
{"id":2497,"date":"2008-05-01T07:15:18","date_gmt":"2008-05-01T15:15:18","guid":{"rendered":"http:\/\/www.carrborocitizen.com\/main\/2008\/05\/01\/candidates-speak-out-on-mental-health-reform\/"},"modified":"2008-05-05T07:38:12","modified_gmt":"2008-05-05T15:38:12","slug":"candidates-speak-out-on-mental-health-reform","status":"publish","type":"post","link":"https:\/\/www.ibiblio.org\/carrborocitizen\/main\/2008\/05\/01\/candidates-speak-out-on-mental-health-reform\/","title":{"rendered":"Candidates speak out on mental health reform"},"content":{"rendered":"<p><strong><em>by Taylor Sisk<\/em><\/strong><em>Staff Writer<\/em>\u00e2\u20ac\u0153How, if elected, do you propose to deal with the provisioning of mental health care services in North Carolina?\u00e2\u20ac\u009dIt\u00e2\u20ac\u2122s a question that has been posed with some regularity to this year\u00e2\u20ac\u2122s candidates for governor \u00e2\u20ac\u201c 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\u00e2\u20ac\u2122s 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\u00e2\u20ac\u2122 credentials.<!--more-->\u00e2\u20ac\u0153Doing away with the blended payment rates for community support is an absolute must that should have been tackled a long time ago,\u00e2\u20ac\u009d Mark Sullivan, executive director of the Orange County Mental Health Association, wrote in an email response to The Citizen. \u00e2\u20ac\u0153In fact, it never should have been proposed, and this single issue encapsulated the incompetence that has been the hallmark of reform.\u00e2\u20ac\u009dIn his response to the AP questionnaire, Moore continued: \u00e2\u20ac\u0153My 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.\u00e2\u20ac\u009d\u00e2\u20ac\u0153Stopping the hemorrhaging of federal dollars because our state facilities are out of compliance should be a top priority, as Moore suggests,\u00e2\u20ac\u009d Sullivan said.\u00e2\u20ac\u0153Also,\u00e2\u20ac\u009d Sullivan continued, \u00e2\u20ac\u0153Moore 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.\u00e2\u20ac\u009dMoore said that he would seek to institute a \u00e2\u20ac\u0153career ladder\u00e2\u20ac\u009d for medical and patient technicians within hospitals. \u00e2\u20ac\u0153To advance on the ladder and earn a higher salary, the staff will achieve more advanced levels of certification.\u00e2\u20ac\u009d 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 \u00e2\u20ac\u0153medical home\u00e2\u20ac\u009d 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: \u00e2\u20ac\u0153I 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.\u00e2\u20ac\u009dPerdue, like Moore, advocated for a medical home approach for the primary care of adults and children. \u00e2\u20ac\u0153Our Community Care of North Carolina has developed a very cost-effective and quality-driven model of statewide case management through health care community networks,\u00e2\u20ac\u009d Perdue says. \u00e2\u20ac\u0153We need to extend this kind of collaboration and community network to the delivery of mental health services.\u00e2\u20ac\u009d\u00e2\u20ac\u0153In my view,\u00e2\u20ac\u009d Perdue continues, \u00e2\u20ac\u0153the 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.\u00e2\u20ac\u009dShe believes that we must also \u00e2\u20ac\u0153strive to define a basic level of mental health services to which needy patients should have access.\u00e2\u20ac\u009dOf Perdue\u00e2\u20ac\u2122s positions, Sullivan said: \u00e2\u20ac\u0153Lt. 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.\u00e2\u20ac\u009dJohn Mader, a local therapist and critic of the Easley administration\u00e2\u20ac\u2122s failed reform effort, said of Perdue: \u00e2\u20ac\u0153I support her goal of clarifying \u00e2\u20ac\u02dca basic level of mental health services for needy people.\u00e2\u20ac\u2122\u00e2\u20ac\u0153However, 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?\u00e2\u20ac\u009dIn response to the AP questionnaire, Bob Orr said: \u00e2\u20ac\u0153We 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.