
{"id":4161,"date":"2008-12-05T07:51:15","date_gmt":"2008-12-05T15:51:15","guid":{"rendered":"http:\/\/www.carrborocitizen.com\/main\/?p=4161"},"modified":"2011-12-15T12:40:21","modified_gmt":"2011-12-15T17:40:21","slug":"breakdown-the-will-to-find-a-better-way","status":"publish","type":"post","link":"https:\/\/www.ibiblio.org\/carrborocitizen\/main\/2008\/12\/05\/breakdown-the-will-to-find-a-better-way\/","title":{"rendered":"Breakdown: The will to find a better way"},"content":{"rendered":"<p><figure id=\"attachment_4162\" aria-describedby=\"caption-attachment-4162\" style=\"width: 300px\" class=\"wp-caption alignleft\"><a href=\"http:\/\/www.carrborocitizen.com\/main\/wp-content\/uploads\/2008\/12\/drstratusa091108.jpg\"><img decoding=\"async\" src=\"http:\/\/www.carrborocitizen.com\/main\/wp-content\/uploads\/2008\/12\/drstratusa091108-300x200.jpg\" alt=\"<em>photo by Ava Barlow<\/em>&#8221; title=&#8221;drstratusa091108&#8243; width=&#8221;300&#8243; height=&#8221;200&#8243; class=&#8221;size-medium wp-image-4162&#8243; \/><\/a><figcaption id=\"caption-attachment-4162\" class=\"wp-caption-text\">Dr. Nicholas Stratas<\/figcaption><\/figure><br \/>\nBy Taylor Sisk<br \/>\nStaff Writer<\/p>\n<p>Nicholas Stratas refers to mental illness as a \u00e2\u20ac\u0153fragmenting\u00e2\u20ac\u009d problem.<\/p>\n<p>Stratas, a Raleigh-based psychiatrist and former state deputy commissioner of mental health, explains that as we become adults, individuation takes place \u00e2\u20ac\u201c boundaries develop, thoughts, feelings and actions are forged \u00e2\u20ac\u201c and we go through a process of internal integration. We begin to form relationships. <\/p>\n<p>But with mental illness, instead of integration there is fragmentation, and that restricts our ability to connect with other people. Family relationships suffer, and problems often spill over into the wider community.<!--more--><\/p>\n<p>Consequently, what\u00e2\u20ac\u2122s needed is a unified, community-based approach to mental illness. What we have now in North Carolina is a fragmented effort, says Stratas. <\/p>\n<p>His sentiments are echoed by mental health advocates throughout the state. We\u00e2\u20ac\u2122ve suffered, they say, from a lack of leadership and the absence of a cohesive vision of how to deal with those who are stigmatized because of their disease.<\/p>\n<p>They argue for an approach that brings to the table the objectives and concerns of those with mental illness, their families and mental health care professionals \u00e2\u20ac\u201c voices that have been inadequately heard for at least three decades. They also argue for a firm commitment of resources and money.<\/p>\n<p><strong>\u00e2\u20ac\u02dcEnormous damage\u00e2\u20ac\u2122 <\/strong><\/p>\n<p>Last spring, Gov. Mike Easley vowed to fix our mental health care system by the time he left office. <\/p>\n<p>But as he transitions out, the system is largely in shambles. State institutions are overcrowded and are losing federal funding. The new $138 million facility in Butner, Central Regional Hospital, has just been determined by state inspectors to be unsafe. And mental health care services are all but nonexistent in many areas of the state. <\/p>\n<p>In sum, the measures promised by House Bill 381, the reform legislation passed in 2001 that called for moving the mentally ill out of state institutions and into community-based services and for those services to be offered by private providers, have failed.<\/p>\n<p>\u00e2\u20ac\u0153Assuming he\u00e2\u20ac\u2122s a good man,\u00e2\u20ac\u009d says Stratas of Easley, \u00e2\u20ac\u0153I\u00e2\u20ac\u2122ll say he\u00e2\u20ac\u2122s managed by remote control. He\u00e2\u20ac\u2122s out of touch.<\/p>\n<p>\u00e2\u20ac\u0153This culture of neglect [in the state institutions] we\u00e2\u20ac\u2122ve read so much about lately begins at the top.\u00e2\u20ac\u009d<\/p>\n<p><strong>Better Way<\/strong><\/p>\n<p>\u00e2\u20ac\u0153We have had terrible leadership [on mental health issues],\u00e2\u20ac\u009d Chapel Hill psychiatrist Clay Whitehead says, \u00e2\u20ac\u0153enormously damaging and destructive, short-sighted leadership in this state under the Easley administration. <\/p>\n<p>\u00e2\u20ac\u0153He\u00e2\u20ac\u2122s done enormous damage and the next couple of decades are going to be seriously affected by it.\u00e2\u20ac\u009d<\/p>\n<p>In her campaign position statement on mental health care, Governor-elect Beverley Perdue promised to \u00e2\u20ac\u0153adopt a disciplined approach with lots of two-way learning between government officials and the mental health community.