. Janowski, psychiatrist and in the UNC Medical School, does not have the on ground experience of psychologists or mental health workers who have been out in the community seeing the clients, realizing what the difficulties are.
Keep it up. You’ll dig your hole deeper. And elections right around the corner.
Lest we forget: in 2001, the NC State Legislature appropriated $47 + million to the Mental Health Trust Fund for the infrastructure development. Soon after that (and you might know about this, Mr. Gerlach, as you are the governor’s financial advisor or so it seems) the Governor raided this ‘trust’ fund as he decided that other parts of the budget needed more money.
And so, a question to Mr. Gerlach: was this money placed back into that Trust Fund and/or what happened to it?