\u00e2\u20ac\u009dOn his website, Orr further articulates his proposals.While affirming that the original idea behind the state\u00e2\u20ac\u2122s mental health care reform was valid \u00e2\u20ac\u201c moving ongoing and support services out into the communities \u00e2\u20ac\u201c Orr says, \u00e2\u20ac\u0153I 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.\u00e2\u20ac\u009dHe says that he believes having the state provide long-term institutional care and LMEs the other services can potentially \u00e2\u20ac\u0153provide consumer choice and consistent care closer to home and at a lower cost,\u00e2\u20ac\u009d but that \u00e2\u20ac\u0153[w]e have not met this intent consistently.\u00e2\u20ac\u009dIn order to remedy that, he says that we must \u00e2\u20ac\u0153provide clear and specific operating guidelines for the LMEs with the appropriate flexibility and funding to create provider networks\u00e2\u20ac\u009d and reassign to the LMEs primary case-management responsibility with the authority to be the \u00e2\u20ac\u0153funnel for all care and services.\u00e2\u20ac\u009d He argues that a single statewide standard for LMEs must be established.Orr says that we must determine \u00e2\u20ac\u0153state 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.\u00e2\u20ac\u009dHe then adds that we must \u00e2\u20ac\u0153put 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.\u00e2\u20ac\u009d\u00e2\u20ac\u0153I appreciate Bob Orr\u00e2\u20ac\u2122s thoughtful and balanced analysis,\u00e2\u20ac\u009d Mader said, \u00e2\u20ac\u0153and ask myself how he will follow through more effectively than the current administration.\u00e2\u20ac\u009d\u00e2\u20ac\u0153Bob Orr seems to have a solid understanding of the issues,\u00e2\u20ac\u009d Sullivan said, \u00e2\u20ac\u0153as 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.\u00e2\u20ac\u009dSullivan sites, as an example, returning case-management responsibilities to the LMEs.\u00e2\u20ac\u0153Case managers help connect consumers with the services that they need and help monitor the quality of the services that are provided,\u00e2\u20ac\u009d he said. \u00e2\u20ac\u0153This should have remained with the LMEs. Conflicts of interest arise when this function is with a private agency.\u00e2\u20ac\u009dHe 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.\u00e2\u20ac\u0153It is a lot to ask these candidates to provide specific recommendations on this complex issue,\u00e2\u20ac\u009d Mader said, \u00e2\u20ac\u0153yet we know that Hooker Odom crafted a wonderfully high-minded plan for \u00e2\u20ac\u02dcState Mental Health Reform.\u00e2\u20ac\u2122 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.\u00e2\u20ac\u0153Who will be making the decisions in the next few years \u00e2\u20ac\u201c the many knowledgeable professionals or a few well-intended department officials?\u00e2\u20ac\u009d<\/p>\n","protected":false},"excerpt":{"rendered":"<p>by Taylor SiskStaff Writer\u00e2\u20ac\u0153How, if elected, do you propose to deal with the provisioning of mental health care services in North Carolina?\u00e2\u20ac\u009dIt\u00e2\u20ac\u2122s a question that has been posed with some regularity to this year\u00e2\u20ac\u2122s candidates for governor \u00e2\u20ac\u201c and urgently so: Our mental health care system is in crisis. Among those candidates, Democrats Richard Moore&#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-2497","post","type-post","status-publish","format-standard","hentry","category-news"],"_links":{"self":[{"href":"https:\/\/www.ibiblio.org\/carrborocitizen\/main\/wp-json\/wp\/v2\/posts\/2497","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=2497"}],"version-history":[{"count":0,"href":"https:\/\/www.ibiblio.org\/carrborocitizen\/main\/wp-json\/wp\/v2\/posts\/2497\/revisions"}],"wp:attachment":[{"href":"https:\/\/www.ibiblio.org\/carrborocitizen\/main\/wp-json\/wp\/v2\/media?parent=2497"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.ibiblio.org\/carrborocitizen\/main\/wp-json\/wp\/v2\/categories?post=2497"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.ibiblio.org\/carrborocitizen\/main\/wp-json\/wp\/v2\/tags?post=2497"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}