\u00e2\u20ac\u009d <\/p>\n<p>David Cornwell, executive director of the advocacy group North Carolina Mental Hope, is skeptical. He observes that at Perdue\u00e2\u20ac\u2122s transition team meeting on mental health last week, \u00e2\u20ac\u0153It\u00e2\u20ac\u2122s my understanding that few, if any, [of those invited] were individuals with an illness.\u00e2\u20ac\u009d<\/p>\n<p>That, says Stratas, is \u00e2\u20ac\u0153very distressing.\u00e2\u20ac\u009d He believes consumers should comprise roughly half of any such advisory team.<\/p>\n<p>For the time being, though, Stratas is maintaining an open-minded approach to the incoming administration.<\/p>\n<p>Meanwhile, he has clear ideas on what needs to happen, proposing, first of all, a statewide patient and provider inventory to identify and classify the population in need of mental health care and pinpoint available treatment.<\/p>\n<p>\u00e2\u20ac\u0153We have to scan the whole state, county by county, patient by patient,\u00e2\u20ac\u009d says Stratas. \u00e2\u20ac\u0153We\u00e2\u20ac\u2122ve got to see what\u00e2\u20ac\u2122s out there so that we can move forward with some intelligence.<\/p>\n<p>\u00e2\u20ac\u0153We don\u00e2\u20ac\u2122t know right now what\u00e2\u20ac\u2122s working and what\u00e2\u20ac\u2122s not. So the first thing is mapping the system.\u00e2\u20ac\u009d<\/p>\n<p>Stratas proposes developing computer-based models that each Local Management Entity (LME), formed to oversee the private providers, could use to determine its community\u00e2\u20ac\u2122s specific needs.<\/p>\n<p>\u00e2\u20ac\u0153What\u00e2\u20ac\u2122s needed in Vance County isn\u00e2\u20ac\u2122t necessarily what\u00e2\u20ac\u2122s needed in Wake County,\u00e2\u20ac\u009d says Stratas.<\/p>\n<p>Also imperative, according to Stratas, is that each LME be directed by a board-certified psychiatrist. <\/p>\n<p>Services provided by LMEs should include a 24-hour crisis intervention program, outpatient psychotherapy and pharmacotherapy, both day and night inpatient programs and community-support services. LMEs should consult with and educate other agencies, including law enforcement, social services, public health, public instruction and the courts.<\/p>\n<p>Stratas sees the money budgeted in 2008-09 for mental health care \u00e2\u20ac\u201c money that\u00e2\u20ac\u2122s already been cut and is likely to be cut again \u00e2\u20ac\u201c as being far too little.<\/p>\n<p>But, he adds, \u00e2\u20ac\u0153I must tell you that, until we\u00e2\u20ac\u2122re clear about what we have and what we need, it may be more money down the drain.\u00e2\u20ac\u009d<\/p>\n<p><strong>A new direction <\/strong><\/p>\n<p>Among the changes made in the course of mental health care reform in North Carolina was the recruitment of an out-of-state company called ValueOptions to review and process all Medicaid payments.<\/p>\n<p>Chapel Hill\u00e2\u20ac\u2122s Rep. Verla Insko, a sponsor of the mental health care reform legislation and co-chair of the joint legislative committee on mental health, says of that decision, \u00e2\u20ac\u0153It was a mistake. It undermined the basic goals of reform, which were to have the public sector manage a unified budget \u00e2\u20ac\u201c a Medicaid, state-dollar and local-dollar budget \u00e2\u20ac\u201c to provide services within each catchment area.\u00e2\u20ac\u009d <\/p>\n<p>Instead, today we have a two-payer system, further fragmenting the funding and delivery of services.<\/p>\n<p>The legislature is now taking action to remove ValueOptions from the equation.<\/p>\n<p>Insko says that LMEs serving 30 percent of the state\u00e2\u20ac\u2122s population will this year reassume the management of Medicaid dollars, and that if all goes well 30 percent more will do so next year and 40 percent the next. <\/p>\n<p>Another move in the right direction, according to Insko, is an effort to integrate mental and physical health care services through Community Care of North Carolina, which operates out of the North Carolina Office of Rural Health and Community Care. It\u00e2\u20ac\u2122s an effort championed by Governor-elect Perdue.<\/p>\n<p><strong>Recruiting talent<\/strong><\/p>\n<p>Given current conditions, it\u00e2\u20ac\u2122s hard to imagine a committed mental health professional wanting to establish a career in North Carolina. But advocates say that the ability to attract talent to effect the changes that need to take place within our communities is at least as critical as any other concern. <\/p>\n<p>Thomas Smith has been practicing psychiatry and advocating for those with mental illnesses in this state for over five decades. He\u00e2\u20ac\u2122s written and circulated a \u00e2\u20ac\u0153Rescue Plan for Mental Health\u00e2\u20ac\u009d in which he writes that we must \u00e2\u20ac\u0153institute a vigorous outreach and recruitment program.