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Candidates speak out on mental health reform

by Taylor SiskStaff Writer“How, if elected, do you propose to deal with the provisioning of mental health care services in North Carolina?”It’s a question that has been posed with some regularity to this year’s candidates for governor – and urgently so: Our mental health care system is in crisis. Among those candidates, Democrats Richard Moore and Beverly Perdue and Republican Bob Orr have offered the more detailed elaborations of what they would do as governor.Last month, the Associated Press asked each of the candidates to describe how they proposed to reform our mental health care system. Richard Moore said that he would complete any outstanding initiatives that the current head of the state’s Department of Health and Human Services, Dempsey Benton, had begun, toward ensuring a smooth transition. Moore said that this would include working to discontinue blended payment rates, by which agencies are reimbursed at the same rate regardless of their employees’ credentials.“Doing away with the blended payment rates for community support is an absolute must that should have been tackled a long time ago,” Mark Sullivan, executive director of the Orange County Mental Health Association, wrote in an email response to The Citizen. “In fact, it never should have been proposed, and this single issue encapsulated the incompetence that has been the hallmark of reform.”In his response to the AP questionnaire, Moore continued: “My budget will include funding for an internal inspection team to ensure we do not forfeit millions in Medicaid/Medicare payments because our hospitals are not in compliance with federal rules. And I will ensure we are filling key positions related to our mental health system with the most highly qualified individuals by offering sufficient salaries to attract them.”“Stopping the hemorrhaging of federal dollars because our state facilities are out of compliance should be a top priority, as Moore suggests,” Sullivan said.“Also,” Sullivan continued, “Moore seems to have an understanding of the workforce problem we have in the state, both at the administrative level and the direct-care level. He has thought about how to attract and retain competent staff, which must be one of our top priorities.”Moore said that he would seek to institute a “career ladder” for medical and patient technicians within hospitals. “To advance on the ladder and earn a higher salary, the staff will achieve more advanced levels of certification.” Moore said that toward this end, he would ask the community colleges, universities and medical hospitals to design continuing education courses.Moore has also pledged to commit more resources to substance abuse treatment programs.He further has proposed to create clear objective criteria for local management entities (LMEs); to develop standard protocols to ensure consistency of treatment between providers; to develop a funding mechanism to ensure that lower-wealth counties receive the resources to attract high-quality providers; and to develop a system of statewide case management through health care community networks, or what is called a “medical home” system.A medical home is a facility that provides a primary-care physician with a team of additional health care professionals.On her website, Beverly Perdue writes: “I do not believe in separating mental from physical health care. An essential element of our health care goal must be assuring access to quality mental health services.”Perdue, like Moore, advocated for a medical home approach for the primary care of adults and children. “Our Community Care of North Carolina has developed a very cost-effective and quality-driven model of statewide case management through health care community networks,” Perdue says. “We need to extend this kind of collaboration and community network to the delivery of mental health services.”“In my view,” Perdue continues, “the concept of a medical home should play a major role in helping to revitalize our badly tattered mental health system within and outside of Medicaid.”She believes that we must also “strive to define a basic level of mental health services to which needy patients should have access.”Of Perdue’s positions, Sullivan said: “Lt. Gov. Perdue shows some real insight with her comment about the problem of separating mental health care and physical. I would like to hear more specifics from her about how the Community Care model would be integrated into our current framework, and more detail about what she would change in the state system.”John Mader, a local therapist and critic of the Easley administration’s failed reform effort, said of Perdue: “I support her goal of clarifying ‘a basic level of mental health services for needy people.’“However, what would she do for the working poor who have insurance, and therefore do not quality for the state IPRS funded services, yet do not have the money to pay their co-pay, which the private agency will require before providing services?”In response to the AP questionnaire, Bob Orr said: “We must determine where privatization is a viable business model, implement a fair and efficient reimbursement process that pays for actual care, fully fund the Mental Health Trust Fund, and ensure that the state has a secure, long term supply of mental health care providers.”On his website, Orr further articulates his proposals.While affirming that the original idea behind the state’s mental health care reform was valid – moving ongoing and support services out into the communities – Orr says, “I am not convinced that we have the right concept of care, and believe we need to answer some important questions about roles and responsibilities to give us a clearer view of how to proceed.”He says that he believes having the state provide long-term institutional care and LMEs the other services can potentially “provide consumer choice and consistent care closer to home and at a lower cost,” but that “[w]e have not met this intent consistently.”In order to remedy that, he says that we must “provide clear and specific operating guidelines for the LMEs with the appropriate flexibility and funding to create provider networks” and reassign to the LMEs primary case-management responsibility with the authority to be the “funnel for all care and services.” He argues that a single statewide standard for LMEs must be established.Orr says that we must determine “state versus local roles and responsibilities for providing the local safety net of 24/7 crisis response, and act immediately to address our acute care deficiencies.”He then adds that we must “put the state hospital downsizing effort on hold, while we address the shortage of beds across the state and focus the reform effort on fixing the community-based system.”“I appreciate Bob Orr’s thoughtful and balanced analysis,” Mader said, “and ask myself how he will follow through more effectively than the current administration.”“Bob Orr seems to have a solid understanding of the issues,” Sullivan said, “as well as a grasp of the principles that have guided reform thus far. He is asking the right questions, and makes a couple of specific suggestions that are on target.”Sullivan sites, as an example, returning case-management responsibilities to the LMEs.“Case managers help connect consumers with the services that they need and help monitor the quality of the services that are provided,” he said. “This should have remained with the LMEs. Conflicts of interest arise when this function is with a private agency.”He also praises Orr for suggesting we must rethink privatization, especially in rural counties, and for recognizing the importance of fully funding the Mental Health Trust Fund.“It is a lot to ask these candidates to provide specific recommendations on this complex issue,” Mader said, “yet we know that Hooker Odom crafted a wonderfully high-minded plan for ‘State Mental Health Reform.’ Many of us in the field questioned its basic assumptions and implementation. A very few individuals actually made the decisions on key parts of the implementation.“Who will be making the decisions in the next few years – the many knowledgeable professionals or a few well-intended department officials?”

  1. This Democrat recognizes that Republican Bob Orr has most thoroughly thought about mental health reform

    Dear Democrat gubernatorial candidates: please stop being afraid of diss’ing Easley. He wrecked mental health reform.

    Only luck will save the Dems from losing the governor’s seat this time around.

    As a doctoral level provider, fully participating in mental health reform in NC:

    1. we do not need more case management.

    2. if the LME’s go back to case management, how will they avoid favoritism?

    3. this favoritism already exists in the largest LME in NC, specifically, Smoky Mountain Center LME, wherein Meridian Behavioral Health Services, run by a retired SMC employee, picks up most of the business.

    WE NEED A OUTCOMES BASED MODEL—-NOT—NOT—NOT—THIS FEE FOR SERVICE MODEL which is nickel and diming providers to death and creates a barrier to services.

    Until you get this, that the model of Fee for Service is associated with the biggest chunk of NC mental health reform failure, we will not move forward.

    Marsha V. Hammond, PhD
    Clinical Licensed Psychologist, Asheville, NC
    NC mental health reform blogspot: http://madame-defarge.blogspot.com/