
{"id":2038,"date":"2008-03-06T08:47:21","date_gmt":"2008-03-06T16:47:21","guid":{"rendered":"http:\/\/www.carrborocitizen.com\/main\/2008\/03\/06\/mental-health-collapse-leaves-network-in-shambles\/"},"modified":"2008-03-06T08:47:21","modified_gmt":"2008-03-06T16:47:21","slug":"mental-health-collapse-leaves-network-in-shambles","status":"publish","type":"post","link":"https:\/\/www.ibiblio.org\/carrborocitizen\/main\/2008\/03\/06\/mental-health-collapse-leaves-network-in-shambles\/","title":{"rendered":"Mental health collapse leaves network in shambles"},"content":{"rendered":"<p><em><strong>By Taylor Sisk<\/strong><br \/>\nStaff Writer <\/em><\/p>\n<p>\u00e2\u20ac\u0153I\u00e2\u20ac\u2122ve come to the conclusion,\u00e2\u20ac\u009d says Karen Dunn, director of Club Nova, a Carrboro clubhouse that helps people with mental illnesses lead productive lives in the community, \u00e2\u20ac\u0153that there must be a new diagnosis that hasn\u00e2\u20ac\u2122t yet ended up in the DSM\u00e2\u20ac\u009d \u00e2\u20ac\u201c by which she refers to the Diagnostic and Statistical Manual of Mental Disorders.<\/p>\n<p>\u00e2\u20ac\u0153It\u00e2\u20ac\u2122s some kind of delusional disorder on a bureaucratic level.\u00e2\u20ac\u009d<\/p>\n<p><!--more-->\u00e2\u20ac\u0153I know people are well intentioned,\u00e2\u20ac\u009d she continues, \u00e2\u20ac\u0153but you just get into that institutional thinking, and it\u00e2\u20ac\u2122s just \u00e2\u20ac\u00a6\u00e2\u20ac\u009d She pauses; shakes her head. \u00e2\u20ac\u0153Talk about the definition of insanity\u00e2\u20ac\u00a6.\u00e2\u20ac\u009d<\/p>\n<p>As Dunn sees it, the breakdown in the provisioning of mental health care services in North Carolina was easily enough forecast. Mental health care reforms that were intended to provide more community-based care and thereby reduce the need for more intensive services were, Dunn says, flawed from the beginning, and yet we continued to drive these reforms headlong into what she and many of her colleagues attest is a pretty much full-blown mental health care crisis in North Carolina.<\/p>\n<p>Across the state, private companies tasked to provide services are going out of business. Last month, Caring Family Network (CFN) \u00e2\u20ac\u201c the primary provider of mental health treatment in Orange, Person and Chatham counties \u00e2\u20ac\u201c announced that it would be discontinuing almost all of its services in the three counties. CFN will no longer provide outpatient and community-based services but will continue to provide therapeutic foster care.<\/p>\n<p>As a result, Marilyn Ghezzi, who until last week was a therapist with CFN, has had to tell clients with whom she\u00e2\u20ac\u2122s built relationships, some as many as 20 years in duration, that she\u00e2\u20ac\u2122ll no longer be their therapist. Other therapists have had to do likewise.<\/p>\n<p>\u00e2\u20ac\u0153They were devastated,\u00e2\u20ac\u009d Ghezzi says of her clients\u00e2\u20ac\u2122 reaction to the news. \u00e2\u20ac\u0153One person said to me, \u00e2\u20ac\u02dcHow can they just change your therapist?\u00e2\u20ac\u2122\u00e2\u20ac\u009d \u00e2\u20ac\u201c which would seem to reflect a tacit belief in mental health care as a fundamental right.<\/p>\n<p>Perhaps it\u00e2\u20ac\u2122s not. But it\u00e2\u20ac\u2122s certainly a critical service \u00e2\u20ac\u201c and one that\u00e2\u20ac\u2122s in critical condition. What those professionals along the front lines of mental health care will tell you is that in addition to weaving a safety net for those with mental disorders they\u00e2\u20ac\u2122re protecting us as citizens and taxpayers, or at least attempting to do so, from further headlines of shootouts along I-40 and from the exorbitant costs of hospitalization and incarceration.