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Mental Health Task Force issues somber report

Posted on October 15, 2009October 18, 2009 by Staff

By Taylor Sisk, Staff Writer

A mental health task force convened by Chapel Hill Mayor Kevin Foy has released its findings, and the bad news comes as no surprise: Those living with mental illness in Orange County – most particularly, young adults and those not covered by Medicaid or private insurance – are dangerously underserved by mental health care services.

The worse news is that state budget cuts mean that mental health care services in Orange, Chatham and Person counties are to be reduced next year by more than $2 million.

The encouraging news, according to task force chair Natalie Ammarell, is that the resources are within this community to begin turning things around. But awareness must first be heightened and communications improved.

A step in that direction was taken at Monday night’s Chapel Hill Town Council meeting, as Foy’s Mental Health Task Force presented its final report. The report cites challenges for the community that include critical gaps in post-hospitalization care and in all services for 18- to 25-year-olds, an over-reliance on UNC’s mental health resources and the daunting task families and individuals face in attempting to navigate the state’s mental health care system.

Among the recommendations made in the report are the placement of more UNC School of Social Work students in local mental health agencies with paid supervision; improved awareness of mental health issues among local law enforcement and safety personnel; and stronger leadership within the community on mental health, developmental disability and substance abuse issues.
Confronting the challenge

In October of last year, Mayor Foy established the task force with a mandate, according to a memorandum submitted then to the town council, to assess the state of the mental health care system in Orange County, create a broader awareness of mental health care issues in the community and provide recommendations on the provisioning of services to county residents.

The 15-member task force was comprised of people representing the OPC Area Program (our local management entity, or LME, tasked with overseeing publicly funded services for Orange, Person and Chatham counties), service providers, social-service agencies, UNC, county government and the Chapel Hill Police Department. The task force held its first meeting in December and met monthly through June. Two public listening sessions also were held.

As Foy noted in announcing the formation of the task force, “The future of mental health care is uncertain.”

Reform measures that began in North Carolina in 2001 are now widely viewed as having rendered disastrous results. The thrust of reform was to move people out of state institutions and into community-based services and to privatize those services.

As the task force report notes, the vision of a “consumer-responsive, community-based network of care” was not “fully realized” in Orange County.

The void of services left by the transition to a new way of providing care was “partially filled by providers whose practices increased the instability of the local system of care,” most notably, “the failure of the Caring Family Network as the primary operator of outpatient mental health clinics.”

According to the report, primary challenges facing the community include the need for more transportation for those who have none, adult daytime programs, after-hours and weekend care, post-hospitalization continuing care, social-work assistance for shelter residents, help for elderly people suffering from depression and help in any and all forms for 18- to 25-year-olds and their families.

Additional challenges cited are an over-reliance on UNC resources “as both first and last resort”; the fact that there is “no simple road map” for navigating the now-privatized mental health care system; people with mental health issues being drawn to the area, both because of services available through UNC and the general attraction of the community; and an inadequate supply of safe and affordable housing.

‘Pretty grim’
Concurrent with the task force’s meetings was the budget debate in Raleigh, and, said Ammarell, the effect was overwhelming.

“You could just see how everyone on the task force was getting crunched,” she said.

Their report indicates that this year’s cuts will mean a reduction of $2.25 million in funds available for services in Orange, Chatham and Person counties, or approximately 21.5 percent of all non-crisis state-funded services.

“I think things are looking pretty grim in the mental health world,” said Bebe Smith, director of outpatient services for UNC’s Schizophrenia Treatment and Evaluation Program, which has a clinic in Carr Mill Mall.

That being the case, Ammarell said, “We had to make choices, and the choice we made was to see if we could make a difference around messaging.”

Task force members, according to the report, had “long discussions about the importance of promoting a ‘message’” that would help the community better understand the challenges facing those living with mental illness.

Better communication is critical, Ammarell said, not just within the community at large but among the agencies that deal with mental health issues.

“If we could really get people to communicate,” she said, the community could take better advantage of an array of services that, relative to the state as a whole, is rich. As examples, she cited the large number of practitioners in the area, the Mental Health Association in Orange County (MHAOC) Pro Bono Counseling Network and the university.

The report recommends that town and county legislative bodies consider establishing ongoing initiatives to provide “issue leadership” that might include standing committees within each of the town and county legislative bodies and a joint committee through the Assembly of Governments. The Chapel Hill Town Council agreed Monday night to further consider a standing committee of the council.

Foy said that a subtext of the report that struck him was the extent to which there still seems to be a stigma attached to mental illness.

“We need to see to it that people get help without that stigma attached,” he said. “Certainly, that’s something we as a community can influence.”

More students in the field
The task force report suggests a means of remedying another problem brought on by the privatization of services, one that would put more help in the field. Prior to reform, social work graduate students would train in mental health clinics. Now they’ve lost those training opportunities, and the opportunity to help.

“Providing good clinical instruction to students takes away from billable activities,” Smith said, “so private agencies have been less inclined to allow their clinical staff to provide field instruction.”

Many graduates, she said, are paying to get the clinical supervision necessary to become licensed.

The report lays out a strategy to offer service-provider agencies a stipend to provide supervision, an initiative Foy applauds.

“Surely, we can tap this great resource,” he said of the students.

The report also recommends creating a partnership with MHAOC to expand its Pro Bono Counseling Network.

“One of the things I’m hopeful of is that some of what we come up with can be used as a blueprint for other communities,” Foy said. “If we figure out a way to start this, we can help others do it.”

Representatives of the task force will make a presentation to the Carrboro Board of Aldermen in November.

Task Force Recommendations
• Increase MSW student placements in provider agencies and add clinical supervision for students and provisionally licensed workers.
• Create a partnership with the Mental Health Association in Orange County to expand the Pro Bono Counseling Network.

Enhanced local law enforcement/safety personnel awareness of and sensitivity to mental health issues
• Extend Crisis Intervention Training (CIT) throughout the ranks of local law enforcement and, ultimately, to other safety personnel.

Strong local government leadership around mental health/developmental disabilities/substance abuse concerns
• Use local government offices (Mayors and Managers) and legislative bodies (Council, Commissioners, Aldermen) as platforms (bully pulpits) and vehicles of support for campaigns/efforts to proactively increase community awareness of mental health/developmental disabilities/substance abuse issues and to reduce associated social stigma.

1 thought on “Mental Health Task Force issues somber report”

  1. Carol M. Ross says:
    January 26, 2010 at 7:36 pm

    Clinical Nurse Specialists in psychiatric/mental health nursing are excellent providers of psychotherapy, clinical supervision, and medication management. And yet, the state of NC does not allow CNSs to practice within the full scope of their ability and training. They could well be a part of the solution to NC’s problems with mental health care!

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