\u00e2\u20ac\u009d<\/p>\n<p>Smith has been enlisted in recent years to recruit talent and, he says, \u00e2\u20ac\u0153It\u00e2\u20ac\u2122s like pulling alligator\u00e2\u20ac\u2122s teeth. To come into an atmosphere like this, where everything is in a state of disruption \u00e2\u20ac\u201c who would want to come and join this force?\u00e2\u20ac\u009d<\/p>\n<p>Still, he writes, we \u00e2\u20ac\u0153absolutely must initiate a full-court press when it comes to finding, training, fielding and retaining psychiatrists and other mental health workers. Otherwise we could end up quite destitute in this respect.\u00e2\u20ac\u009d<\/p>\n<p><strong>From within<\/strong><\/p>\n<p>But the message that most clearly emanates from advocates with mental illness \u00e2\u20ac\u201d those who suffer when services aren\u00e2\u20ac\u2122t available \u00e2\u20ac\u201d and those who work most closely among them is that change must first come from within \u00e2\u20ac\u201c from within our communities and ourselves. <\/p>\n<p>North Carolina Mental Hope\u00e2\u20ac\u2122s David Cornwell says that among elected officials and the public \u00e2\u20ac\u0153there\u00e2\u20ac\u2122s simply going to have to be a parity of concern for mental illnesses on par with that of other physical illnesses and other societal issues.<\/p>\n<p>\u00e2\u20ac\u0153[W]ere it not for the crushing stigma of mental illness, maybe our cause could have a Michael Fox, a Lance Armstrong, a Jerry\u00e2\u20ac\u2122s Kids telethon.\u00e2\u20ac\u009d<\/p>\n<p>In an open letter to outgoing-Gov. Easley, Nicholas Stratas wrote: \u00e2\u20ac\u0153Your administration has for eight years failed to appreciate that, as we treat those unable to help themselves, so we treat ourselves.\u00e2\u20ac\u009d<\/p>\n<p>That treatment, says Smith, involves challenging those with mental illness to navigate through a fragmented, labyrinthian system, and to do so while, quite often, \u00e2\u20ac\u0153suffering the tortures of the damned.\u00e2\u20ac\u009d<\/p>\n<p>\u00e2\u20ac\u0153We really need to recognize the errors of our present system,\u00e2\u20ac\u009d says Clay Whitehead. \u00e2\u20ac\u0153Then we have to tap the public sentiment and the values of our communities, and we have to explore where we have leadership, and followership, and in what direction that takes us.<\/p>\n<p>\u00e2\u20ac\u0153Do we want to throw these people into the streets and prisons? &#8230; Because that\u00e2\u20ac\u2122s what we\u00e2\u20ac\u2122re talking about. And if we don\u00e2\u20ac\u2122t want to do that, then we have to take care of people.<\/p>\n<p>\u00e2\u20ac\u0153There\u00e2\u20ac\u2122s no relativity theory involved in that. If we want to take care of people, we basically know how to do it. And if we don\u00e2\u20ac\u2122t, what are we going to do with them, and where are they going to go?\u00e2\u20ac\u009d<\/p>\n<p><em>Next in the series: Efforts to improve mental health care in Orange County, including the recent formation of a Chapel Hill Mental Health Task Force, a joint town\/university effort to discuss, examine and assess mental health care services in Chapel Hill.<br \/>\n<\/em><\/p>\n","protected":false},"excerpt":{"rendered":"<p>By Taylor Sisk Staff Writer Nicholas Stratas refers to mental illness as a \u00e2\u20ac\u0153fragmenting\u00e2\u20ac\u009d problem. Stratas, a Raleigh-based psychiatrist and former state deputy commissioner of mental health, explains that as we become adults, individuation takes place \u00e2\u20ac\u201c boundaries develop, thoughts, feelings and actions are forged \u00e2\u20ac\u201c and we go through a process of internal integration&#8230;.<\/p>\n","protected":false},"author":12,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[4,30],"tags":[],"class_list":["post-4161","post","type-post","status-publish","format-standard","hentry","category-news","category-top-story"],"_links":{"self":[{"href":"https:\/\/www.ibiblio.org\/carrborocitizen\/main\/wp-json\/wp\/v2\/posts\/4161","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=4161"}],"version-history":[{"count":4,"href":"https:\/\/www.ibiblio.org\/carrborocitizen\/main\/wp-json\/wp\/v2\/posts\/4161\/revisions"}],"predecessor-version":[{"id":4753,"href":"https:\/\/www.ibiblio.org\/carrborocitizen\/main\/wp-json\/wp\/v2\/posts\/4161\/revisions\/4753"}],"wp:attachment":[{"href":"https:\/\/www.ibiblio.org\/carrborocitizen\/main\/wp-json\/wp\/v2\/media?parent=4161"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.ibiblio.org\/carrborocitizen\/main\/wp-json\/wp\/v2\/categories?post=4161"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.ibiblio.org\/carrborocitizen\/main\/wp-json\/wp\/v2\/tags?post=4161"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}