<\/p>\n<p>Mental health care reform has failed. Keeping people with manageable mental disorders in their\u00c2\u00a0 communities, cared for by those communities, was the spirit behind that reform. It was well intentioned, as Dunn suggests, but very poorly executed.<\/p>\n<p>Who are \u00e2\u20ac\u02dcthey\u00e2\u20ac\u2122?<\/p>\n<p>\u00e2\u20ac\u0153How can they just change your therapist?\u00e2\u20ac\u009d Ghezzi\u00e2\u20ac\u2122s clients asked. But she found that she couldn\u00e2\u20ac\u2122t even tell them who \u00e2\u20ac\u0153they\u00e2\u20ac\u009d were.<\/p>\n<p>\u00e2\u20ac\u0153I\u00e2\u20ac\u2122m not really sure who they are,\u00e2\u20ac\u009d Ghezzi says, wondering aloud who to blame for the crisis we\u00e2\u20ac\u2122re now facing here in Orange County.<\/p>\n<p>There\u00e2\u20ac\u2122s plenty of blame to go around, she says: the Department of Health and Human Services, the governor, legislators, CFN as well. But, Ghezzi says, \u00e2\u20ac\u0153I think it mostly falls on the state reform plan. I think that\u00e2\u20ac\u2122s definitely the main cause of all this.\u00e2\u20ac\u009d<\/p>\n<p>The idea behind reform was that there were certain mental health care services the private sector could better provide. In 2001, the General Assembly voted to overhaul the system. Counties would no longer directly provide treatment. They would instead form local management entities (LMEs) that would oversee private providers. More treatment would be provided within the communities toward the objective of keeping people out of the four state-run mental hospitals.<\/p>\n<p>As has been documented in a recent series of articles in the News &amp; Observer, many private companies have been using employees with only high school educations, called para-professionals, to provide community support services \u00e2\u20ac\u201c such as assisting with grocery shopping or homework \u00e2\u20ac\u201c for which the companies bill the state $60.96.<\/p>\n<p>The allegations are that, at that rate, state reform created an incentive for companies to provide community support services, and to provide them with para-professionals, and not to provide more intensive services.<\/p>\n<p>The News &amp; Observer reported that between March 2006 and January 2008, the cost of community support services rose to nearly $1.4 billion, or 90 percent of all community spending. According to the N&amp;O, \u00e2\u20ac\u0153During that same period, the government spent $78 million \u00e2\u20ac\u201c 4.9 percent \u00e2\u20ac\u201c on the seven services more likely to reduce the need for hospitalization.\u00e2\u20ac\u009d<\/p>\n<p>The cost of those community support services had risen to nearly 20 times the state\u00e2\u20ac\u2122s original estimate.<\/p>\n<p>A \u00e2\u20ac\u02dcdifferent animal\u00e2\u20ac\u2122<\/p>\n<p>In some ways, the post-reform delivery of mental health services has played out differently in Orange County, where using para-professionals for community support services has not been as widely practiced.<\/p>\n<p>When CFN took over the Orange Person Chatham (OPC) Area Plan in 2006 \u00e2\u20ac\u201c OPC having resisted divestiture of its services as long as it could \u00e2\u20ac\u201c Ghezzi says there was a team of four community support workers: two of them had master\u00e2\u20ac\u2122s degrees in social work; two had bachelor\u00e2\u20ac\u2122s degrees. CFN did then hire more para-professionals, but not a great many.<\/p>\n<p>That aside, CFN wasn\u00e2\u20ac\u2122t entirely prepared for the task at hand.<\/p>\n<p>\u00e2\u20ac\u0153I think one thing that was striking,\u00e2\u20ac\u009d Ghezzi recalls, \u00e2\u20ac\u0153was that they didn\u00e2\u20ac\u2122t seem very knowledgeable about outpatient clinics.