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Breakdown: Amid the doom and gloom, positive developments in Orange County

Following is the final story in our Breakdown series on mental health care in North Carolina.

by Taylor Sisk
Staff Writer

Buried in the deluge of news about our state’s collapsing mental health care system are reports of at least two encouraging developments in Orange County, each the sort of community-based response that local advocates say is the only way out of the crisis.

The first is at Carrboro’s Carr Mill Mall, where the UNC Department of Psychiatry has opened a community mental health clinic to house its Schizophrenia Treatment and Evaluation Program (STEP) Clinic and the clinic’s Outreach and Support Intervention Services (OASIS) program. OASIS provides help to adolescents and young adults who are experiencing, or are at risk of experiencing, early psychosis.

The second comes from the Town of Chapel Hill, where Mayor Kevin Foy has convened a Mental Health Task Force, comprised of advocates from the community, local government and UNC.

Community based

John Gilmore, vice chair of the UNC Department of Psychiatry, envisioned a community clinic that would provide services for people with severe and persistent mental illness. Thanks to $100,000 from the state’s Mental Health Trust Fund, $400,000 from the state Legislature and, most recently, a $900,000 grant from the Duke Endowment, that vision has now become a reality.

The clinic is located on the second floor of Carr Mill Mall and will be called the UNC Center of Excellence for Community Mental Health. Gilmore’s long-term goal is to provide comprehensive services to the community, utilizing university resources from the departments of psychiatry and psychology, the schools of social work and nursing and the rehabilitation counseling program.

The clinic will initially be staffed by two full-time social workers and a part-time psychiatrist and psychologist from the university. Students will also work in the program, thereby gaining real-world experience.

“One of the main goals,” says Gilmore, “is to develop an interdisciplinary training program in community mental health. We hope to develop evidence-based practices and then go out across the state to train practitioners.”

While initially focusing on schizophrenia and psychotic disorders, Gilmore says, “We’re going to do the best that we can to see as many people as we can. We’ll take all comers at this point.”

The OASIS program has moved from offices near University Mall to Carr Mill Mall and has been offering services at Carr Mill for about a month. The STEP Clinic is due to open soon after the first of the year.

Nowhere to go

Gilmore is also serving on Chapel Hill Mayor Foy’s Mental Health Task Force.

“I think it’s a good group,” Gilmore says. “Many of the important players in the community are there. The charge is a good one.”

That charge is to identify the impact on the community of “changes in the mental health service delivery system … create awareness and generate discussion about the mental health service system” and then “make recommendations for the future.”

The task force is chaired by Dr. Natalie Ammarell, a longtime consultant in the delivery of human services and former president of the Inter-Faith Council. While at IFC, Ammarell began discussions with Foy about the way mental illness affects the entire community, in particular with regard to homelessness.

Former county Commissioner Margaret Brown has also shared her concerns about the relationship between mental illness and homelessness with Foy, and encouraged him to form a task force.

Mental health reform in North Carolina was initiated in 2001, with a mandate to move the mentally ill out of state institutions and into community-based services delivered by private providers. But community-based services were never sufficiently funded. Without adequate community services, state institutions have become so overcrowded that stays are generally limited to a few days, regardless of a patient’s needs.

Brown recognized early on that the premature release of mental patients from UNC Hospitals into a community with very limited options for care was bound to exacerbate the county’s homeless problem.

“When you start ending these programs and dumping all these people out, where are they going to go?” Brown asks. “The only places to go are to the emergency room [or] on the street.

“So I went to Kevin Foy and said, ‘Kevin, why don’t you pull together a meeting of the head of psychiatry and the chancellor and some other people, and let’s sit down and talk about mental health reform and the impact it’s going to have on the town of Chapel Hill.

“Let’s anticipate the impact and see if we can’t brainstorm.”

Ammarell agrees with Gilmore that Foy’s task force represents diverse perspectives on mental health issues in Orange County, but stresses the importance of continually hearing from other voices, particularly of the consumers of mental health care services.

“My goal is to get lots of perspectives at the table,” says Ammarell, “but to keep it a manageable size.”

She also stresses that while the task force has been formed in Chapel Hill, its mandate is to address the needs of the entire county, “because everyone is affected.” In recognition of that mandate, the task force includes Gwen Harvey, Orange County’s assistant county manager.

Ultimately, Ammarell says, “The goal is to look at how our work can reach beyond Orange County. The mayor is already looking into that.”

“The fact that all of these key stakeholders are coming together to dialogue and strategize is positive,” Mark Sullivan, task force member and executive director of the Orange County Mental Health Association, writes in an email reply.

“The issues that we are facing are the results of state policy that we do not have much influence over, and the economic landscape makes things more challenging.

“However, I am hopeful that we can overcome some of the turf issues that are problematic and that we can begin to take responsibility for our community as a community.”

‘Down and dirty’

Chapel Hill psychiatrist Clay Whitehead was another early task force advocate, and is now one of the 15 members.

“The number-one objective I have is trying to get people aware of the problem,” says Whitehead.

His second objective is to “open the possibility of a community renewal” built on an understanding of the depths of the problem, and to “do something creative and benevolent” to address that problem.

It just makes sense to use local talent and resources, and locally generated funds, to solve a local problem, Whitehead says. Stressing the importance of the university’s involvement, he sees the opening of the UNC Center of Excellence for Community Mental Health as exactly the sort of initiative that can begin to address this crisis.

Whitehead says we could create a model program, but it should not be approached as “some rarified research kind of enterprise.”

While “the ‘great institution on the hill’ can offer a great deal” in terms of best-practice and administrative models, he says, “We’re talking down and dirty here. We’ve got to get out there and take care of people.”

Beginning anew

Newspaper accounts depict a broken mental health care system in North Carolina. But for many advocates, including Margaret Brown and Clay Whitehead, there is no “system” at all. Reassembling a network that worked relatively well four decades ago isn’t an option.

“There’s nothing to knit back together,” says Brown. Building anew, she urges, must begin at the community level, and the university’s involvement is critical.

She stresses that the town must show leadership, and says she has faith in Foy.

“Kevin is the only person of leadership in this community that I can see that could pull this together,” she says.

She believes Foy understands the issues and potential repercussions, and is uniquely positioned, as mayor of Chapel Hill, to urge the university to commit its considerable resources.

Ignoring this crisis, says Whitehead, is clearly no longer an option. He believes spreading awareness should be the first objective of any local initiative.

“Everyday you see something in the paper about how another clinic is closing up,” he says, while yet another state official urges us to be patient with reform.

“What excites me,” Whitehead says, “is that a few people here have perceived that this is not such a great situation, and are trying to figure out what can be done.”

Are we as a nation any closer to recognizing that we have a mental health care crisis, and that mental illness is as critical as any other serious illness?

“I think there are more people that know this,” Whitehead says. “But it’s still very much stigmatized. We’re in denial.”

He believes though that with a creative approach here in Orange County, “We might be able to illustrate how a local community can tackle and resolve this problem.”

Whitehead acknowledges that the task ahead is daunting, particularly within the current economic climate.

But, he says, “When people start to think – and they are now starting to think – they’re going to realize that we’ve got a serious problem in this country,” and that we must chart a path for providing “the greatest good for the greatest number.”

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