
{"id":1947,"date":"2008-02-27T16:22:13","date_gmt":"2008-02-28T00:22:13","guid":{"rendered":"http:\/\/www.carrborocitizen.com\/main\/2008\/02\/27\/a-series-of-problems\/"},"modified":"2008-02-27T16:22:13","modified_gmt":"2008-02-28T00:22:13","slug":"a-series-of-problems","status":"publish","type":"post","link":"https:\/\/www.ibiblio.org\/carrborocitizen\/main\/2008\/02\/27\/a-series-of-problems\/","title":{"rendered":"A series of problems"},"content":{"rendered":"<p><em><strong>By Chris Fitzsimon<br \/>\n<\/strong><\/em><br \/>\nThe crisis in North Carolina\u00e2\u20ac\u2122s mental health system is center stage this week in the state\u00e2\u20ac\u2122s 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.<\/p>\n<p><em>The Raleigh News &amp; Observer<\/em> kicked off a five-part series Sunday about the ongoing problems with the 2001 mental health reform efforts under the bold banner headline \u00e2\u20ac\u0153Reform wastes millions, enriches providers, fails to serve mentally ill.\u00e2\u20ac\u009d <!--more--><\/p>\n<p>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.<\/p>\n<p>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 clich\u00c3\u00a9s and slogans than displays of meaningful understanding of the system\u00e2\u20ac\u2122s problems, much less solutions to them.<\/p>\n<p>The first part of the News &amp; Observer series included more disturbing revelations about a mental health system plagued by problems since the 2001 reform effort began.<\/p>\n<p>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.<\/p>\n<p>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.<\/p>\n<p>The state launched community support services in 2006 and expected it would cost $5 million a month, according to the News &amp; 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.<\/p>\n<p>The audit concluded that more than a third of the services provided were not \u00e2\u20ac\u0153medically necessary.\u00e2\u20ac\u009d<\/p>\n<p><em> The News &amp; Observer<\/em> 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.<\/p>\n<p>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\u00e2\u20ac\u2122t be charging high rates for services provided by low-wage workers, but the community support issue is more complicated than portrayed in the <em>News &amp; Observer<\/em>.<\/p>\n<p>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.<\/p>\n<p>The story doesn\u00e2\u20ac\u2122t explicitly say the services shouldn\u00e2\u20ac\u2122t be provided, but many readers are likely to seize on the activity itself as waste, not the reimbursement rate.<\/p>\n<p>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 \u00e2\u20ac\u0153vigorously\u00e2\u20ac\u009d 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 \u00e2\u20ac\u0153just happened sort of overnight in late October and we never thought they would do it.\u00e2\u20ac\u009d<\/p>\n<p>That\u00e2\u20ac\u2122s troubling enough \u00e2\u20ac\u201d 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.<\/p>\n<p>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.<\/p>\n<p>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 \u00e2\u20ac\u0153fixing the mental health system a top priority\u00e2\u20ac\u009d and that \u00e2\u20ac\u0153reform has been attempted many times, but this effort is going to succeed because the time is right.\u00e2\u20ac\u009d<\/p>\n<p>Doesn\u00e2\u20ac\u2122t sound like very vigorous opposition. The newspaper series resumes Tuesday, so maybe we\u00e2\u20ac\u2122ll find out more about the governor who opposed reform but didn\u00e2\u20ac\u2122t tell anybody.<\/p>\n<p>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\u00e2\u20ac\u2122s mental health services \u00e2\u20ac\u201d a lack of leadership. Hard to argue with that.<\/p>\n<p><em>Chris Fitzsimon is director of N.C. Policy Watch. www.ncpolicywatch.com<\/em><\/p>\n","protected":false},"excerpt":{"rendered":"<p>By Chris Fitzsimon The crisis in North Carolina\u00e2\u20ac\u2122s mental health system is center stage this week in the state\u00e2\u20ac\u2122s 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 &amp; Observer kicked off a&#8230;<\/p>\n","protected":false},"author":12,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[5],"tags":[],"class_list":["post-1947","post","type-post","status-publish","format-standard","hentry","category-opinion"],"_links":{"self":[{"href":"https:\/\/www.ibiblio.org\/carrborocitizen\/main\/wp-json\/wp\/v2\/posts\/1947","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.ibiblio.org\/carrborocitizen\/main\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.ibiblio.org\/carrborocitizen\/main\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.ibiblio.org\/carrborocitizen\/main\/wp-json\/wp\/v2\/users\/12"}],"replies":[{"embeddable":true,"href":"https:\/\/www.ibiblio.org\/carrborocitizen\/main\/wp-json\/wp\/v2\/comments?post=1947"}],"version-history":[{"count":0,"href":"https:\/\/www.ibiblio.org\/carrborocitizen\/main\/wp-json\/wp\/v2\/posts\/1947\/revisions"}],"wp:attachment":[{"href":"https:\/\/www.ibiblio.org\/carrborocitizen\/main\/wp-json\/wp\/v2\/media?parent=1947"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.ibiblio.org\/carrborocitizen\/main\/wp-json\/wp\/v2\/categories?post=1947"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.ibiblio.org\/carrborocitizen\/main\/wp-json\/wp\/v2\/tags?post=1947"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}