\u00e2\u20ac\u009d CFN arrived with a solid reputation as a foster care agency. \u00e2\u20ac\u0153But a busy mental health clinic is a pretty different animal.\u00e2\u20ac\u009d CFN had operated smaller clinics, but Orange County alone had nearly 1,000 clients. \u00e2\u20ac\u0153They didn\u00e2\u20ac\u2122t really know what a busy mental health clinic was like.\u00e2\u20ac\u009d<\/p>\n<p>In 2007, according to Ghezzi, \u00e2\u20ac\u0153things started to fall apart.\u00e2\u20ac\u009d Three rounds of layoffs ensued. In May, CFN announced that due in large measure to rate cuts by the state for community support services (in response to charges of overspending, the hourly rate of $60.96 was reduced to $51.28), it would be cutting back services and closing facilities.<\/p>\n<p>\u00e2\u20ac\u0153Once layoffs started,\u00e2\u20ac\u009d Ghezzi says, \u00e2\u20ac\u0153people lost their therapists; staff who weren\u00e2\u20ac\u2122t laid off started job hunting.\u00e2\u20ac\u009d<\/p>\n<p>John Mader, a therapist who prior to divestiture worked for OPC, points out that those who were receiving these services are not only having to now cope with the transition to new caregivers, adjust to relationships with new providers, but are having to do so in the \u00e2\u20ac\u0153face of complete ambiguity.\u00e2\u20ac\u009d<\/p>\n<p>\u00e2\u20ac\u0153This is not effective therapeutic closure,\u00e2\u20ac\u009d Mader says, \u00e2\u20ac\u0153and that\u00e2\u20ac\u2122s hard.\u00e2\u20ac\u009d<\/p>\n<p>Mader says that people are being told to be patient, that new providers will be found. \u00e2\u20ac\u0153But in the meantime, we don\u00e2\u20ac\u2122t know when or who they will see.\u00e2\u20ac\u009d<\/p>\n<p>\u00e2\u20ac\u02dcNobody knew\u00e2\u20ac\u2122<\/p>\n<p>State government officials have now acknowledged that we have a very serious mental health care problem. They\u00e2\u20ac\u2122ve had no choice. There it is, on the front page of the state\u00e2\u20ac\u2122s paper of record \u00e2\u20ac\u201c stories of waste and, worse, abuse of the mentally ill \u00e2\u20ac\u201c of the disintegration of our health care infrastructure.<\/p>\n<p>And here it is in our communities \u00e2\u20ac\u201c where health care professionals such as Karen Dunn, Marilyn Ghezzi and John Mader have collectively spent over 65 years caring for those with mental health disorders, many of whom are today facing, optimistically, uncertainty \u00e2\u20ac\u201c the fraying of a safety net that in the best of times was tenuous, and no clear understanding of their path to further care \u00e2\u20ac\u201c and, at worst, a frightening world in which that care is not to be had.<\/p>\n<p>\u00e2\u20ac\u0153I was just trying to do the best thing by each client on a case-by-case basis,\u00e2\u20ac\u009d says Ghezzi, \u00e2\u20ac\u0153and we didn\u00e2\u20ac\u2122t have a lot of guidance on what to do \u00e2\u20ac\u201c partly because nobody knew.\u00e2\u20ac\u009d<\/p>\n<p>Nobody knew. But how, Karen Dunn asks, could that be?<\/p>\n<p>Providing just the basics, says Dunn, was the way the state wrote the plan:<\/p>\n<p>\u00e2\u20ac\u0153The whole plan was to get people this basic community support in order to reduce hospitalizations and to prevent utilizing these higher levels of service unnecessarily.<\/p>\n<p>\u00e2\u20ac\u0153And now it\u00e2\u20ac\u2122s kind of like this huge surprise that this is how the system is playing out, when it was planned out that way from the beginning?\u00e2\u20ac\u009d<\/p>\n<p>She agrees with administering more services within our communities. But not at the risk of neglecting other, more intensive services.<\/p>\n<p>Dunn is particularly perplexed by Gov. Easley\u00e2\u20ac\u2122s attempts at distancing himself from the reform legislation. In the News &amp; Observer series, Easley is quoted as saying at a December news conference, \u00e2\u20ac\u0153It just happened overnight in late October [2001], and we never thought they would do it.\u00e2\u20ac\u009d<\/p>\n<p>And yet at the time, both Easley and then-Secretary of Health and Human Services Carmen Hooker Odom seemed to be champions of that legislation.<\/p>\n<p>\u00e2\u20ac\u0153If the governor had no clue,\u00e2\u20ac\u009d Dunn says, \u00e2\u20ac\u0153he was asleep at the wheel and should be charged with reckless driving. And that\u00e2\u20ac\u2122s putting it mildly. Because it\u00e2\u20ac\u2122s not just reckless driving \u00e2\u20ac\u201c it\u00e2\u20ac\u2122s been an endangerment of all our citizens who are living with serious mental illness.<\/p>\n<p>\u00e2\u20ac\u0153It really has put lives at risk, and continues to do so.\u00e2\u20ac\u009d<\/p>\n<p>This week, Easley held a press conference at which he proposed turning direct control of the state\u00e2\u20ac\u2122s mental health system back to the Department of Health and Human Services and establishing differential pay for community support services depending on the level of those services.<br \/>\nIn some respects, Orange County is in a worse predicament than most counties.<\/p>\n<p>\u00e2\u20ac\u0153Sort of a Chapel Hill phenomenon is that we have so many uninsured,\u00e2\u20ac\u009d says Ghezzi, \u00e2\u20ac\u0153and that\u00e2\u20ac\u2122s really a problem. We\u00e2\u20ac\u2122ve always had a really high number of uninsured, and we were the safety net, which is now gone.\u00e2\u20ac\u009d<\/p>\n<p>We know of the ones we\u00e2\u20ac\u2122ve failed. But what of the others out there?<\/p>\n<p>\u00e2\u20ac\u0153I think there are a lot more people who have not touched base with the system at this point,\u00e2\u20ac\u009d Dunn says. \u00e2\u20ac\u0153That\u00e2\u20ac\u2122s a whole other level of community outreach that doesn\u00e2\u20ac\u2122t happen \u00e2\u20ac\u00a6 people the system hasn\u00e2\u20ac\u2122t even seen.\u00e2\u20ac\u009d How do we begin to address those?<\/p>\n<p>Despite all, says Dunn: \u00e2\u20ac\u0153I always hold out hope.\u00e2\u20ac\u009d<\/p>\n<p>We\u00e2\u20ac\u2122ll all soon learn if that hope is founded.<\/p>\n<p><em>Next: Where do we go from here?\u00c2\u00a0<\/em><\/p>\n","protected":false},"excerpt":{"rendered":"<p>By Taylor Sisk Staff Writer \u00e2\u20ac\u0153I\u00e2\u20ac\u2122ve come to the conclusion,\u00e2\u20ac\u009d says Karen Dunn, director of Club Nova, a Carrboro clubhouse that helps people with mental illnesses lead productive lives in the community, \u00e2\u20ac\u0153that there must be a new diagnosis that hasn\u00e2\u20ac\u2122t yet ended up in the DSM\u00e2\u20ac\u009d \u00e2\u20ac\u201c by which she refers to the Diagnostic&#8230;<\/p>\n","protected":false},"author":12,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[4],"tags":[],"class_list":["post-2038","post","type-post","status-publish","format-standard","hentry","category-news"],"_links":{"self":[{"href":"https:\/\/www.ibiblio.org\/carrborocitizen\/main\/wp-json\/wp\/v2\/posts\/2038","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=2038"}],"version-history":[{"count":0,"href":"https:\/\/www.ibiblio.org\/carrborocitizen\/main\/wp-json\/wp\/v2\/posts\/2038\/revisions"}],"wp:attachment":[{"href":"https:\/\/www.ibiblio.org\/carrborocitizen\/main\/wp-json\/wp\/v2\/media?parent=2038"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.ibiblio.org\/carrborocitizen\/main\/wp-json\/wp\/v2\/categories?post=2038"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.ibiblio.org\/carrborocitizen\/main\/wp-json\/wp\/v2\/tags?post=2038"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}